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Restoring Hand Function in People with Complete Spinal Cord Injury
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Restoring Hand Function in People with Complete Spinal Cord Injury
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Spinal cord injuries’ devastating consequences rob a person’s physical and mental well-being. To improve the quality of life for those afflicted by spinal trauma, peripheral nerve transfers are a line of treatment that could restore some of the lost function in the muscles once receiving innervation from the injured portion of the spinal cord.
Amir Faraji, MD, PhD, Assistant Professor of Neurological Surgery, is one of the principal investigators of a multicenter clinical study to evaluate the outcomes of patients receiving a nerve transfer surgery for complete spinal cord injuries leading to a loss of function in the arm and hand. Currently, Houston Methodist is the only site in the southern United States that is enrolling patients for this Department of Defense-funded multicenter study. “This project stemmed from my interest in treating spinal cord injury patients, which is an area that Houston Methodist has a history in for many years,” said Faraji.
The recovery from nerve transfers is slow and won’t restore the lost movement completely, but it will certainly improve quality of life vastly.
Amir Faraji, MD, PhD
Spinal cord injuries affect roughly one in every 1,000 people in the United States and could be caused by falls, vehicle accidents and infections, among other reasons. In addition to the physiological and medical impacts, the injury poses a huge psychological burden due to lack of functional independence, which deeply impacts an individual’s daily life. Thus, recovering some of the lost muscular functions due to the injury has been an active area of clinical interventions. Among the available surgical options, tendon and peripheral nerve transfers have carved out a space for treating spinal cord injuries. A tendon transfer is an orthopedic procedure in which a working tendon is moved to a muscle whose function is lost. For example, if the hand function is lost, a working tendon from the arm is cut and reconnected to the hand. Faraji said that although the procedure could be done at any time after the injury, fine hand movements will still be lacking. This limitation of tendon transfers, however, could be overcome with nerve transfers. In this procedure, a donor nerve originating from above the injury site in the spinal cord is transferred into a recipient nerve conduit in the arm that comes from below the injury. Faraji and his team’s study tests the efficacy of nerve transfers in patients that have little to no arm and hand function due to complete spinal cord injury. For their clinical trial, the researchers included patients between 18 and 65 years of age who have sustained a traumatic injury to the C4-C8 region of the spinal cord no more than 36 months ago. These candidates also have little to no use of their hands and have received at least three months of nonoperative rehabilitation therapy. Prior to the nerve transfer, the patients receive preoperative electromyography and nerve conduction evaluations to ensure that the donor and recipient nerves are viable for nerve transfer. Most notably, if the patients are planning on undergoing a tendon transfer during the study period or have had a tendon transfer in the past, they are excluded from the study. Although their study is still underway, Faraji noted that they have promising evidence that it is successful in allowing meaningful hand movements around 50% of the time. Further, the clinical study also keeps patients in occupational therapy so that the nerves are encouraged to grow toward their muscle target. Faraji noted that one of the main goals of the study is to better define patient outcomes after the surgical procedure. With this information in hand, the outcomes of the patient could be optimized even further by promoting nerve growth with growth factors or electrical stimulation. “The recovery from nerve transfers is slow and won’t restore the lost movement completely, but it will certainly improve quality of life vastly,” said Faraji. “If the surgery helps our patients hold a toothbrush to brush their teeth or grab their cellphones better, it goes a long way in improving their functional independence.”
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