Surgeons 'rewire' nerves of paralysed patients to enable hand movement

Surgeons in Australia have trialed a life-changing operation, in which nerves in paralysed people’s bodies are ‘rewired’ to give movement to their arms and hands, according to a recent BBC News article.

Although completely normal function has not been restored, patients who took part in the trial can now feed themselves, type using a keyboard, apply make-up, handle money and turn a key.

One patient said the pioneering surgery had given him independence he had never imagined. Paul Robinson, 36 from Brisbane, became paralysed when he came off his dirt bike in February 2015 and damaged the spinal cord in his neck.

"I had no movement in my hands or fingers, no movement from the arm down and weakness in my shoulders," he said.

Paul had to move back in with his parents as he needed help with simple tasks such as cutting up his food.

His nerves were ‘rewired’ just before Christmas in 2015, an experience which he labels as one of the most painful in his life. He then started the process of recovery which included physiotherapy to ‘relearn’ how to move his arms and hands.

Paul told the BBC: "I recently moved into my own house and am living independently, I never thought it would be possible to live on my own.

"I play sport (wheelchair rugby) and am studying engineering. It's made a huge difference in my life - being able to cut up food, hold normal cutlery and use a pen to write at university."

Paralysis & the spinal cord

Known as the vertebral column (or spinal column) the spine is a fundamental part of the human body that houses and protects the spinal cord. The spine is comprised of protective bones called vertebrae, which start in the skull and make their way down to your lower back.

Humans rely on the spinal column for core internal support. It plays a key role when we stand, bend and turn, all the while protecting the spinal cord from serious injury.

Built into the spinal column is the spinal cord. It is a complex series of nerves that start at the bottom of your brain and run down the vertebral column, all the way to the backbone. The spinal cord, along with the brain, are a significant part of the central nervous system. The spinal cord as part of the central nervous system has an important role to play in the following areas:

• Walking - walking is a complex activity coordinated by your brain and the spinal cord. Groups of muscles in your legs have to coordinate to extend and contract repeatedly. Neurons called ‘central pattern generators’ send signals to muscles in your legs to make that happen.
• Electrical communication - electrical signals are sent up and down the spinal cord, facilitating communication between the whole of the body and the brain
• Reflexes - involuntary movements that are governed by external stimuli and your brain. For instance, your instinctive reaction to touching something very hot is to withdraw the part of the body affected immediately.

Certain injuries to your spinal cord will halt messages travelling from the brain to control the rest of the body and the result is paralysis.

The procedure

Patients featured in the trial had quadriplegia – paralysis affecting all of their limbs – but ultimately were still able to move some muscles in their upper arms.

Functioning nerves to such muscles were then rewired, by cutting the nerves and attaching these to nerves that control other muscles – for example, nerves that once turned the palm up to face the ceiling could be used to extend all the fingers in that hand. Which means that if that patient was to think of turning their hand over, all of their fingers would extend instead.

Dr Natasha van Zyl from Austin Health in Melbourne, comments: "We believe that nerve transfer surgery offers an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions to perform everyday tasks, and giving them greater independence and the ability to participate more easily in family and work life."

Dr van Zyl went on to stress that the operation does not restore normal hand function, instead focusing on enabling patients to open and close their hand, as well as extending their elbow to reach something.

She added: "So you can get your hand open, get it around something and then grasp and pinch. We are not trying to restore the very fine co-ordination of the hand."

Unfortunately, the procedure will not work for all patients with paralysis and its success will depend on the type of injury sustained. For instance, if the injury is so far up the spinal cord that it has caused total paralysis there would be no functioning nerves to rewire. And as the procedure focuses on upper limbs, if someone had suffered a spinal cord injury further down their back and their lower limbs were paralysed, the procedure would not be necessary.

The procedure is also not guaranteed to work on all patients with quadriplegia – a total of 59 nerve transfers were performed in 16 patients throughout the trial. It failed on four occasions, resulting in a permanent reduction in sensation in two of those instances.

However, researchers added that as around 250,000 people around the world suffer spinal cord injuries resulting in quadriplegia each year, there is a large group of patients who could benefit from the procedure.

Expert opinion

Dr Ida Fox - Plastic & Reconstructive Surgery, Peripheral Nerve Surgery, Hand and Wrist Surgery at Washington University, said: "Nerve transfers represent a huge advance in reconstruction to restore hand function following spinal cord injury."

She said it was important for patients to have surgery soon after the injury but hoped it could be used "throughout the world".

Helen Shaw, a Partner in our Personal Injury team who specialises in spine and back injuries, comments:

“Although this appears to be an encouraging development, it must also be borne in mind that it will only be potentially suitable for patients with particular levels/types of injury”

Read how Helen secured £3.75 million in damages for a man who was left paralysed following an incident on a building site.

Read how Helen secured over £3 million in compensation for a man who was left paralysed after falling through a skylight at work.

Helen has specialised in serious personal injury claims for over 30 years and is a Partner at Potter Rees Dolan. Should you have any questions relating to personal injury or indeed any aspect of this article and wish to speak with Helen or any other member of our personal injury team, please call 0800 027 2557 or fill out the contact form at the side of this page. Alternatively, you can contact Helen directly here.