Use of the NESS Handmaster to restore handfunction in tetraplegia: clinical experiences in ten patients

Objective: To explore possible functional effects of the Handmaster in tetr aplegia and to determine suitable patients for the system. Patients: Patients with a cervical spinal cord injury between C4 and CG, mo tor group 0-3. Important selection criteria were a stable clinical situatio n and the absence of other medical problems and complications. Design: Ten patients were consecutively selected from the in- and outpatien t department of a large rehabilitation hospital in The Netherlands. Each pa tient was fitted with a Handmaster by a qualified therapist and underwent m uscle strength and functional training for at least 2 months. Methods: Functional evaluation comprised the performance of a defined set o f tasks and at Least one additional task as selected by patients themselves . Tasks were performed both with and without the Handmaster. Finally, patie nts were asked for their opinion on Handmaster use as well as their willing ness to future use. Results: In six patients a stimulated grasp and release with either one or both grasp modes (key- and palmar pinch) of the Handmaster was possible. Fo ur patients could perform the set of tasks using the Handmaster, while they were not able to do so without the Handmaster. Eventually, one patient con tinued using the Handmaster during ADL at home. Conclusion: The Handmaster has a functional benefit in a limited group of p atients with a C5 SCI motor group 0 and 1. Suitable patients should have su fficient shoulder and biceps Function combined with absent or weak wrist ex tensors. Though functional use was the main reason for using the Handmaster , this case series showed that therapeutic use can also be considered.