Original Communications| Volume 25, ISSUE 6, P1140-1146, November 2000

Kinematic assessment of manual skill following functional hand surgery in tetraplegia


      To determine whether surgical key grip reinforcement actually leads to a better movement ability we developed a procedure for the kinematic analysis of manual skill following hand surgery in tetraplegia. The functional results of surgery in 5 cases were examined by the kinematic analysis of drawing movements using an electronic pen and a digitizer under 3 conditions: with eyes open, with eyes closed, and while performing a concurrent arithmetic task. Movement velocity and dysfluency (ie, the number of velocity changes per centimeter) were measured before and at several moments after surgery during subsequent rehabilitation. Both movement velocity and dysfluency showed good stability across repeated trials and were consistently affected by visual deprivation. Movement velocity showed a 39% increment between the first and last assessment. Although grip strength increased in all patients, it was not associated with the change of movement velocity. These results suggest that other factors (eg, deep sensibility, cognition, muscle coordination) play a critical role in the ability to use improved grip force for controlling drawing movements and emphasize the value of a kinematic assessment besides measuring isolated grip force in the evaluation of functional hand surgery. (J Hand Surg 2000;25A:1140-1146. Copyright © 2000 by the American Society for Surgery of the Hand.)


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        • Moberg E
        The upper limb in tetraplegia: a new approach to surgical rehabilitation.
        George Thieme, Stuttgart1978
        • Johnstone BR
        • Jordan CJ
        • Buntine JA
        A review of surgical rehabilitation of the upper limb in quadriplegia.
        Paraplegia. 1988; 26: 317-339
        • Waters RL
        • Sie IH
        • Gellman H
        • Tognella M
        Functional hand surgery following tetraplegia.
        Arch Phys Med Rehabil. 1996; 77: 86-94
        • Keith MW
        • Lacey SH
        Surgical rehabilitation of the tetraplegic upper extremity.
        J Neurol Rehabil. 1991; 5: 75-87
        • Smith BT
        • Mulcahey MJ
        • Betz RR
        Quantitative comparison of grasp and release abilities with and without functional neuromuscular stimulation in adolescents with tetraplegia.
        Paraplegia. 1996; 34: 16-23
        • House JH
        • Gwathmey FW
        • Lundsgaard DK
        Restoration of strong grasp and lateral pinch in tetraplegia due to cervical spinal cord injury.
        J Hand Surg. 1976; 1: 152-159
        • House JH
        • Shannon MA
        Restoration of strong grasp and lateral pinch in tetraplegia: a comparison of two methods of thumb control in each patient.
        J Hand Surg. 1985; 10A: 21-29
        • Kelly CM
        • Freehafer AA
        • Peckham PH
        • Stroh K
        Postoperative results opponensplasty and flexor tendon transfer in patients with spinal cord injuries.
        J Hand Surg. 1985; 10A: 890-894
        • Paul SD
        • Gellman H
        • Waters R
        • Willstein G
        • Tognella M
        Single-stage reconstruction of key pinch and extension of the elbow in tetraplegic patients.
        J Bone Joint Surg. 1994; 76A: 1451-1456
        • Vanden Berghe A
        • Van Laere M
        • Hellings S
        • Vercauteren M
        Reconstruction of the upper extremity in tetraplegia: functional assessment, surgical procedures and rehabilitation.
        Paraplegia. 1991; 29: 103-112
        • Colyer RA
        • Kappelman B
        Flexor pollicis longus tenodesis in tetraplegia at the sixth cervical level: a prospective evaluation of functional gain.
        J Bone Joint Surg. 1981; 63A: 376-379
        • Ejeskär A
        • DahllÖf A
        Results of reconstructive surgery in the upper limb of tetraplegic patients.
        Paraplegia. 1988; 26: 204-208
        • Freehafer AA
        • Kelly CM
        • Peckham PH
        Tendon transfer for the restoration of upper limb function after a cervical spinal cord injury.
        J Hand Surg. 1984; 9A: 887-893
        • Freehafer AA
        Tendon transfers in patients with cervical spinal cord injury.
        J Hand Surg. 1991; 16A: 804-809
        • House JH
        • Comadoll J
        • Dahl AL
        One-stage key pinch and release with thumb carpal-metacarpal fusion in tetraplegia.
        J Hand Surg. 1992; 17A: 530-538
        • Lamb DW
        • Chan KM
        Surgical reconstruction of the upper limb in traumatic tetraplegia: a review of 41 patients.
        J Bone Joint Surg. 1983; 65B: 291-298
        • Mohammed KD
        • Rothwell AG
        • Sinclair SW
        • Willems SM
        • Bean AR
        Upper-limb surgery for tetraplegia.
        J Bone Joint Surg. 1992; 74B: 873-879
        • Curtin M
        Development of a tetraplegic hand assessment and splinting protocol.
        Paraplegia. 1994; 32: 159-169
        • Wuolle KS
        • Van Doren CL
        • Thrope GB
        • Keith MW
        • Peckham PH
        Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis.
        J Hand Surg. 1994; 19A: 209-218
        • Teulings H-L
        • Maarse FJ
        Digital recording and processing of handwriting movements.
        Hum Movement Sci. 1984; 3: 193-217
        • Mulder T
        Current topics in motor control: implications for rehabilitation.
        in: Neurological rehabilitation. Churchill Livingstone, Edinburgh1993: 126-137
        • Geurts ACH
        • Mulder TW
        • Nienhuis B
        • Rijken RAJ
        Dual-task assessment of reorganization of postural control in persons with lower limb amputation.
        Arch Phys Med Rehabil. 1991; 72: 1059-1064
        • Geurts ACH
        • Mulder TW
        • Nienhuis B
        • Rijken RAJ
        Postural reorganization following lower limb amputation: possible motor and sensory determinants of recovery.
        Scand J Rehabil Med. 1992; 24: 83-90
        • de Visser E
        • Pauwels J
        • Duysens JEJ
        • Mulder T
        • Veth RPH
        Gait adaptations during walking under visual and cognitive constraints: a study of patients recovering from limb-saving surgery of the lower limb.
        Am J Phys Med Rehabil. 1998; 77: 503-509
        • Hufschmidt A
        • Dichgans J
        • Mauritz K-H
        • Hufschmidt M
        Some methods and parameters of body sway quantification and their neurological applications.
        Arch Psychiatr Neurol Sci. 1980; 228: 135-150
        • Jeannerod M
        The neural and behavioural organization of goal-directed movements.
        Oxford University Press, Oxford1990