Donor activation focused rehabilitation approach to hand closing nerve transfer surgery in individuals with cervical level spinal cord injury

Spinal Cord Series and Cases, 2022 · DOI: https://doi.org/10.1038/s41394-022-00512-y · Published: April 13, 2022

Spinal Cord Injury Surgery Rehabilitation

Simple Explanation

Nerve transfers are a surgical technique used to restore hand closing function in individuals with mid-cervical spinal cord injuries. This involves rerouting a working nerve to a non-working muscle, bypassing the spinal cord injury. The study introduces a specific rehabilitation approach called DAFRA (Donor Activation Focused Rehabilitation Approach). DAFRA is a three-phase program designed to maximize hand function recovery after nerve transfer surgery. DAFRA emphasizes patient education, exercises to activate the donor nerve and strengthen the new neural pathways, and incorporating hand movements into daily activities. The therapy progresses slowly over at least two years.

Study Duration

August 2013 to August 2018, with at least 18 months of follow-up (averaged 40 months)

Participants

Nine males with cervical SCI

Evidence Level

Case Series

Key Findings

1
Subtle gains in hand closing were first observed at an average of 8.4 months after surgery, demonstrating the slow nature of recovery.
2
Participants experienced notable improvements, including reduced reliance on assistive devices, increased independence in self-care tasks like feeding and catheterization, and measurable grip strength.
3
The study highlights the importance of a deliberate, slow-paced rehabilitation program (DAFRA) in achieving improved outcomes after nerve transfer surgery for hand closing in individuals with cervical SCI.

Research Summary

This case series describes the Donor Activation Focused Rehabilitation Approach (DAFRA) for individuals with cervical spinal cord injury (SCI) undergoing nerve transfer surgery to restore hand closing function. The DAFRA program consists of three phases: early (education, limb preparation, and donor activation exercises), middle (volitional recipient muscle activation), and late (strengthening and incorporation of motion in activities of daily living). The study demonstrates that a slow-paced, incremental therapy program like DAFRA can lead to improved hand function, reduced reliance on assistive devices, and increased independence in daily activities for individuals with cervical SCI after nerve transfer surgery.

Practical Implications

Rehabilitation Protocol

The DAFRA protocol provides therapists with a structured approach to rehabilitation after hand closing nerve transfers in cervical SCI, outlining specific exercises and timelines.

Patient Expectations

The study emphasizes the importance of setting realistic expectations for patients regarding the slow and incremental nature of recovery after nerve transfer surgery.

Functional Improvements

Nerve transfer surgery combined with DAFRA can lead to significant improvements in hand function and independence in daily activities for individuals with cervical SCI.

Study Limitations

1
The same therapist provided therapy and assessed outcomes, providing a potential source of bias.
2
Missing GRASSP data for two subjects.
3
Future studies should include a prospective data collection that better captures the exercises that improve achievable participant goals.

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