Dr. Kim Anderson
Arm and hand function is important to people living with cervical spinal injuries. There are many research efforts underway to develop new treatments to restore arm and hand function. There are some surgical options already available to improve arm and hand function, but some have a limited time window during which they need to be done in order to be effective. Nerve transfers are an example of a surgical option and they usually need to be done no less than 12-18 months after the initial injury.
The injury inside the spinal cord is messy and can be different in each person. Some damage causes spasticity to develop, which can help keep muscles bulky. Some damage prevents spasticity from developing and causes muscles to waste away. Early after injury, the body is in shock and the spinal cord is even in shock. During that time period it is hard to know what different kinds of damage has occurred in the spinal cord for specific muscles in the arms and hands. Knowing that information is critical in order to know if someone would benefit from a nerve transfer. Therefore, one of the NORSCIS research projects has to do with early testing of arm and hand muscles in people with cervical spinal cord injury in our inpatient rehabilitation unit.
We are testing muscle strength and activity in the arms and hands of people with brand new cervical spinal injury. In any of those muscles that are paralyzed, we test to see if the muscle responds to electrical stimulation. We also test those paralyzed muscles to see if there is any spontaneous activity present.
So far, we have learned that:
- some of the muscles that are paralyzed within the first few days after injury do recover some voluntary movement within the first 1 or 2 months after injury;
- many of the muscles that are paralyzed do respond to electrical stimulation;
- and many of those muscles do have spontaneous activity within the muscle even though the individuals cannot move the muscles.
There are, however, some muscles that do not respond to electrical stimulation and do not have spontaneous activity. Our ability to tell the difference between all of these muscles is important and is helping identify early on who might benefit from a nerve transfer to improve their arm and hand function. We continue to collect the rest of our data and we will report back our final results next year!
