"When evaluating a patient for limb reconstruction after a spinal cord injury, it's important for us to determine a few different aspects of the injury. One, we need to perform a physical examination and determine the strength of the remaining muscles. Two, we need to evaluate the MRI and look at the extent of the damage to the spinal cord itself. And thirdly, we perform an EMG or a nerve test to evaluate the health of the muscles that are going to be transferred from, and the health of the muscles being transferred to. A patient who has a significant lower motor neuron injury, that is, a large segment of the spinal cord has had tissue damage, may have the equivalent of a peripheral nerve injury. In this case, the muscles of the arm will begin to become atrophic or wither away and lose tone. These patients usually have floppy hands, have lost reflexes and do not respond to stimulation. Such a patient will need to undergo reconstructive procedures within the first year. Other patients maintain tone, spasticity, have the reflexes, but the muscles don't move. In these cases, the patients may benefit from reconstructive surgery many years after their injury. That spasticity maintains the health of the muscle and opens up opportunities for later intervention. So these tests, particularly the nerve tests, are typically not performed in the traditional rehabilitation setting. They're only performed to determine the candidacy for the procedures to be undertaken to restore function. The vast majority of patients who have suffered a cervical spinal cord injury can benefit from reconstructive procedures. Patients who are a C4 level and above have very few options, whereas a C5 level and below, there are a number of options to restore arm and hand function."
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