The goal of this prospective, open-label cohort study is to assess functional outcomes in individuals with cervical spinal cord injury who have undergone nerve transfer surgery to restore upper limb function. The main questions it aims to answer are:
* Does nerve transfer improve hand function in individuals with cervical spinal cord injury? * What factors are associated with functional improvement following nerve transfer? Researchers will compare functional outcomes at 24 months post-surgery to 1) baseline outcomes and 2) individuals with cervical spinal cord injury who did not undergo nerve transfer.
Participants who have received nerve transfer surgery as part of their regular medical care will complete functional hand tests, electrodiagnostic assessments, and questionnaires on independence and mood every 3 months for 24 months after surgery.
Traumatic, motor-complete cervical SCI (AIS A or B)
Male or female, ages 18-70
Consent and plan to undergo nerve transfer to restore grasp function in at least one limb
Motor grade 4-5 at C5
Inability or unwillingness to participate in post-operative rehabilitation (in person or virtual)
Secondary complication of SCI (e.g., intractable neuropathic pain, edema, contracture) or major medical comorbidity (e.g., traumatic brain injury) that would independently influence response to surgery or ability to participate in rehabilitation
Patient referrals are ensured through established care pathways for upper-limb rehabilitation in SCI, including nerve transfer. Research objectives will be facilitated through already available institutional clinical and rehabilitation resources at each study site. Potential participants will be informed of the study directly by their treating physicians. The research study will be introduced by the PI or one of the co-Is of the study, who are also responsible for clinical care of all prospective participants.
Cohort
Prospective
Nerve transfer surgery
Procedure/SurgeryThe intervention in this study, which follows our clinical approach, is the "double nerve transfer" to restore grasp function (i.e., hand opening and hand closing). Finger and thumb extension (hand opening) is restored via the supinator-posterior interosseous nerve (PIN) transfer. Finger and thumb flexion (hand closing) is restored via a nerve transfer to the anterior interosseous nerve (AIN). There are two donor nerve options available to restore function to the muscles supplied by the AIN: the nerve to the brachialis and the nerve to the extensor carpi radialis longus (ECRL) or extensor carpi radialis brevis (ECRB).
GRASSP (within-participant)
Change in Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) score from baseline to 24 months post-surgery. GRASSP is a validated upper limb functional measure and previously is used in SCI (Kalsi-Ryan et al. 2012) incorporates three domains vital to upper limb function: sensation, strength, and prehension.
GRASSP (between-participant)
Difference in longitudinal change in mean total GRASSP score between the surgical cohort and matched historical controls with cervical SCI who did not receive nerve transfer
Donor nerve health
The presence (or absence) of pathological spontaneous activity will be determined in donor muscles using needle electromyography.
Beck's Depression Inventory (BDI)
The questionnaire is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression.
Douleur Neuropathique 4 (DN-4)
A questionnaire consisting of 10 items and can be useful in assessment of neuropathic pain. The items related to pain quality are based on an interview and examination of the patient.
Spinal Cord Independence Measure Version III (SCIM-III)
The SCIM-III has been developed to address three specific areas of function in patients with spinal cord injuries such as activities of daily living, respiration and sphincter management, and a patient's mobility abilities.
Click on the lead sponsor to view all of their trials.
University of British Columbia
Lead sponsor
Queen's University
Collaborator
Dalhousie University
Collaborator
University of Toronto
Collaborator
Wings for Life
Collaborator
