Cervical Spinal Cord Injury
Conditions
Keywords
tendon transfer, elbow
Brief summary
Active elbow extension has significant functional benefits for individuals with tetraplegia. The proposed work will provide information to assess how effectively people are using their elbow extension tendon transfers, and whether one surgery works more effectively than the other. This study will provide recommendations to clinicians about the possibility of improving function after surgery using rehab techniques.
Detailed description
Voluntary control of elbow extension significantly improves functional abilities for individuals with tetraplegia. As a result, surgical reconstruction of elbow extension via tendon transfer is considered a fundamental intervention that benefits the patient, even if other tendon transfers aimed at improving hand function are never performed. Presently, there are two common tendon transfer surgeries used to restore elbow extension following spinal cord injury. These are the posterior deltoid to triceps transfer and the biceps to triceps transfer. Both surgeries significantly improve voluntary elbow extension, although there is variability in the amount of control that is restored among patients. This study will directly compare the performance of the posterior deltoid transfer to the biceps transfer with regard to: voluntary elbow extension strength, the ability to activate the transfer, and neural factors associated with voluntary and involuntary control of individual muscles. These comparisons will be made in functionally relevant postures and will provide fundamental information that will improve clinical understanding of the capacity of each of these two procedures to restore elbow extension. The fundamental hypothesis of this proposal is that an inability to maximally activate the transferred posterior deltoid and the transferred biceps significantly limits the elbow extension moment that can be produced.
Interventions
None listed
Sponsors
Shirley Ryan AbilityLab
Northwestern University
Case Western Reserve University
Loyola University
MetroHealth System, Ohio
VA Office of Research and Development
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Cervical Spinal Cord Injury (C5-C7) * Posterior Deltoid to Triceps Tendon Transfer at least one year post-surgery * Biceps to Triceps Tendon Transfer at least one year post-surgery
Exclusion criteria
* Subjects will be excluded from the studies if there is presence of concurrent severe medical illness, including: * unhealed decubiti * use of baclofen pumps * existing infection * cardiovascular disease * significant osteoporosis (as indicated by a history of fractures following injury) * or a history of pulmonary complications or autonomic dysreflexia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Elbow Extension Strength | At least one year post surgery | Elbow extension strength was measured as the maximum elbow extension moment that subject's could generate. We used an elbow moment transducer to measure elbow moments under isometric (no change in arm posture) conditions. Subjects performed three trials at maximum effort, holding maximum elbow extension for 5 to 7 seconds. The maximum moment was computed as the maximum average moment sustained over a 0.5 second window. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Group 1 Subjects with posterior deltoid-to-triceps tendon transfers | 4 |
| Group 2 Subjects with biceps-to-triceps tendon transfers | 5 |
| Group 3 Subjects with cervical SCI who have not had tendon transfers | 3 |
| Group 4 Unimpaired control subjects | 2 |
| Total | 14 |
Baseline characteristics
| Characteristic | Group 1 | Group 2 | Group 3 | Group 4 | Total |
|---|---|---|---|---|---|
| Age, Continuous | 43.8 years STANDARD_DEVIATION 7.3 | 26.6 years STANDARD_DEVIATION 8.2 | 45.2 years STANDARD_DEVIATION 11.5 | 33.5 years STANDARD_DEVIATION 0.7 | 37.3 years STANDARD_DEVIATION 12.1 |
| Sex: Female, Male Female | 2 Participants | 0 Participants | 0 Participants | 1 Participants | 3 Participants |
| Sex: Female, Male Male | 2 Participants | 5 Participants | 3 Participants | 1 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 4 | 0 / 5 | 0 / 3 | 0 / 2 |
| serious Total, serious adverse events | 0 / 4 | 0 / 5 | 0 / 3 | 0 / 2 |
Outcome results
Primary
Elbow Extension Strength
Elbow extension strength was measured as the maximum elbow extension moment that subject's could generate. We used an elbow moment transducer to measure elbow moments under isometric (no change in arm posture) conditions. Subjects performed three trials at maximum effort, holding maximum elbow extension for 5 to 7 seconds. The maximum moment was computed as the maximum average moment sustained over a 0.5 second window.
Time frame: At least one year post surgery
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 1 | Elbow Extension Strength | 2.74 Newton-Meters | Standard Deviation 0.22 |
| Group 2 | Elbow Extension Strength | 8.8 Newton-Meters | Standard Deviation 3.9 |
| Group 3 | Elbow Extension Strength | 0 Newton-Meters | Standard Deviation 0 |
| Group 4 | Elbow Extension Strength | 68.7 Newton-Meters | Standard Deviation 12.3 |