Mulcahey M J, Smith B T, Betz R R, Weiss A A
Shriners Hospitals Philadelphia Unit, Pennsylvania 19152, USA.
Am J Occup Ther. 1995 Jul-Aug;49(7):607-17. doi: 10.5014/ajot.49.7.607.
Tendon transfer surgery to augment hand function lost to spinal cord injury (SCI) has gained acceptance as a rehabilitation option for adults but has yet to be fully explored in children. In this study, hand function and performance of activities of daily living in an 11-year-old child with an SCI were evaluated before and after surgical transfers of the brachioradialis to the flexor pollices longus and the extensor carpi radialis longus to the flexor digitorum profundus.
With the use of a single-subject AB design, repeated measures of pinch force, the Jebsen Test of Hand Function for Children and the Grasp and Release Test were obtained before tendon transfer surgery and at 2 1/2 6, and 12 months after surgery. Activities of daily living were assessed with the Functional Independence Measure (FIM) and the Common Object Test (COT) before surgery and 12 months after surgery.
Each assessment revealed a significant improvement in hand function after surgery. Pinch force was measurable only after tendon transfers and increased throughout the first year. By two standard deviation analyses, after surgery there were significantly more task completions for all Grasp and Release Test objects, and task completion times were shorter for the light and heavy objects of the Jebsen Test of Hand Function for Children. FIM results showed that self-catheterization and cutting food were possible only after surgery, and results of the COT revealed new unilateral and bilateral abilities that facilitated the client's independence in writing, eating, applying toothpaste, and brushing teeth.
This single-subject study demonstrates the benefits of tendon transfers for active grasp in a child with an SCI.
肌腱转移手术用于增强因脊髓损伤（SCI）而丧失的手部功能，已成为成人康复的一种选择，但在儿童中尚未得到充分探索。在本研究中，对一名11岁脊髓损伤儿童在将肱桡肌转移至拇长屈肌以及桡侧腕长伸肌转移至指深屈肌的手术前后，评估其手部功能和日常生活活动表现。
采用单受试者AB设计，在肌腱转移手术前以及术后2个半月、6个月和12个月，重复测量捏力、儿童手部功能杰布森测试以及抓握和松开测试。在手术前和术后12个月，使用功能独立性测量（FIM）和常见物品测试（COT）评估日常生活活动。
每次评估均显示术后手部功能有显著改善。捏力仅在肌腱转移后可测量，并在第一年持续增加。通过双标准差分析，术后儿童手部功能杰布森测试中所有抓握和松开测试物品的任务完成次数显著增多，对于轻、重物品的任务完成时间缩短。FIM结果显示，仅在术后能够进行自我导尿和切割食物，COT结果显示出现了新的单侧和双侧能力，有助于患者在书写、进食、涂抹牙膏和刷牙方面实现独立。
这项单受试者研究证明了肌腱转移对脊髓损伤儿童主动抓握的益处。
