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Key Points

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  • Physical rehabilitation increases muscle strength and function to improve hand task performance and quality of life in individuals with SCI.
  • Minimal clinical research evidence exists to support the use of orthoses in preventing joint problems or improving hand function.
  • Providing education to manual wheelchair users may be effective in improving wheelchair skills and preventing shoulder pain.
  • Motor imagery may be an effective intervention for improving movement performance in persons with SCI.
  • There is limited evidence to support the use of action-observation therapy in SCI rehabilitation.
  • Rehabilitation using virtual reality interventions produces similar results to conventional therapy and may help to improve hand function, as well as activities of daily living, through an engaging platform as a supplement to conventional therapy.
  • Upper extremity robotics improve hand function in individuals who have suffered upper limb paralysis following a spinal cord injury. However, further research is necessary to determine the efficacy of upper extremity robotic exoskeletons as part of a robotic rehabilitation program.
  • BCI technology as a rehabilitative therapy is feasible and may be efficacious in promoting neuroplasticity, however, further technological advancement is necessary to provide benefit as an assistive device in tasks related to daily living at home.
  • EMG biofeedback does not improve motor function of the upper extremity
    in SCI rehabilitation patients.
  • A variety of neuroprostheses exist that have demonstrated significant improvements in upper extremity function. As technology and surgical procedures advance, these systems may become more affordable and accessible for individuals with SCI.
  • There is mixed evidence about the efficacy of NMES to improve muscle strength.
  • When combined with TENS, functional task practice may improve aspects of hand-related function, however, more clinical trials to determine the long-term rehabilitative effects of TENS therapy are necessary.
  • The evidence is conflicting as to whether FES is effective alone or in combination with massed practice training.
  • More research is necessary to determine the efficacy of muscle vibration therapy in SCI rehabilitation.
  • rTMS has many applications and may improve functional outcomes alone or in combination with PNS and reconstructive surgery.
  • tDCS may provide some advantage in improving upper extremity muscle strength and hand grasp, however, larger clinical trials are necessary to determine the effectiveness of tDCS as a long-term rehabilitative therapy.
  • Intrathecal baclofen may be an effective intervention for upper extremity
    hypertonia of spinal cord origin.
  • Surgical intervention for recovery of upper limb function significantly improves motor outcomes and the ability to perform ADLs.
  • A variety of diverse pinch and grasp reconstructive procedures improve hand function and QOL.
  • Deltoid-to-triceps surgery may improve motor function and the ability to perform daily living tasks, leading to surgical satisfaction.
  • Biceps-to-triceps elbow extension is a viable surgical option for those with limited function, impacting activities of daily living.
  • Multiple reconstructive surgeries help to improve pinch, grip, and elbow extension functions that improve ADL performance and QOL in tetraplegia.
  • Nerve transfer surgery to restore hand and upper limb function in SCI patients is a viable alternative to tendon transfer in acceptable candidates.
  • Acupuncture and Trager therapy may reduce upper limb pain post-SCI, however, there is limited evidence that acupuncture improves neurological and functional recovery in SCI.