Every patient who comes to MetroHealth’s Tetraplegia Management Clinic has one goal: to regain function in their upper extremities. Sometimes that means a splint or Botox. Other times, it means nerve transfer or tendon transfer surgery—or both. Always, it means a personalized treatment plan from a team with deep expertise in managing this life-altering condition.
“Through our multidisciplinary approach and research, we offer innovative, evidence-based care for patients,” says Kyle Chepla, MD, co-director of the clinic. “The work can be extremely challenging, but the rewards far outweigh the difficulties.”
A Team of Experts
The Tetraplegia Management Clinic is the only one of its kind in Ohio and attracts patients from across the country. The team provides both surgical and nonsurgical therapies, along with long-term follow-up.
“We like to see patients as soon as possible after their injury, once they’re medically stable,” Dr. Chepla says. “The first visit includes a detailed health history and gives us a sense of their long-term prognosis.”
During each visit, patients meet with the entire team, which includes Dr. Chepla (plastic surgeon and hand surgeon), Michael Keith, MD (orthopedic surgeon and clinic co-director), Matt Boberek, OTD, OTR/L, CHT (occupational therapist), Kim Walsh, MS, OTR/L, CHT (research occupational therapist) and Nicole Broz, BSN, RN.
Together the providers create a unified, personalized treatment plan for each patient. They also work closely with physical medicine and rehabilitation providers to co-manage patients and ensure a seamless care experience. “About half of our patients have surgery and the other half don’t,” Dr. Chepla says. “We continue to manage them for years and may make new treatment recommendations as their needs change.”
While in-person appointments are ideal, they aren’t always possible. The team offers virtual visits to patients who are too ill to travel or have transportation issues.
Surgical Approaches for Motor Complete Injuries
While some patients recover some function after their injury, this typically occurs within the first six months. Depending on whether there is any motor function below their level of injury patients are considered “motor complete” or “motor incomplete” and these two types require different treatment approaches.
Patients with motor complete injuries have no function below the level of their spinal cord injury. “These are the patients we try to evaluate early, because in some situations nerve transfer to restore function needs to be done six to nine months after their injury,” Dr. Chepla says.
Nerve transfer involves rerouting a small, working nerve from above the injury to a paralyzed muscle, allowing the nerve to regenerate into that muscle over several months. This can:
- Reanimate hand muscles for basic grasp and release
- Restore triceps function for elbow extension
- Significantly improve a patient’s ability to feed and dress themselves, perform self-catheterization and manage other daily activities that require reach and grip.
These gains also increase safety and independence, since patients can reposition themselves and handle essential tasks without constant assistance.
Tendon transfer, which moves the tendon of a functioning muscle to replace a nonfunctioning one, relies on redundant muscles that can take on a new role without sacrificing existing movement. This approach can:
- Restore missing motions, such as wrist extension or finger flexion
- Improve a patient’s ability to grasp, pinch and release objects
- Make hand-to-mouth movements smoother for feeding and grooming
Interventions for People with Motor Incomplete Injuries
In patients with motor incomplete injuries, signal transmission continues below the level of injury. These patients tend to experience a higher rate of spasticity and increased muscle tone. Their treatment plan may include nonsurgical options, such as Botox and splinting, or surgical procedures, including muscle lengthening, nerve transection and tendon transfer.
These interventions can reduce pain and spasticity, protect joint mobility and restore missing movements. For many patients, that translates into smoother hand control, more reliable grasp and release, and greater ease with daily tasks like feeding, grooming and using adaptive equipment.
Research That Drives Innovation
The Tetraplegia Management Clinic conducts research to advance the field and develop new therapies. This includes clinical outcomes studies to evaluate newer procedures available to patients seen in their clinic. “We want to understand which surgical approaches are superior and which type of patients will benefit most from specific therapies,” Dr. Chepla explains.
Another area of focus is functional electrical stimulation (FES), which uses implanted neurostimulators to reanimate paralyzed muscles and restore hand and arm movement.
Challenges and Rewards
The MetroHealth team sees firsthand how demanding daily life can be for people with tetraplegia. “Our patients rely on others for so much—feeding, dressing, basic mobility,” Dr. Chepla says. “That’s why even small gains in independence can make such a difference. The people we care for are incredibly appreciative, and that gratitude makes the work very rewarding for our team.”
To refer a patient to the Tetraplegia Management Clinic at the MetroHealth Rehabilitation Institute, call 216-778-4450 or send an email to Nicole Broz, RN.
