From regained function to daily use: experiences of surgical reconstruction of grip in people with tetraplegia

Abstract

Purpose: To capture patients’ relearning processes from regained function to improvements in daily life after grip reconstructive surgery in tetraplegia. Subjects: Eleven people with tetraplegia who underwent grip reconstructive surgery during February 2009 to March 2011. Methods: Qualitative interviews were conducted 7 to 17 months after surgery and analysed using grounded theory. Results: Determination to reach a higher level of independence was the core concept to integrate regained function into daily life. There were 3 phases identified; “Initiate activity training,” “Establish hand control in daily activities,” and “Challenge dependence.” Between the phases psychological stages occurred, first; “a belief in improved ability”, and later in the process; “confidence in ability”. The process to fully integrate regain function in daily life was described as long and time-consuming. However, the participants claimed it useful to do the skills training in their home environment, without long-term in clinic rehabilitation. Conclusion: Relearning activities in daily life after a grip reconstruction is a time-consuming and demanding process. It includes skills training, mental strategies and psychological stages together with environmental and social factors. Accordingly, rehabilitation after grip reconstruction in tetraplegia should focus on both grip skills and psychological stages, to encourage that patient’s keep their determination and achieve greater independence.

Implications for Rehabilitation

• There is a stepwise process to transform improved function into daily use.

• The most important factor to transform improved function into daily use was motivation to reach a higher independence. Other important factors were; skills training, use of individual learning strategies, belief and confidence in personal ability, social and environmental factors.

• There was a long and demanding process to fully transform the improved function into daily use.

• The participants preferred to do activity training in the specific environment, usually at home.

• Daily activity
• grip reconstruction
• independence
• outcome
• surgery
• tetraplegia

Acknowledgements

The authors are grateful to the participants for their willingness to share their experiences and to Occupational therapist Anna-Karin Gustavsson for valuable clinical feedback.

Declarations of interest

This investigation conforms to the Göteborg University Human Research Protection Program guidelines. Funding for this project was provided by Stiftelsen Promobilia, Swedish Research Council Grant 11200, Göteborg University, Sahlgrenska University Hospital. The authors have no financial disclosures.