OUTCOMES OF TENDON TRANSFER SURGERY AND OCCUPATIONAL-THERAPY IN A CHILD WITH TETRAPLEGIA SECONDARY TO SPINAL-CORD INJURY

Objective. Tendon transfer surgery to augment hand function lost to sp inal cord injury (SCI) has gained acceptance as a rehabilitation optio n for adults but has yet to be fully explored in children. In this stu dy, hand function and performance of activities of daily living in an 11-year-old child with an SCI were evaluated before and after surgical transfers of the brachioradialis to the flexor pollices longus and th e extensor carpi radialis longus to the flexor digitorum profundus. Me thod. With the use of a single-subject AB design, repeated measures of pinch force, the Jebsen Test of Hand Function for Children and the Gr asp and Release Test were obtained before tendon transfer surgery and at 21/2, 6, and 12 months after surgery. Activities of daily living we re assessed with the Functional Independence Measure (FIM) and the Com mon Object Test (GOT) before surgery and 12 months after surgery. Resu lts. Each assessment revealed a significant improvement in hand functi on after surgery. Pinch force was measurable only after tendon transfe rs and increased throughout the first year By two standard deviation a nalyses, after surgery there were significantly more task completions for all Grasp and Release Test objects, and task completion times were shorter for the light and heavy objects of the Jebsen Test of Hand Fu nction for Children. FIM results showed that elf-catheterization and c utting food were possible only after surgery, and results of the COT r evealed new unilateral and bilateral abilities that facilitated the cl ient's independence in writing, eating, applying toothpaste, and brush ing teeth. Conclusion. This single-subject study demonstrates the bene fits of tendon transfers for active grasp in a child with an SCI.