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| Name | Class |
|---|---|
| Shirley Ryan AbilityLab | OTHER |
| Northwestern University | OTHER |
| Case Western Reserve University | OTHER |
| Loyola University |
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Active elbow extension has significant functional benefits for individuals with tetraplegia. The proposed work will provide information to assess how effectively people are using their elbow extension tendon transfers, and whether one surgery works more effectively than the other. This study will provide recommendations to clinicians about the possibility of improving function after surgery using rehab techniques.
Voluntary control of elbow extension significantly improves functional abilities for individuals with tetraplegia. As a result, surgical reconstruction of elbow extension via tendon transfer is considered a fundamental intervention that benefits the patient, even if other tendon transfers aimed at improving hand function are never performed. Presently, there are two common tendon transfer surgeries used to restore elbow extension following spinal cord injury. These are the posterior deltoid to triceps transfer and the biceps to triceps transfer. Both surgeries significantly improve voluntary elbow extension, although there is variability in the amount of control that is restored among patients. This study will directly compare the performance of the posterior deltoid transfer to the biceps transfer with regard to: voluntary elbow extension strength, the ability to activate the transfer, and neural factors associated with voluntary and involuntary control of individual muscles. These comparisons will be made in functionally relevant postures and will provide fundamental information that will improve clinical understanding of the capacity of each of these two procedures to restore elbow extension.
The fundamental hypothesis of this proposal is that an inability to maximally activate the transferred posterior deltoid and the transferred biceps significantly limits the elbow extension moment that can be produced.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Subjects with posterior deltoid-to-triceps tendon transfers | ||
| Group 2 | Subjects with biceps-to-triceps tendon transfers | ||
| Group 3 | Subjects with cervical SCI who have not had tendon transfers | ||
| Group 4 | Unimpaired control subjects |
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| Measure | Description | Time Frame |
|---|---|---|
| Elbow Extension Strength | Elbow extension strength was measured as the maximum elbow extension moment that subject's could generate. We used an elbow moment transducer to measure elbow moments under isometric (no change in arm posture) conditions. Subjects performed three trials at maximum effort, holding maximum elbow extension for 5 to 7 seconds. The maximum moment was computed as the maximum average moment sustained over a 0.5 second window. | At least one year post surgery |
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Inclusion Criteria:
Exclusion Criteria:
Subjects will be excluded from the studies if there is presence of concurrent severe medical illness, including:
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Three groups of subjects will be recruited to participate in the experiments: individuals that have had the posterior deltoid to triceps tendon transfer, individuals that have the biceps to triceps tendon transfer, and individuals with SCI between C5-C7 who have not had tendon transfers. Nominally, we plan to recruit 15 subjects from each group.
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| Name | Affiliation | Role |
|---|---|---|
| Wendy M Murray, PhD | Edward Hines Jr. VA Hospital, Hines, IL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Edward Hines Jr. VA Hospital, Hines, IL | Hines | Illinois | 60141-5000 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Group 1 | Subjects with posterior deltoid-to-triceps tendon transfers |
| FG001 | Group 2 | Subjects with biceps-to-triceps tendon transfers |
| FG002 | Group 3 | Subjects with cervical SCI who have not had tendon transfers |
| FG003 | Group 4 | Unimpaired control subjects |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Group 1 | Subjects with posterior deltoid-to-triceps tendon transfers |
| BG001 | Group 2 | Subjects with biceps-to-triceps tendon transfers |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Elbow Extension Strength | Elbow extension strength was measured as the maximum elbow extension moment that subject's could generate. We used an elbow moment transducer to measure elbow moments under isometric (no change in arm posture) conditions. Subjects performed three trials at maximum effort, holding maximum elbow extension for 5 to 7 seconds. The maximum moment was computed as the maximum average moment sustained over a 0.5 second window. | Posted | Mean | Standard Deviation | Newton-Meters | At least one year post surgery | Upper limbs | Participants |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1 | Subjects with posterior deltoid-to-triceps tendon transfers |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Wendy Murray | Rehabilitation Institute of Chicago | 3122386965 | w-murray@northwestern.edu |
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| OTHER |
| MetroHealth System, Ohio | OTHER |
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| BG002 | Group 3 | Subjects with cervical SCI who have not had tendon transfers |
| BG003 | Group 4 | Unimpaired control subjects |
| BG004 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| OG002 | Group 3 | Subjects with cervical SCI who have not had tendon transfers |
| OG003 | Group 4 | Unimpaired control subjects |
|
|
| 0 |
| 4 |
| 0 |
| 4 |
| EG001 | Group 2 | Subjects with biceps-to-triceps tendon transfers | 0 | 5 | 0 | 5 |
| EG002 | Group 3 | Subjects with cervical SCI who have not had tendon transfers | 0 | 3 | 0 | 3 |
| EG003 | Group 4 | Unimpaired control subjects | 0 | 2 | 0 | 2 |
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