Tuesday, August 18, 2009

Who we are

The tetraplegia hand surgery service at our National Center is devoted to improve the arm and hand function in patients paralyzed after spinal cord injury. Using reconstructive hand surgery where intact muscles and tendons are transferred to replace the lost function, dramatic improvements of the quality of life can be achieved. Our team consists of eleven people (two hand surgeons, one rehabilitation doctor, two physiotherapists, two occupational therapists, two nurses, one secretary and one research coordinator) with expertise in different aspects of the treatment and care of individuals with tetraplegia. We are operating a subspeciality of highest standard and we are continuously striving for refinement and improvement of all steps of treatment involved in this type of very challenging surgery and rehabilitation. Our service is certified according to ISO-9001 standard. The research efforts are covering various fields spanning from developing new surgical techniques and rehabilitation protocols to molecular biology.

Our surgical research involves the use of dynamic laser measurements to better set the optimal force balance during tendon transfer surgery. By applying this technique we have modified certain parts of muscle tendon transfer procedures and we have also been able to prove that there is a decreased risk of tendon rupture when tension is set to optimum during the surgical procedure. The information gathered from clinical trials in Sweden and the US will constitute future guidelines for surgeons performing this kind of surgery. We believe by using these exact methods of measurements improved functional results will be obtained. Another field of interest is to improve surgical strategies to correct spasticity is its long-term effects of stiffness in patients with incomplete tetraplegia.

The rehabilitation research is focused on indentifying and meeting more exactly the patient’s prioritized goal of the surgery and ensuing rehabilitation. We are also performing research on physical training to improving wheel-chair maneuverability as well as functional training after spasticity surgery.

In the molecular biology part of this project we are defining differences between various muscle proteins responsible for muscle elasticity and tension. If we can determine what components are responsible for muscle tension, we will also be able to understand how these components change as a result of spinal cord injury and also what consequences these changes will cause for regulation of muscle tension. We can also foresee future opportunities to genetically modify elastic proteins in a way that e.g. spasticity will not be as pronounced as it would have been without treatment.

Patients with tetraplegia living in Sweden are surgically reconstructed and rehabilitated in one centralized unit serving Sweden - Sahlgrenska University Hospital in Göteborg. Approximately 60% of the patients with traumatic tetraplegia undergo reconstructions of arm and hand functions. Optimal timing is when the patient is physically, mentally and socially ready to undergo surgery and the quite demanding postoperative rehabilitation, usually one year after injury at the earliest. In our unit, tetraplegia reconstruction surgery is performed on a regular basis i.e., one to two reconstructions per week. A full surgical service and rehabilitation is provided. Depending on the specific needs of the individual, several options for reconstruction are available. The most common operation is grip reconstruction. Briefly, this surgery includes tendon transfers to power thumb and finger flexion, adjustment of position of the thumb and during the recent years often combined with reconstruction of opening of the hand, i.e., finger and thumb extensors. Because of the shift towards more frequent incomplete spinal cord injuries, surgical reconstruction now also includes spasticity operations.