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Thread: Subjects Needed for Research on Restoring Hand Function in People with Cervical Spina

  1. #1

    Exclamation Subjects Needed for Research on Restoring Hand Function in People with Cervical Spina

    http://nerve.wustl.edu


    Subjects Needed for Research on Restoring Hand Function in People with Cervical Spinal Cord Injury

    Cervical spinal cord injury (SCI) is a life altering and devastating injury. Some people with cervical SCI can lift and bend their arms but have very limited use of their hands. Improving hand function is rated as more important to patients then restoring other functions such as walking. This research investigates the novel application of a well-known technique?peripheral nerve transfer surgery?to restore hand function in people with cervical SCI.

    Nerve transfers can be used to essentially rewire the system to make some muscles work again following SCI. The transfer is done in the arm and bypasses the damaged spinal cord to deliver a signal from the brain to a muscle that became disconnected following injury. A donor nerve is taken from a non-essential uninjured muscle and transferred to provide a more critical function. Because the nerve transfer procedure involves cutting and reattaching nerve tissue, time is required to regenerate working connections between the nerves and muscle and to allow the brain to relearn how to use and strengthen that muscle.

    This work will bring together a multidisciplinary research team to perform an investigation of this surgery. Detailed assessment of patients who have already had the surgery will provide information on what makes a good candidate for the surgery. Rigorous study of a new group of patients will provide much needed information on even subtle positive or negative changes in function. Measurements of changes in quality of life and interviews of patients and caregivers will improve our understanding of the best way to use this surgical treatment.

    This study will provide preliminary data that could lead to future studies at other SCI centers, to compare this technique to other treatments, and to expand the technique to improve other functions.

    MORE ON WEBSITE....
    http://nerve.wustl.edu

  2. #2

    I just recently had that procedure done on my left hand and right hand

    Quote Originally Posted by cljanney View Post
    back in May I had this procedure done. It can take up to a year or longer before you get any of the benefits so unfortunately I cannot tell you how well it works.

    I can tell you that this is an excellent hospital and the surgeons, doctors, nurses,therapists and everyone else involved have been excellent to work with.

    if anyone would like help getting to the right people to speak with their determine whether or not this is something that would make good sense for you please let me know.

    I would be happy to help.

  3. #3
    Quote Originally Posted by JAMESRRR View Post
    back in May I had this procedure done. It can take up to a year or longer before you get any of the benefits so unfortunately I cannot tell you how well it works.
    JAMESRRR, best of luck with your outcome!
    I guess you're one of the 14 mentioned below in the WUSTL article!

    I have a peripheral nerve brachial plexus injury, nerves were torn out of the spinal cord, so all my restorative surgeries where similar to what Mackinnon is doing at WUSTL (assuming she was your surgeon). It took 18 months before I had any flicker of movement in my shoulder, that was 13 years ago. Fingers crossed for you and hope movement comes back steady and strong.

    I also caught a screening of the documentary "A Spark of Nerve" that featured the SCI cervical nerve procedure mentioned in the below article. It's an important film. My type of injury is rare, and most neurosurgeons prescribe a "wait & see" approach that leaves injured paralyzed for life, when at least some function can be restored.

    www.sparkofnerve.com

    A wiggle stuns the world

    In 2008, Tom Wachtel, a 69-year-old Phoenix trauma surgeon, was driving to the hospital to perform emergency surgery when his car struck the median and flipped nose to end. Wachtel broke his neck and suffered a devastating spinal cord injury that left him a quadriplegic.

    A couple years later, he sought out Mackinnon. Nerve transfer surgery never had been applied to a patient with a spinal cord injury and Mackinnon wasn?t sure it would work. Wachtel was willing to take the chance on the belief that others could learn from the experience.

    For nine months post-surgery, they waited. That?s how long it took for the rerouted nerve to grow six inches toward Wachtel?s hand muscles.

