Use of the NESS Handmaster to restore handfunction in tetraplegia: clinical experiences in ten patients

Objective: To explore possible functional effects of the Handmaster in tetraplegia and to determine suitable patients for the system. Patients: Patients with a cervical spinal cord injury between C4 and CG, motor group 0-3. Important selection criteria were a stable clinical situation and the absence of other medical problems and complications. Design: Ten patients were consecutively selected from the in- and outpatient department of a large rehabilitation hospital in The Netherlands. Each patient was fitted with a Handmaster by a qualified therapist and underwent muscle strength and functional training for at least 2 months. Methods: Functional evaluation comprised the performance of a defined set of tasks and at Least one additional task as selected by patients themselves. Tasks were performed both with and without the Handmaster. Finally, patients were asked for their opinion on Handmaster use as well as their willingness to future use. Results: In six patients a stimulated grasp and release with either one or both grasp modes (key- and palmar pinch) of the Handmaster was possible. Four patients could perform the set of tasks using the Handmaster, while they were not able to do so without the Handmaster. Eventually, one patient continued using the Handmaster during ADL at home. Conclusion: The Handmaster has a functional benefit in a limited group of patients with a C5 SCI motor group 0 and 1. Suitable patients should have sufficient shoulder and biceps Function combined with absent or weak wrist extensors. Though functional use was the main reason for using the Handmaster, this case series showed that therapeutic use can also be considered.