Isabelle LAFFONT, MD

(Service de MPR Widal I. Hôpital Raymond Poincaré. 92380 Garches. France)


  1. If not followed by rehabilitatuion in  an experienced rehabilitation center, surgery of upper limb in tetraplegia is unuseful and dangerous.
  2. Information of patient comes not only from the medical team, but also from other patients.
  3. A good collaboration between physiatrists and surgeons is mandatory.
  4. A good collaboration between physiotherapists and occupational therapists is mandatory.
Preoperative physiotherapy is sometimes useful (not systematically) :
  • Passive Articular range may be increased if needed
  • Muscle to be transferred may be reinforced if needed
Each surgical procedure follows the same postoperative pattern.
First month postop = immobilization of the upper limb.
  • Patient is in an electric wheelchair.
  • His free joints are mobilised
  • Controlled isometric contractions are started on transferred muscle(s)
Second month postop
  • Articular range of motion is progressively recovered
  • Transferred muscle is first exercised (physiotherapy), then integrated in its new function (occupational therapy).
Third month postop
  • Occupational therapy
  • Motor reinforcement