    One day he wiggled his finger and thumb. And Mackinnon? ?I just went to the floor. I was so stunned and excited,? she said.

    Wachtel had become the first quadriplegic to regain hand function via nerve transfer surgery, and the story made international headlines.

    Eventually, Wachtel managed to eat a complete meal by himself and take control over other small, daily tasks. He gained enough independence to celebrate his 50th wedding anniversary at a Las Vegas restaurant. Two years into his recovery, he could catch a soccer ball.


    All those who?ve had a successful nerve transfer surgery, raise your arms ?. Tom Wachtel, MD, with Loren Schaller.


    Mackinnon since has trained Fox as the surgical lead on nerve transfer procedures involving the cervical spinal cord. In total, 14 patients at Washington University Medical Center have undergone the procedure.

    The technique has shown promising results for restoring function to select patients that otherwise would have been confined to a lifetime of hand paralysis, and ultimately laying the foundation for an emerging medical specialty.

    ?The world of nerve transfer surgery has been evolving for the last couple decades, in large part due to the efforts of Dr. Mackinnon,? said Gerald Wolff, MD, residency program director for the rehabilitation center at University of Ottawa in Canada, who was mentored by Mackinnon and Fox on the procedure.

  4. #4
    This group presented at W2W a couple years ago and explained their efforts in moving forward with better techniques and strategies as time goes on. They've made some remarkable advancements over the last several years!

    LINK

  5. #5
    Senior Member nate007's Avatar
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    Quote Originally Posted by JAMESRRR View Post
    back in May I had this procedure done. It can take up to a year or longer before you get any of the benefits so unfortunately I cannot tell you how well it works.

    I can tell you that this is an excellent hospital and the surgeons, doctors, nurses,therapists and everyone else involved have been excellent to work with.

    if anyone would like help getting to the right people to speak with their determine whether or not this is something that would make good sense for you please let me know.

    I would be happy to help.
    Hi JAMESRRR,

    I'm curious about the follow-up after the surgery, because it looks pretty invasive. Was there a lot of soreness in your arms? Were you able to use them normally afterwards? Was there any risk of them damaging the nerves in your arms that were already functional?

  6. #6
    Moved to "Recovery & Exercise" as this topic is not really related to SCI Cure.

    (KLD)

  7. #7
    Quote Originally Posted by nate007 View Post
    Hi JAMESRRR,

    I'm curious about the follow-up after the surgery, because it looks pretty invasive. Was there a lot of soreness in your arms? Were you able to use them normally afterwards? Was there any risk of them damaging the nerves in your arms that were already functional?
    it took about a week for the real pain to subside, but it was well controlled with medication. The arms where the incisions were made were sore from probably three or four additional weeks.after about six weeks I was able to start transferring again with the slide board although transfers were not as good as they were before. They are continuing to get better.

    Afterwords my thumbs were real week. This lasted for about six weeks but eventually the strength came back. This was important to me as I use my thumbs and Dragon voice recognition to do all my typing.

    I'm about 10 weeks out now and still have nerve pain in my hands, but this is getting better over time. As long as I do not overuse them the nerve pain is not too bad. Gabapentin seems to control it pretty well.

    Wouldn't really want to speak about all the risks. But, in my mind they were well worth taking.

  8. #8
    Senior Member nate007's Avatar
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    Quote Originally Posted by JAMESRRR View Post
    it took about a week for the real pain to subside, but it was well controlled with medication. The arms where the incisions were made were sore from probably three or four additional weeks.after about six weeks I was able to start transferring again with the slide board although transfers were not as good as they were before. They are continuing to get better.

    Afterwords my thumbs were real week. This lasted for about six weeks but eventually the strength came back. This was important to me as I use my thumbs and Dragon voice recognition to do all my typing.

    I'm about 10 weeks out now and still have nerve pain in my hands, but this is getting better over time. As long as I do not overuse them the nerve pain is not too bad. Gabapentin seems to control it pretty well.

