Assessment of upper limb in tetraplegia: Considerations in evaluation and outcomes research

This article briefly discusses several measurement tools for evaluating the upper limb of persons with tetraplegia. Muscle strength testing and electrodiagnostics are discussed as they relate to technique and usefulness for clinical trials. Standardized measures of hand function are reviewed; their limitations for clinical trials during acute spinal cord injury (SCI) care are acknowledged and their strengths for interventional studies and clinical trials during chronic phases of SCI care are defined. Recommendations are set forth for incorporating the International Classification for Surgery of the Hand in Tetraplegia motor and sensory examinations as adjuncts to the International Standards for Neurological Classification of SCI motor and sensory examinations and for further developing electrodiagnostic techniques as measurement tools for acute clinical trials. The Grasp and Release Test is described and recommended for clinical trials involving persons in the chronic stages of SCI. Lastly, we note that much work remains in the development, validation, and clinical deployment of an assessment of upper-limb function in SCI.