Surgeons have helped several paralyzed patients with a new procedure to Arm and hand movements. The so-called nerve transfer to be initiated that are still functional nerves, to make paralyzed muscles to move. The patients learned using an intensive physiotherapy in the period of two years, to perform independently activities of daily living, such as eating and drinking, brushing teeth, write, use the Computer or a wheelchair to drive. This is the Team to Natasha van Zyl of Austin Health reported in Melbourne in the journal “The Lancet”.
The 13 patients with an average age of 27 years were paralyzed after a neck injury to his spine on all four limbs (quadriplegia). “For people with quadriplegia is the single most important goal is the improvement of the hand function,” van Zyl quoted in the “Lancet”message. A prerequisite for treatment was that the spinal cord was not injured above the sixth cervical vertebra. Because of the Arm of several cervical vertebrae from supplies intact nerve for Transfer in these cases is still non-available. The surgeon above the sixth cervical vertebra rises could end strands of nerves redirect so that you einwuchsen in the paralyzed Arm muscles, and again gave impetus to.
Redirection of neural connections
In a variant, the Doctors took those nerve, which activates the small round muscle in the shoulder area, and combined it with a neural pathway that leads to the triceps to the elbow extensor muscle in the upper arm. In other variants, the nerves were redirected connections to different muscles of the forearm. A nerve can activate multiple muscles.
“In addition, we have shown that nerve transfers can be successfully with traditional tendon transfers combined in order to achieve the maximum Benefit,” explains van Zyl. In the decades of major tendon transfer to the end of a tendon is sewn to the other muscle.
In the case of the combination of the two methods, the patients used the Arm with the nerve transfers for fine motor activities when using the Arm with the tendon transplant for powerful activities. “None of the participants regretted the surgery, and all reported that they do it again and would recommend to others,” write the researchers. However, four of the total of 59 nerve Enver plantations had not led to the desired success.
Cost-effective treatment for paraplegia
In a “Lancet”comment Elspeth Hill and Ida Fox of Washington University in St. Louis: “nerve transfers are a cost-effective way, the use of the body’s own ability to movement in a paralyzed limb restore are writing.” They note that one of the disadvantages of Enver plantations of Nerve counting the months before new movements are possible, and the years, until the full power is reached. However, a total nerve transfers represent an enormous step forward, the hand function after a spinal cord injury, write Hill and Fox.
Rüdiger Rupp, University hospital Heidelberg, impressed with the study, mainly due to the relatively large number of patients. So far, mainly case studies, nerve transfers have been published. “It is an honest study, which also addresses the limitations of the method and the satisfaction of the patients”, emphasized the head of the section of Experimental Neurorehabilitation at the Department of Paraplegiology. Does not belong to the limits that the injury to the spinal cord has been lagging for longer than 18 months and that the shoulder and elbow functions were at least partially still present. If no residual function of the nerve pathways are no longer present, is not also the presented method to be applicable.