Current Trends in the Management of the Upper Limb in Spinal Cord Injury

There are nearly 12,000 new cases of spinal cord injury each year. About half of those involve some part of the arm and hand, representing significant disability and dependence for those patients. Restoration of upper limb function remains a high priority in rehabilitation; however, treatment protocols are widely variable and poorly defined. Recent research efforts fall into three main categories: therapeutic interventions, surgical reconstruction, and robotic developments. Therapeutic interventions involving high repetitions of motor and sensory input are under investigation but have limited support in the literature. Patients with incomplete injuries have a better prognosis. Surgical reconstruction techniques are evolving from advances in treatment of brachial plexopathy. Although these hold great potential for return of function, they are also high-risk techniques for which complications and inconsistent results have been reported. Finally, robotic developments, including exoskeletons and implants, show great promise but still have practical constraints. Management of the upper limb remains a complicated problem and more research efforts should be devoted to defining strategies for intervention.