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Nerve transfer

Arm function restored to paralysed patients as part of groundbreaking Australian study

Two years after the procedure, most participants were able to feed themselves, use tools and handle electronic devices.

SURGEONS HAVE HELPED to restore arm function in paralysed patients in Australia, according to the results of a groundbreaking study released today.

Operations and intense physiotherapy were carried out on 13 young adults who had suffered spinal injuries which rendered them tetraplegic, as part of the largest ever application of a technique known as nerve transfer surgery.

The surgeons succeeded in attaching individual nerves from above the zone of the spinal injury to nerves below the trauma site. The functioning nerves were then used to stimulate paralysed muscles below the injury zone.

Each nerve transfer took around two hours of painstaking reconstruction, with 59 transfers undertaken by the team.

Two years after the procedure, most participants in the trial were able to reach out their arms, open and close their palms and manipulate objects, and were also able to feed themselves, use tools and handle electronic devices.

While the nerve transfer technique is sporadically practised, most operations aimed at restoring upper limb function have traditionally involved tendon reconstruction.

That involves re-routing muscles that still work but are designed for another function to another site to do the work of paralysed muscles.

Perform daily activities

“Nerve transfers have been around for a long time but they weren’t really being used for spinal chord injury before,” Natasha van Zyl, a surgeon at Austin Health in Melbourne, told AFP.

Before to surgery, none of the patients were able to score on grasp or pinch strength tests.

But two years after the surgery, they scored well enough to perform most daily activities involving the use of their hands, including brushing their teeth and writing.

“The number one priority of spinal chord injury patients, above walking, above sexual function, is hand function,” said van Zyl, lead author of the study published in The Lancet.

“You give them hand function, they can start to work more effectively, look after themselves independently, drive, live alone.”

The team stressed that their study involved a small sample size and that four nerve transfers procedures failed to improve hand or arm function.

They also said the surgery did not have any effect on the patients’ trunk control and that they still remained wheelchair-bound afterwards.

But the surgeons said the technique was a “major advance” in efforts to give people a level of independence and control back after suffering life-changing injuries.

“To all the people in the world who have spinal chord injury and to all the people who treat them, the message is ‘it is possible to restore hand function and elbow function’,” van Zyl said.

With reporting from - © AFP 2019.

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