A Synthesis of Best Evidence for the Restoration of Upper-Extremity Function in People with Tetraplegia

Purpose: Because upper-limb function represents overall function for individuals with tetraplegia, the restoration of upper-extremity function is exceedingly important for this population. The purpose of this review was to identify interventions that optimize upper-limb function after tetraplegia based on best available evidence. Methods: A search of MEDLINE, AMED, and PubMed with the search terms "hand function AND tetraplegia" and "upper limb function AND tetraplegia" found 384 articles. After elimination of duplicates and review of titles and abstracts, 43 studies were found to be applicable. Study quality of all applicable studies was assessed with a modified version of the Scottish Intercollegiate Guidelines Network for Cohort Studies methodology. Results: The applicable studies were organized into three categories: conventional therapies (CT), electrical stimulation therapies (ES), and surgical interventions (SI). The proportion of papers in each category that presented with sufficient methodological quality to contribute to best evidence was as follows: CT: 0/2; ES: 10/21; SI: 6/20. Conclusions: ES therapies are beneficial as assistive technologies and as therapeutic intervention in the subacute phase of recovery. SIs are suitable for individuals who meet very specific criteria for tendon-transfer surgery. Further clinical trials are warranted for ES and SI therapies to substantiate prescription of therapeutics.