Saturday, November 10, 2007

Rehabilitation

The modern rehabilitation after reconstructive hand surgery in tetraplegia is far more sophisticated than previously. This is mainly due to the fact that several individual procedures are combined in one and the same reconstruction. A grip reconstruction can include fusion of the basis of the thumb combined with fusion of the thumb, multiple tendon anchorings (tenodesis) as well as multiple tendon transfer procedures. Activation of an arm and hand that has been rebalanced in such a complex way, requires a lot from both the patient and the physiotherapist responsible for the post-operative training.

The cornerstone in this rehabilitation process is early activation of the new muscles that power the new function. In other words, the patient is instructed to exercise the new functions the day after surgery in a controlled, supervised and yet active motion that requires focus to really identify the new muscle and utilize the function.

To be able to rely on the new and transferred motors it is of course important that one can trust that the attachment sites (tendon to tendon sutures) have a sufficient integrity and can withstand certain amount of load. Initially, the load is minimal because it is only the activation and motion without any external load that is exercised. The theme of the training is always to accomplish a performance that will optimize the hand function so its new performance meets the prioritized goals presented by the patient prior to surgery.

One month after surgical reconstruction of Triceps the patient can train voluntary elbow extension movements under guidance of physiotherapist and with support and protection of an orthosis.

Occasionally the physiotherapist is using so called biofeedback, i.e. electrical stimulation to better isolate the function of the new muscles performing different tasks. This may sound very complicated, but in fact this is usually not a big problem even in patients that are elderly.

The rehabilitation protocol is detailed in close cooperation between physiotherapist, patient and surgeon, and includes several active sessions per day with usually fewer repetitions but more of focus upon quality of the activation pattern following reconstruction.


This patient practices grip and release exercises one month after reconstruction of key pinch and finger flexion.

2-3 days of training after surgery is usually enough for the patient to be able to return to home and follow the written and oral information about home training program for the next 3-4 weeks.

The next step after the training period at home is to return to the treating unit with new training under supervision and with a more clear orientation towards refining typical activities of daily life.

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