Functional Goals of Individuals with Cervical Spinal Cord Injury undergoing Surgical Reconstruction for Elbow Extension and their Representation in Standard Assessments.

Abstract

This study aims to examine the most frequently pursued goals among individuals with cervical spinal cord injury (cSCI) undergoing posterior deltoid-to-triceps transfer, and to assess the extent to which these goals are represented in existing questionnaires and assessments. Retrospective observational study SETTING: Spinal cord Injury rehabilitation centre in Switzerland PARTICIPANTS: 47 participants (37 male, 10 female) with cSCI, levels of injury C4-C6, mean age of 33.4 years (SD 10.7 years), 4.8 years (SD 6.7 years) between injury and surgical reconstruction. In total, 307 goals were consolidated into 32 activities of daily living (ADLs). The goals were additionally categorized according to the Activity and Participation component of the International Classification of Functioning, Disability and Health (ICF), and by three functional workspaces (below, at and above shoulder level). The frequency of each ADL, ICF category, and workspace was determined across all goals and stratified by levels of injury. The 15 most most frequently ADLs were compared with the items from existing questionnaires and assessments. Not applicable. The most frequently pursued ADLs were "performing a transfer" (15%), "taking an object from the shelf" (14%), followed by "operating a manual wheelchair" and "dressing upper body" (each 7%). These rankings remained consistent across different ICF categories and levels of injury. Most of the ADLs happen "below shoulder level" (47%), then "above shoulder level" (32%) and "at shoulder level" (21%). Among existing questionnaires and assessments, the Van Lieshout Test showed the highest overlap (33%) with the 15 most relevant ADLs. An active elbow extension is crucial not only for overhead activities, but also for activities below shoulder level. Existing questionnaires and assessments insufficiently cover the most frequently pursued ADLs, emphasizing the need for a tailored tool for individuals with cSCI undergoing surgical reconstruction of active elbow extension.