    Wouldn't really want to speak about all the risks. But, in my mind they were well worth taking.

    That's quite a stretch to not be able to transfer independently. I'm a textbook C6 with a little sensation in my thumbs, but no movement. The prospect of gaining the use of my triceps and some of my thumbs and index fingers is really appealing. It'd make a huge difference, but six weeks without being able to transfer... I don't even own a lift anymore. How far did you have to travel, and how did you manage post-surgery?

  9. #9
    Quote Originally Posted by nate007 View Post
    That's quite a stretch to not be able to transfer independently. I'm a textbook C6 with a little sensation in my thumbs, but no movement. The prospect of gaining the use of my triceps and some of my thumbs and index fingers is really appealing. It'd make a huge difference, but six weeks without being able to transfer... I don't even own a lift anymore. How far did you have to travel, and how did you manage post-surgery?
    let me clarify a little bit. Prior to the surgeries I was a minimal assist transfer on the slide board. When I say I did not use the slide board for six weeks keep in mind that I had my first surgery on my right hand on May 13 and my second surgery on the left hand was on June 13. I was able to begin transferring with the slide board using medium assist during the first week of July. So when I say it took me six weeks part of the issue is the fact that I did my right hand and then three weeks later I did my left hand.

    If your transfers were better than mine and you were able to independently transfer then you could probably use a slide using minimum assist. You may be able to cover faster than I. Just keep in mind that you got some pretty long cuts in your arm. My right arm has an incision from near the top of my bicep down about 3 inches on my forearm then there's another six-inch cut on the top of my forearm. It is pretty much the same on the left arm so you don't want to put too much pressure on those until they are better healed. By July 4 I was also able to get on my hand ergonomic or and begin exercising again.

    I live in St. Louis so the overall trip was not bad. I had two appointments prior to the surgery, which if you are coming from out of town I think you could probably get it down to one appointment prior to the surgery. Both surgeries I did midmorning and was out of surgery by four or 5 o'clock. I spent the night in the hospital trying to get pain under control. They inserted a paintball that apply to local anesthetic directly to the wound sites which was very helpful in controlling the pain. Both days by 8 AM in the morning I had the pain under control and was ready to leave. I was sent home with some oxycodone 5mg. this was more than enough to keep the pain under control.

    So far I have been back for two doctors appointments to gauge how well things are feeling and I have another one scheduled for three months out. I have also been to one therapy session and have another one scheduled a month that a month out.

    If you are coming from out of town, my guess would be that you could reduce those follow-up appointments and get some type of therapy at home.

    I am the C7 injury and have feeling in both my thumb and forefinger but cannot use them for any type of grasp. Assuming that the surgery works getting that grasp between the thumb and the pointer finger will go a long way towards making me more independent. Obviously, it won't solve everything, but I think what I have to gain will be well worth it. There are lot of simple tasks that I am mostly dependent on people now. This won't solve all of them, but it will go a long way.

    PM me if you are interested in learning more. If you decided to come to St. Louis to have the procedure performed I can help you in terms of finding transportation and a place to stay. I cannot tell you that the surgery would be right for you, but I think I can inform you quite a bit about what takes place and that may be helpful in making a decision. I chose to go ahead and have both hands done. Some people may choose to get one hand done, wait for the results, and then get the second hand done. At this point, six weeks after the left-hand and closer to 10 on the right-hand I do not feel that I've lost anything from the surgery so if for some reason it didn't work I don't think that I've lost anything other than a lot of time and some inconvenience.

    If I can just get some grass back between my thumb and forefinger it will be well worth it.

  10. #10
    Senior Member nate007's Avatar
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    Thanks for the info! I had just assumed that you had them both done at the same time. I'm a very long day's drive from St. Louis, so I'd likely be staying in town for a few days, but the travel after that would be pretty uncomfortable.

    Did you talk to anyone who had had the surgery before you had it? I'm curious to know exactly how much function people have gained.

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