None listed
Conditions
Brief summary
The aims of this project are to: 1) conduct a prospective case series of nerve transfer surgery in eligible patients with tetraplegia; 2) implement and refine a standardised protocol for clinical and neurophysiological assessment and post-operative therapy; 3) evaluate the outcomes and cost-benefit of nerve transfers. Fifteen patients with complete or incomplete SCI between C5 and C7, who are deemed suitable for surgery by the Upper Limb Program Team, will be evaluated. Participants will undergo thorough clinical and neurophysiological assessment pre- and up to 24 months post-operatively. Donor and recipient nerve and muscle tissue samples will be examined histologically, and functional tests of upper limb performance will also be conducted. Expected outcomes include evidence of the functional effectiveness of nerve transfer surgery, refinement of selection criteria and post-operative management, cost-benefit of nerve transfer surgery , and histological information about the health of the donor and recipient nerves and muscles.
Interventions
Nerve transfer surgery involves the transfer of an expendable, intact nerve (or fascicle of a nerve) to the non-functional nerve of a paralysed muscle. Nerves are carefully identified and dissected to prepare for the transfer. The donor and recipient nerves are divided in close proximity and are then co-apted or joined with the use of an operating microscope. The duration of surgery varies depending on the nerves involved but can range from 1-2 hours per transfer. Post operatively, the arm is i
Nerve transfer surgery involves the transfer of an expendable, intact nerve (or fascicle of a nerve) to the non-functional nerve of a paralysed muscle. Nerves are carefully identified and dissected to prepare for the transfer. The donor and recipient nerves are divided in close proximity and are then co-apted or joined with the use of an operating microscope. The duration of surgery varies depending on the nerves involved but can range from 1-2 hours per transfer. Post operatively, the arm is immobilised for 2-3 weeks to protect the transfer. After the period of immobilisation, rehabilitation is provided by an occupational therapist. Between 3 weeks to 6 months, depending on target nerve, daily pairing exercises (pairing donor muscle action to recipient muscle action) are performed till the first flickers of activity in recipient muscle/s are observed. Pairing continues till muscle strength is M3 or stable for 3 months, then dissociation between donor and recipient actions is encouraged. A home exercise program will be completed 2 – 5 times a day, initially for pairing exercises then active strengthening, totalling no more than 15 minutes each day.
Sponsors
The University of Melbourne
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
12 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Complete or incomplete tetraplegia with C5 – C7 motor neurological level 2. Spinal injury sustained within the last 12-18 months 3. Assessed as suitable for nerve transfer surgery by the surgical and occupational therapy team at the Upper Limb Program Multidisciplinary Clinic at Royal Talbot. 4. Consent to nerve transfer surgery after being fully informed about expected outcomes, potential risks, surgical procedure, recovery time, postoperative therapy commitments and the same for the equivalent tendon transfers 5. Able to comply with therapy protocols postoperatively
Exclusion criteria
1. Accompanying head injury, brachial plexus or peripheral nerve injury at the time of, or preceding the spinal cord injury 2. Any other pre-existing neurological condition 3. Cognitive impairment limiting ability to consent to surgery or comply with postoperative rehabilitation 4. Skeletal or joint injury significantly limiting passive range of movement across a joint relevant to the proposed nerve transfer
Outcome results
None listed