At the recent world congress in reconstructive hand surgery and rehabilitation in tetraplegia (Philadelphia, 2007), a resolution regarding assessment of individuals with tetraplegia was presented and accepted.  Briefly, this resolution stated that every person who sustains a cervical spinal cord injury with tetraplegia should be examined, assessed and informed concerning the options of possible reconstruction of motor function of the hands and arms.  It is of course a long way before this ambitious goal can be achieved but the resolution put forward by the leading experts in this field certainly stresses the necessity of increasing the awareness and improving the infrastructure to meet patients’ demand of informed discussions of options for improvement of hand function.

Function on request - our philosophy

Persons with tetraplegia having sufficient remaining functioning muscles, which in practice means good elbow flexion strength, can usually get an improved hand function by surgical reconstruction. The individual herself/himself is the only person who knows exactly what performance goals that need to be met to become more independent. In other words, it is absolutely imperative to carefully investigate how the individual’s specific requests of functions and expectations of outcome match the given prerequisites for reaching these goals.
Expanded surgical options available to tailor specific functions require a deepened communication between patient and surgeon/caregivers to reach the best possible results. Specific needs like “be able to write by hand”, “dress myself”, “drive my manual wheelchair”, “better control of steering wheel”, “catherize myself” make it more easy to analyze the detailed components of these particular motions. Analyses of the combined and more complex motions give a better foundation for a dialogue of how well the surgical procedures and post-operative training can reach the prioritized goals.
This approach represents reasonable patient demands on surgeons and rehabilitation team and gives greater patient satisfaction. If, for any reason, there is a mismatch between patient wishes and surgeon’s predicted result, surgery must not be undertaken.

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