Tuesday , July 5 2022

Tetraplegics can move their hands again – Nottwil's luminosity makes it possible


Thanks to new methods, quadriplegics can move their arms and arms again. Such surgeries can only be held around 30 surgeons worldwide. Jan Fridén is one of the Swiss Paraplegic Center in Nottwil.

Niels Jost

The hand surgeon, Jan Fridén, has already performed surgery on more than 1200 tetraplegics, so they can move their hands partially. (Photo: Nadia Schärli (Nottwil 30 October 2018))

The hand surgeon, Jan Fridén, has already performed surgery on more than 1200 tetraplegics, so they can move their hands partially. (Photo: Nadia Schärli (Nottwil 30 October 2018))

Jan Fridén is a man who is trying. He does not have time to have an interview. Therefore, the appointment is arranged several weeks in advance. So it's surprising how the surgeon will appear at our meeting at the Swiss Paraplegiary Center (SPZ) in Nottwil: T-shirt, casual trainer pants and boundaries. Fridén looks charismatic, relaxed, but his eyes are focused. He has been in the executive board, the Swede explains, but his colleagues in the law department and tetrahedral surgery now continue with the procedure.

Although Fridén speaks good German and even a little German Swiss, we speak in English. Therefore, it could explain more clearly how quadriplegics may move their arms and hands can restrict – and why one in five decided against such an OP.

Jan Fridén, you are considered to be corrosive in tetrahedral surgery, have performed around 1200 hand rebuilding in patients with spinal injuries. We can only do about 30 world surgeons – although the methodology has been known since the 1970's.

At the time, the method did not get too much attention. Only about ten years ago, the nerve transfer technology was restored and since then it has been developed consistently. My technique is unique because we can do it with only one surgery, so that the patient can open and collect his fingers without using the original muscles or tendons. This is done by placing the muscles or nerves in a different situation.

Which patients are you and the six-person team caring for in the SPZ?

People with injuries of the spinal cord but also the brain come to us. People who do not have weapons functions that are not manual or limited. Either due to an accident, illness or infection, that we can recover all or part of the functions. There are three surgical methods: We either move muscles, tendons or nerves and replace them.

"If you can move your hands again, you'll regain huge quality of life."

How do I work?

The method we use depends on how high the spinal cord has damaged. If the paralysis is relatively deep, for example, there is a question of muscle transfer. We move whole muscles of the upper or lower arm to a place that can perform central functions, such as folding the fingers or closing and opening the fist.

That is, tetraplegic muscles are paralyzed, but still completely?

The muscles are completely active. They only need one stimulus. For this, we cut a whole nerve and insert them on the nerves that do not operate. The nerve grows again – up to a millimeter per day! We make sure that growing nerves find the target muscles, which in turn allow the mentioned hand functions.

The interview is being interrupted. Fridén cell phone rings. "Here's the operating room, I have to get there quickly," he said. Some advice later, he focuses again on the conversation, but said: "In 30 minutes, I have to be back in the operating room, is it possible ? "

How long does surgery take?

Five to six hours. But that's not enough.

What do you mean?

After this complicated surgery, patients have to wait for the SPZ for up to three months and then spend several months in the classroom. Say: From home to home, back to the clinic. This is the main reason why one in five rejects an operation.

How long is the rehabilitation process taking?

The patient must release all his arm and his / her hand functions. It takes up to 12 months – and that's hard work. Because of even simple steps in everyday life, the movements are extremely complicated. For example, if you want to build a glass, you must first stretch your arm, then open your hand, hold the glass with enough weight, and finally turn the glass off again. That means a lot of timing and balance.

"If someone is not prepared to face the learning process, the surgery will not help."

Is your approach always successful?

If someone is not happy to face the learning process, the OP will not help. But before all interventions, we carry out tests and predict what functions the patient will recover. The ability to recover the skills is 100 per cent, but in any case we will make an improvement.

Does that mean?

If you can move your hands again, you will recover a huge quality of life. You will be when you can shake someone's hands or beat them, or even for communication, for example with a mobile phone. In addition, patients can move their own wheelchairs. Such interventions change the whole life of the patient and their environment. That's my merge to go to the everyday work.

Does the insurance pay for the procedure?

Yes, but we need to tell insurers exactly what skills the patient will return. But only when someone is able to wear again, this relieves the long-term health system.

Recently, the media said that paraffig can walk again thanks to ETH therapy. Would that also be with your method?

No The legs have the weight of the whole body. At present, we can not reconsider that there is a lot of muscle growth by transmission techniques or transmission nerves.

However, there seems to be no restrictions on modern medication. How far should this go? Also playing ethical in your work
Principles of a role?

Of course. Against the way, I wonder how I can give as many people as possible to modern modes of this type. These are only available in around 15 countries around the world. It would be good if there were much more.

You have been in the SPZ since 2011, before, you have led the Center for Tetra-Hand Surgery at the University Hospital in Gothenburg, your home. Why change to Nottwil?

The Center of Competence with the Department of Hand Surgery in Nottwil is unique in Europe. Our team includes not only surgeons, but also of physiotherapists and occupational therapists, researcher and doctoral student.

After 60 minutes the interview ends. Fridén left only 5 minutes for the photo session. "Then I have to go to the operating room."

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