Functional hand development in tetraplegia.

The development of the 'functional hand' in tetraplegics has been historically facilitated through specialized hand positioning schemes. However, clinical experience at the University Hospital Heidelberg demonstrates no direct relationship between various hand positioning techniques and the probability of functional hand development. The aim of this study was to document the various methods of hand positioning and the resulting functional outcome. In a multi-center study, the paralysed thumb and finger positioning of 64 tetraplegics and the resultant functional outcome was evaluated with a specially developed survey form. Results indicated that the functional outcome of the tetraplegic hand was highly dependent on the level of the spinal cord injury and only to a minor degree dependent upon the different methods of hand positioning employed. The conclusion drawn is that remaining neurologic function after injury determines the final functional outcome of the tetraplegic hand.