Hand function is, by most, considered the most important ability leading to independence with activities of daily living. Attendant care is by far considered a medical necessity because of the lack of hand function needed by a person to groom, dress, eat, toilet, drive, use a phone, use a computer, manage money, and the list does go on. Tendon transfers have been an elective surgical intervention for dozens of years but are for some reason, a well kept secret for populations such as spinal cord injuries. No one would hesitate to offer Chipper Jones of the Atlanta Braves a tendon transfer if he had an injury that would warrant it. But take a 23 year old C5-6 tetraplegic, and you will find recommendations such as a power wheelchair, hoyer lift, attendant care, occupational therapy, orthotics, assistive devices and assistive technology that are all costly, and require maintenance and replacement. You will rarely, if ever find a recommendation for tendon transfers.
Three primary tendon transfers, which are deemed very useful to the C5-6 SCI population, have the potential to strengthen pinch, grip, and elbow extension.
- A “key” pinch procedure might offer the ability turn pages, hold a book, take money out of your wallet, use and ATM, catherize yourself, write with a pen or pencil, brush your teeth, feed yourself with utensil WITHOUT a u-cuff or other device.
- Improved grip strength might allow you to grasp a water bottle, a doorknob, hold a medicine bottle and even take the cap off!
- Elbow Extension gives you triceps strength and increases your “work space”. A person could then prop sit, help themselves scoot and sit, propel a manual wheelchair, and reach outward and upward.
A young lady’s story at the Shepherd Center caught my ear. She had been injured at the C5 level for almost 15 years. She had attendant care, family and friends, and a husband and 2 small children. She went through all three procedures on both arms. The procedures themselves are outpatient. She returned to therapy 3 weeks later for 3 times per week for 8 weeks. Now she has a lifetime of independence she did not have for 15 years that does not require maintenance or replacement. She was able to discard all assistive device and adaptive equipment. She was able to put on her make-up, catheterize herself and shave her legs.
The best part of all this… she made her kids a homemade macaroni and cheese for the first time! She was able to grip the egg, crack it, stir it up, get a GALLON of milk out of the fridge, open the top, pour, put a pot of water on the stove, grate cheese and prepare the plates and eat it without any fancy utensil!
How much in ancillary/assistive devices/attendant care costs do you think would have been saved if she had this done 8-12 months post injury? The average C5 tetraplegic has at least 8 hours of attendant care. Over her 15 years the costs (attendant only) would be almost $1,000,000. Sounds like a no brainer to me!
While this is an excellent illustration about saving costs, it also clearly exhibits that this young woman’s life is so much more full and productive. She can take care of her family and kids. PRICELESS!
Guest Post by:
Neile Manning, BSW, C-SWCM
Certified Social Work Case Manager
Neile is a key member of the MK Consulting Case Management team and has extensive background in wokring with disabilities.