Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery, a case report.

CONTEXT: A 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively). FINDINGS: Upon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements. CLINICAL RELEVANCE: Nerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.

Predictive Factors for Returning to Work in Burn Adult Patients That Were Working Before Their Injury.

The goal of this study was to identify predictive factors that influence return to work in burn patients treated at the National Center for Burn Care and Research at the National Institute of Rehabilitation (CENIAQ) in México City. This is a retrospective case-control study that included all burn patients of working age (16-91 years old), treated between January 2011 and December 2013. Patients were divided into two groups: unemployed (no work group) and those who returned to work (RTW). The statistical analysis was performed by a logistic regression univariate and multivariate analysis. A total of 210 subjects were included in the study. The mean age was 38 ± 15 years and 66.7% of them were male. One hundred sixty-five patients (79.6%) were able to return to work after treatment. Through univariate analysis it was found that the predictive factors for not returning to work after injury were: education lower than elementary school (OR: 3.59; CI 95%: 1.79-7.32); history of epilepsy prior to burn injury (OR: 10.18; CI 95%: 1.9-54.43); total burned surface area (TBSA) ≥20% (OR: 2.87; CI 95%: 1.46-5.64); third-degree burns (OR: 2.64; CI 95%: 1.32-5.29); hospital stay ≥20 days (OR: 2.8; CI 95%: 1.47-5.68); length of stay in the burn intensive care unit (OR: 2.5; CI 95%: 1.25-4.97); secondary infection (OR: 2.24; CI 95%: 1.15-4.38); amputations (one or more regardless of amputation level; OR: 8; CI 95%: 2.52-25.30); burn of the upper extremity (shoulder; OR: 2.21; CI 95%: 0.97-5.03); thigh (OR: 2.41; CI 95%: 1.32-5.14); and knee (OR: 2.81; CI 95%: 1.21-6.55). Some of these factors have never been reported by other authors.