1. Individuals were considered ineligible for restorative elbow extension if triceps was already at least 3/5, for restorative wrist extension if wrist extensors were already at least 3/5, and/or for restorative prehension surgery if they already had a sufficient pinch strength. Sufficient key pinch strength was determined qualitatively by reviewing occupational therapy reports detailing the individuals’ performance in functional tasks requiring key pinch grip.
2. Since muscles used as donor sites (ex : biceps, brachioradialis, deltoid, extensor carpi radialis brevis) typically lose one Medical Research Council (MRC) grade after transfer, the team at our institution is careful to consider transferring only if these muscles have a MRC grade of 5/5, or expected grade of 5/5 after a strengthening program.
3. Charts were screened for medical comorbidities such as recurring infections, contractures or severe spasticity, as these are known to potentially hinder the surgery or rehabilitation process by their nature or their cumulative effect.
4. E.g. during inpatient rehabilitation, non-attendance to outpatient follow-up appointments, or unstable psychosocial situation such as homelessness. Issues such as these were considered in the interest of appropriate resource allocation, as rehabilitation following reconstructive U/E surgery is a long and demanding process for an individual with SCI.
