Tetraplegia [Neurosurgery Wiki]

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====== Tetraplegia ======
Tetraplegia, also known as [[quadriplegia]], is [[paralysis]] caused by illness or injury that results in the partial or total loss of use of all their limbs and torso; [[paraplegia]] is similar but does not affect the arms. The loss is usually sensory and motor, which means that both sensation and control are lost. [[Tetraparesis]] or [[quadriparesis]], on the other hand, means muscle weakness affecting all four limbs. It may be flaccid or spastic.

[[Nerve transfer]]s are a technically feasible means of restoring the upper extremity function in [[tetraplegia]] in cases that may not be amenable to tendon transfers
((Brown JM. Nerve transfers in tetraplegia I: Background and technique. Surg
Neurol Int. 2011;2:121. doi: 10.4103/2152-7806.84392. Epub 2011 Aug 30. PubMed
PMID: 21918736; PubMed Central PMCID: PMC3172032.
)).
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In recent years, the majority of the population has become increasingly reliant on continuous and independent control of [[smart device]]s to conduct activities of daily living. Upper extremity movement is typically required to generate the motor outputs that control these interfaces, such as rapidly and accurately navigating and clicking a mouse, or activating a touch screen. For people living with [[tetraplegia]], these abilities are lost, significantly compromising their ability to interact with their environment. Implantable [[brain computer interface]]s (BCIs) hold promise for restoring lost neurologic function, including motor [[neuroprostheses]] (MNPs). An implantable MNP can directly infer motor intent by detecting brain signals and transmitting the motor signal out of the brain to generate a motor output and subsequently control computer actions. This physiological function is typically performed by the motor [[neuron]]s in the human body. To evaluate the use of these implanted technologies, there is a need for an objective measurement of the effectiveness of MNPs in restoring motor outputs. Here, we propose the concept of digital motor outputs (DMOs) to address this: a motor output decoded directly from a neural recording during an attempted limb or orofacial movement is transformed into a command that controls an electronic device. Digital motor outputs are diverse and can be categorized as discrete or continuous representations of motor control, and the clinical utility of the control of a single, discrete DMO has been reported in multiple studies. This sets the stage for the DMO to emerge as a quantitative measure of MNP performance
((Sawyer A, Cooke L, Ramsey NF, Putrino D. The digital motor output: a conceptual framework for a meaningful clinical performance metric for a motor neuroprosthesis. J Neurointerv Surg. 2023 Jul 31:jnis-2023-020316. doi: 10.1136/jnis-2023-020316. Epub ahead of print. PMID: 37524520.)).