Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study

Abstract

Context: Patient goals are critical when determining surgical options for restoration of hand function in spinal cord injury (SCI).

Objective: We characterized the discussion of goals specific to hand function during acute rehabilitation admission at a single Canadian center following cervical SCI, before the introduction of a hand surgery program for the tetraplegia population.

Methods: A retrospective chart review of a single-center adult rehabilitation hospital from 2012 to 2022 of traumatic cervical SCI admissions was conducted. Charts were reviewed for discussion of specific goals that require hand function and recorded for analysis. Hand function goals were categorized and mapped to Canadian Occupational Performance Measures (COPM) domains, and patterns were analyzed on a population level.

Results: Over ten years, 134 individuals with acute traumatic SCI were admitted, 88 met study inclusion criteria with documented goals requiring hand function, and 32 unique goal types were recorded. The most common goal domain across all AIS categories was functional mobility. Motor complete patients primarily had self-care goals. Leisure and productivity goals were overall rarely captured. Most documented goals focused on basic activities of daily living (ADLs).

Conclusions: We observed a historical emphasis on hand function goals of ADLs, but not capturing the depth and breadth of other domains where hand function is essential. With the development of hand surgery programs in the tetraplegia population, standardized tools and detailed discussion of hand function goals may better capture patient priorities, including productivity and leisure, and improve our discussion of functional outcomes when evaluating the success of surgery.

Keywords: Cervical spinal cord injury; Functional recovery; Hand function; Patient goals; Upper limb reanimation.