A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia.
Ines Bersch, Jörg Krebs, Jan Fridén
PMID 36188973WHAT IT FOUND
Motor point mapping and ASIA scores taken 4 to 8 weeks after cervical spinal cord injury predict hand muscle strength at 6 months.
Intact lower motor neurons and AIS C or D scores strongly indicate that patients will develop useful voluntary movement.
Key findings
01Motor point status and ASIA impairment score assessed 4-8 weeks post-injury are significant predictors of muscle strength at 24 weeks, whereas neurological level of injury and age are not.
02Patients with innervated muscles and AIS C or D classifications had significantly higher odds of strength improvement in finger flexors and extensors compared to those with denervated muscles or AIS A.
03Brachioradialis muscles frequently show intact lower motor neurons even when the injury level does not match the muscle's segmental innervation, complicating assumptions about donor muscle viability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only examined two specific extrinsic hand muscles and one forearm muscle, so findings may not apply to intrinsic hand muscles which are also critical for hand shape and function. The analysis was retrospective, relying on existing data rather than a prospectively designed trial. The study did not measure the actual proportion of denervated versus innervated tissue within 'partially innervated' muscles, which limits precision in treatment planning for that group. Brachioradialis data included a small number of patients with conditions other than traumatic spinal cord injury (Guillain-Barré syndrome and sarcoidosis), which may affect generalizability to pure traumatic cases.
Declared interests
The authors declared no commercial or financial conflicts of interest. The study was funded by the Swiss Paraplegic Centre.
The easy way to misread this
Do not assume that a high ASIA score or a specific injury level alone guarantees good hand function without checking motor point integrity. Conversely, do not withhold early active training solely based on injury level if the motor point mapping shows intact lower motor neurons, as these patients are likely to recover strength.