ABSTRACT
OBJECTIVE: Evaluate the effectiveness of electrical stimulation and biofeedback on the recovery of tenodesis grasp in tetraplegic individuals during the initial phase of acute rehabilitation. DESIGN: A 2 x 2 block design was used with subjects randomized to treatment groups. Forty-five subjects completed the study. SETTING: Inpatient occupational therapy department. SUBJECTS: Inpatients with tetraplegia, first admission for rehabilitation after an acute spinal cord injury. INTERVENTIONS: The four treatment groups were: conventional treatment, electrical stimulation, biofeedback, and combined electrical stimulation and biofeedback. The treatment period was between 5 and 6 weeks. MAIN OUTCOME MEASURES: Manual muscle testing and scoring of activities of daily living performance by a blinded evaluator. RESULTS: All four treatment groups showed improvements. No treatment group was superior to the others. CONCLUSIONS: Biofeedback and electrical stimulation alone or in combination offer no advantages over conventional rehabilitation treatment of wrist extensors in tetraplegic patients after spinal cord injury.
Subject(s)
Biofeedback, Psychology/methods , Electric Stimulation Therapy/methods , Hand Strength , Quadriplegia/rehabilitation , Activities of Daily Living , Adult , Combined Modality Therapy , Fingers/physiopathology , Humans , Quadriplegia/etiology , Quadriplegia/physiopathology , Single-Blind Method , Spinal Cord Injuries/complications , Treatment OutcomeABSTRACT
Proximal upper extremity weakness may develop secondary to central cord syndrome due to spinal cord injury or brachial plexus injury. Functional deficits, pain, decreased upper extremity arm swing during gait, and shoulder subluxation are common sequelae of these injuries. This report describes a new orthotic design that can be easily fabricated in two to four hours from readily available materials to compensate for these deficits. This orthosis allows for early participation in activities of daily living for patients with greater proximal than distal upper extremity weakness. The orthosis consists of a figure-eight shoulder harness and unilateral or bilateral forearm cuffs of orthoplast connected to the harness by flexible rubber tubing. The length of the tubing is adjustable through clamps connected to the forearm cuff to allow for variable arm positioning. Three patients, aged 14, 64, and 68, two with central cord syndrome and one with injury to the upper portion of the brachial plexus (Erb palsy) are described. Shoulder girdle musculature was less than 2, biceps less than 2, triceps less than 4, and hands less than 5 in all patients. Benefits from use of this orthosis may include improved arm swing and balance during ambulation, reduced shoulder pain and subluxation, and increased independence for tasks such as carrying lightweight objects, lower extremity dressing, bathing, light homemaking, and leisure activities such as gardening.
