Key Points

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  • Neuromuscular stimulation-assisted exercise following a SCI is effective in improving muscle strength, preventing injury and increasing independence in all phases of rehabilitation.
  • Augmented feedback does not improve motor function of the upper extremity in SCI rehabilitation patients.
  • Intrathecal baclofen may be an effective intervention for upper extremity hypertonia of spinal cord origin.
  • Afferent inputs in the form of sensory stimulation associated with repetitive movement and peripheral nerve stimulation may induce beneficial cortical neuroplasticity required for improvement in upper extremity function.
  • Restorative therapy interventions need to be associated with meaningful change in functional motor performance and incorporate technology that is available in the clinic and at home.
  • The use of concomitant auricular and electrical acupuncture therapies when implemented early in acute spinal cord injured persons may contribute to neurologic and functional recoveries in spinal cord injured individuals with AIS A and B.
  • There is clinical and intuitive support for the use of splinting for the prevention of joint problems and promotion of function for the tetraplegic hand; however, there is very little research evidence to validate its overall effectiveness.
  • Shoulder exercise and stretching protocol reduces post SCI shoulder pain intensity.
  • Acupuncture and Trager therapy may reduce post-SCI upper limb pain.
  • Prevention of upper limb injury and subsequent pain is critical.
  • Reconstructive surgery appears to improve pinch, grip and elbow extension functions that improve both ADL performance and quality of life in tetraplegia.
  • Nerve transfer surgery to restore hand and upper limb function in the person with tetraplegia is emerging as another surgical alternative.
  • The use of neuroprostheses appears to have a positive impact on pinch and grip strength and ADL functions in C5-C6 complete tetraplegia, however, access to the devices are limited and continue to be expensive in use.
  • The IST-12 neuroprosthesis, a second generation, myoelectrically controlled implantable device appears to have a positive effect on pinch and grasp functions which result in increased independence with activities of daily living.