'Life-Changing' Nerve Surgery Helps Paralysed People Regain Hand And Arm Movement

Patients could hold a drink, use cutlery, brush their hair or teeth, and put on makeup.
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People who were paralysed have been able to move their elbows and hands once more thanks to a groundbreaking type of nerve surgery.

As a result of the surgical technique, which involved attaching functioning nerves above the spinal injury to paralysed nerves below the injury, 13 young adults are now able to perform actions they never thought they’d be able to do again.

According to a study published in The Lancet, two years after surgery and following intensive physical therapy, participants were able to reach their arm out in front of them and open their hand to pick up and manipulate objects.

Lead researcher Dr Natasha van Zyl from Austin Health in Melbourne, Australia told HuffPost UK the surgery is “a life-changing event” which enables people to do everyday tasks without the use of aids and adaptive devices.

“Most often we are reconstructing elbow extension, hand opening, grasp and pinch,” she explained. “After reconstruction people can hold a drink, use cutlery, brush their hair or teeth, put on makeup, handle money, pick up objects, use tools and use electronic devices more easily and independently.”

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The study recruited 16 young adults (with an average age of 27) who had experienced a traumatic spinal cord injury to the neck in the past 18 months – most of which as a result of road traffic accidents or sports injuries.

They underwent single or multiple nerve transfers in one or both upper limbs to restore elbow extension, grasp, pinch and hand opening.

In total, 59 nerve transfers were completed among the 13 men and three women. Nerve transfers were combined with tendon transfers in 10 of the patients to allow different reconstructions to be performed in each hand. The former restored more natural movement and finer motor control in one hand, while tendon transfers restored power and heavy lifting ability in the other.

While only a small study, researchers said the nerve transfers are a major advancement in the restoration of hand and arm function, and offer another safe, reliable surgical option for people living with tetraplegia (paralysis of both the upper and lower limbs).

Four nerve transfers failed in three of the participants and the authors conclude that more research will be needed to determine who are the best candidates to have surgery in future.

The surgery could be game-changing in some cases though. “For people with tetraplegia, improvement in hand function is the single most important goal,” said Dr van Zyl.

Nerve transfer surgery offers an exciting new option for these individuals, she added, “giving them greater independence and the ability to participate more easily in family and work life”.

The study also showed that nerve transfers can be successfully combined with traditional tendon transfer techniques to maximise benefits – people could have one hand that was strong and another which was supple, more natural-looking and would be better for tasks such as typing or using devices.

“When grasp and pinch was restored using nerve transfers in one hand and tendon transfers in the other, participants consistently reported that they liked both hands for different reasons and would not choose to have two hands reconstructed in the same way,” Dr van Zyl explained.

At 24 months post-surgery, significant improvements were noted in the patients’ ability to pick up and release several objects within a specified timeframe. Prior to surgery, none of the participants were able to score on the grasp or pinch strength tests, but two years later strength was high enough to perform most activities of daily living.

Researchers said that for best results, the surgery should be completed within six to 12 months of injury, but that it wasn’t a fast process. It can take months after surgery for nerves to regrow into the paralysed muscle and for new movement to be seen – and years until full strength is achieved.

“Stem cells and neuroprostheses could change the landscape of regenerative medicine in the future,” said Dr Ida Fox from Washington University. “For now, nerve transfers are a cost-effective way to harness the body’s innate capability to restore movement in a paralysed limb.”