The 11th International Meeting on Surgical Rehabilitation of the Tetraplegic Upper Limb was recently held in Hong Kong. Participants from all continents participated in vivid discussions about various topics related to the reconstruction and rehabilitation of hand control in tetraplegia. The invited speakers covered a wide and informative spectrum of topics:
Tragedy and Miracle Khalid Mohammed (New Zealand), Debilitating contractures in tetraplegia, Anne Bryden (USA), Spasticity reducing surgery in tetraplegia
Carina Reinholdt (Sweden), Local experience in tetraplegic hand management Josephine Wing Yuk Ip (Hong Kong), Shoulder Pain in tetraplegia Khalid Mohammed, Nerve transfer in tetraplegia Andreas Gohritz (Switzerland), Tetraplegic Hand Reconstruction: the High and the Low Pak-Cheong Ho (Hong Kong), The Alphabet procedure Jan Fridén (Sweden), Surgical balance of the thumb Jeremy Simcock / Gordon Beadel (New Zealand), Techniques for Intrinsic Balancing in the Hand James House (USA), Lessons Learned: Neuroprosthetics, 1976-2013 Michael Keith (USA), Myoelectric Control for Upper Extremity Neuroprostheses Dustin Hardwick, Functional electrical stimulation in tetraplegia hand surgery Ines Bersch-Porada (Switzerland).
Panel discussions about current trends and choice of surgical techniques allowed colleagues to challenge the experts. Multiple high-standard free papers were presented. Some current trends could be identified. They included the use of neurotization to reanimate key motor functions, single-stage multi-procedure reconstructions, immediate active mobilization after surgery and a more clear focus on patient perceived perspective of decision-making process before surgery and considerations during the surgical rehabilitation.
A lot of attention was paid to the "art" of intrinsic balancing i.e., the intricate restoration of normality of grasp. Jan Fridén, James house and Ursina Arnet (Photo left) provided clinical and kinematical data on how to best rebalance a paralyzed hand by use of active or passive actuators on finger joints. A consensus was reached about not only understanding the mechanics of the hand balance but also the superiority of the House procedure before other procedures to secure intrinsic balance.
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