Nerve Transfers to Improve Upper Extremity Function and Quality of Life in Tetraplegic Patients
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Tetraplegia
- Sponsor
- Washington University School of Medicine
- Enrollment
- 70
- Locations
- 9
- Primary Endpoint
- Manual Motor Testing
- Status
- Active, not recruiting
- Last Updated
- 7 months ago
Overview
Brief Summary
Current treatment strategies of acute cervical spinal cord injuries remain limited. Treatment options that provide meaningful improvements in patient quality of like and long-term functional independence will provide a significant public health impact. Specific aim: Measure the efficacy of nerve transfer surgery in the treatment of patients with complete spinal cord injuries with no hand function. Optimize the efficiency of nerve transfer surgery by evaluating patient outcomes in relation to patient selection and quality of life and functional independence.
Detailed Description
Study Design and Feasibility: A prospective multi-institutional non-randomized single arm design will be utilized. Seventy subjects with cervical ASIA A-B (International Standards for Neurological Classification of Spinal Cord Injury) SCI and hand function impairment that fit the International Classification for Surgery of the Hand 0-4 will be identified. Only patients with stable ASIA scores and no evidence of functional improvement in motor or sensory examination for at least 3 months will be recruited. All patients will undergo Electromyography (EMG) and nerve conduction studies (NCS) to verify intact innervation (normal compound muscle action potentials (CMAPs)) to the paralyzed target muscles below the level of injury. Functional electrical stimulation (FES) will be used to verify loss of lower motor neuron function in key muscle groups in the zone of injury and help differentiate those muscle with intact connections to preserve anterior horn cells. Only those patients with clinically normal, Medical Research Council (MRC) muscle grade 5/5 donor (axonal donor) function will be enrolled. Outcome Measures Primary Outcome Measures: Pre- and Post-operative upper motor strength. (Manual motor testing \& Hand Held Dynamometry) Secondary Outcome Measures: Disabilities of the Arm, Shoulder, and Hand (DASH), Michigan Hand Questionnaire (MHQ), Spinal Cord Injury Quality of Life (SCIQOL), GRASSP test (pre-operative, post-operatively - 6 months, 12 months, and 24 months, 36 months and 48 months), rates of intraoperative and post-operative complications, and rates of reoperation. Rehabilitation and hand therapy are critical components of motor re-education following nerve transfers. Cortical plasticity and motor remapping occurs following nerve transfers allowing independent functional control of the recipient muscles. All patients will begin rehabilitation and hand therapy beginning 2 weeks after surgery. They undergo one hour of hand therapy and occupational therapy for motor re-education once to twice a week for 48 months following surgery. Rehabilitation will be phased to early and late - added exercises focusing on co-contraction, repetition, and range of motion will be included as home therapy.
Investigators
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Manual Motor Testing
Time Frame: 48 months
Change from baseline testing strength of upper extremities at 48 months post-operatively
Handheld Dynamometry
Time Frame: 48 months
Change from baseline grip strength at 48 months post-operatively
Secondary Outcomes
- Rates of Intra-operative and post-operative complications(48 months)
- Changes in the Graded Redefined Assessment of Strength, Sensation and Prehension scores (GRASSP)(48 months)
- Change in Disabilities of Arm, Shoulder and Hand (DASH) scores(48 months)
- Change in Spinal Cord Injury Quality of Life (SCIQOL) scores(48 months)
- Neuro Quality of Life - Depression Short Form (NQOL-Dep)(48 months)
- Hand Function, measured by the GRASSP test(48 months)
- Neuro Quality of Life - Upper Extremity Short Form (NQOL-UEF)(48 Months)