Assessment of the upper limb of the tetraplegic patient

• Published in: Hand surgery and rehabilitation 2022-02, Vol.41, p.S137-S147
• Main Authors: Moiziard, V., Lansaman, T., Mauruc Soubirac, E., Revol, M., Coulet, B., Hugeron, C., Gelis, A., Laffont, I.
• Format: Article
• Language: English
• Subjects: Assessment; Evaluation; Female; Grip; Hand Strength; Hand Strength - physiology; Human health and pathology; Humans; Life Sciences; Membre supérieur; Préhension; Quadriplegia; Quadriplegia - surgery; Range of Motion, Articular; Rhumatology and musculoskeletal system; Spinal Cord Injuries; Spinal Cord Injuries - complications; Surgery; Tetraplegia; Tétraplégie; Upper Extremity; Upper Extremity - surgery; Upper limb
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2019.02.004

The aim of our study is to describe the assessment of the upper limb in tetraplegic patients to follow his (her) neurological progression and to define the medical or surgical treatment program. We selected upper limb assessment tools and scales for tetraplegic patients described in the medical literature through a PubMed search over the last four decades. For each method, we present the implementation rules and its metrological properties, including its validity in French. We selected five clinical scales for functional evaluation of grasping, as well as four scales for evaluating the overall function of these patients. Finally, we identified three complementary precision assessment tools. The AIS (ASIA Impairment Scale) classification describes the level and the severity of the spinal cord lesion. The Giens classification is more practical for describing the upper limb in middle and low tetraplegia. Impairments can be assessed with most common generic scales and nonspecific measurement devices: range of motion, strength, sensory loss, spasticity, joint pain. Measurement of pinch and grip strength is widely used and easy to perform. The Capabilities of Upper Extremity (CUE) and the Jebsen Taylor Test are the best validated and usable scales. At a general functional level, the Spinal Cord Independence Measure (SCIM) is the most relevant scale in these patients. Motor nerve blocks, electromyography, movement analysis and echography are promising additional methods. Assessment of the upper limb of tetraplegic patients relies both on generic and specific assessment tools and scales. Le but de notre étude est de décrire l’évaluation du membre supérieur des tétraplégiques utilisable pour suivre leur éventuelle évolution neurologique et définir le programme thérapeutique médical ou chirurgical. Nous avons sélectionné des outils d’évaluation du membre supérieur du patient tétraplégique et les échelles décrits dans la littérature médicale dans PubMed durant les quatre dernières décennies. Pour chaque méthode, nous présentons les règles de réalisation et ses qualités métrologiques, y compris sa validité en langue français. Nous avons sélectionné 5 échelles cliniques d’évaluation fonctionnelle de la préhension et 4 échelles pour l’évaluation des capacités fonctionnelles globales de ces patients. Enfin, nous avons identifié 3 outils complémentaires d’évaluation instrumentale. La classification de l’AIS (ASIA Impairment Scale) décrit le niveau et la gravité de la lési