"Rewiring" the nerves to thwart paralysis

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In Australia, thirteen quadriplegics have been able to use their arms again thanks to the recent technique of nerve transfer.

By Coline Buanic Posted today at 17h42, updated at 18h14

Time to Reading 4 min.

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Quadriplegia is not always synonymous with total paralysis of the four limbs. Some arm muscles remain functional if the spinal cord injury is low enough to allow the use of reconstructive surgery. Thirteen tetraplegic Australians have found partial use of their upper limbs as a result of nerve transfers, during a study described Thursday, July 4 in the journal The Lancet. After twenty-four months of intensive rehabilitation, the researchers measured a "Significant improvement" the strength and agility of the patients' hands.

Operations aimed at restoring the extension of the elbow, the opening of the hand and the seizure of objects, by a gesture of thumb-index "pincer" and with full hand. Simple movements integrated into everyday life – to recover from a supine position, to grab a drink or hold a pen – to the point of forgetting the complex physiological workings at work and the autonomy they confer.

Quadriplegic patients also consider the restoration of the use of their hands priority for their quality of life, in front of intestinal and vesicular control or sexual function. The extension of the elbow is even more important for paralyzed persons when it is requested during wheelchair propulsion and transfer of position, for example from the chair to the bed.

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Sixteen participants with recent spinal cord injury were recruited for this study, mostly young men (77% male, 27 years old). Road accidents were the leading cause of injury, followed by sport. Less than eighteen months after the trauma, fifty-nine nerve transfers were performed on all patients. Surgeons sectioned still moving muscle nerves above the lesion to graft them to the nonfunctional "recipient" nerves of paralyzed muscles, connected to the spinal cord below the wound.

No revolution

Abandoned since 1965, the application of this technique to spinal cord injury has regained the attention of researchers over the last decade. The practice, however, remains the preserve of a small circle of scientists, including Natasha van Zyl, lead author of the study and surgeon in Melbourne.

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