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Hand Function pp 115-132 | Cite as

Hand Function in Tetraplegia

  • Şafak Sahir KaramehmetoğluEmail author
  • Tuğçe Özekli Mısırlıoğlu
Chapter

Abstract

The clinical evaluation of hand and arm function of tetraplegics is extremely important, as this is assumed to play a key role in the activities of daily living (ADL) and independence and needed to establish a good rehabilitation policy. The International Classification of Functioning, Disability and Health (ICF) offer some practical assistance when faced with the choice of measurement tools available and the objectives of measuring. Clinicians and patients are more interested in the performance of arm and hand activities at the “activity” level in accordance with the ICF nomenclature. Whether it is “general” or “specific,” “basic” or “complex,” “Quadriplegia Index of Function” and “Spinal Cord Independence Measure (SCIM)” are the most commonly used methods in the assessment of hand functions in tetraplegics.

Keywords

Spinal Cord Injury Functional Electrical Stimulation Hand Function Functional Independence Measure American Spinal Injury Association 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    American Spinal Cord Injury Association/International Medical Society of Paraplegia. International Standards of Neurological and Functional Classification of Spinal Cord Injury Patients. Chicago; 2000.Google Scholar
  2. 2.
    Marino RJ, Shea JA, Stineman MG. The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia. Arch Phys Med Rehabil. 1998;79(12):1512–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Hanson RW, Franklin MR. Sexual loss in relation to other functional losses for spinal cord injured males. Arch Phys Med Rehabil. 1976;57:291–3.PubMedGoogle Scholar
  4. 4.
    Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following complete tetraplegia. Arch Phys Med Rehabil. 1993;74(3):242–7.PubMedGoogle Scholar
  5. 5.
    Blaustein DM, Zafonte R, Thomas D, Herbison GJ, Ditunno JF. Predicting recovery of motor complete quadriplegic patients. 24 hour v 72 hour motor index scores. Am J Phys Med Rehabil. 1993;72(5):306–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Brown PJ, Marino RJ, Herbison GJ, Ditunno JF. The 72-hour examination as a predictor of recovery in motor complete quadriplegia. Arch Phys Med Rehabil. 1991;72(8):546–8.PubMedGoogle Scholar
  7. 7.
    Lazar RB, Yarkony GM, Ortolano D, Heinemann AW, Perlow E, Lovell L, Meyer PR. Prediction of functional outcome by motor capability after spinal cord injury. Arch Phys Med Rehabil. 1989;70:819–22.PubMedGoogle Scholar
  8. 8.
    Mange KC, Ditunno JF, Herbison GJ, Jaweed MM. Recovery of strength at the zone of injury in motor complete and motor incomplete cervical spinal cord injured patients. Arch Phys Med Rehabil. 1990;71(8):562–5.PubMedGoogle Scholar
  9. 9.
    Maynard FM, Reynolds GG, Fountain S, Wilmont C, Hamilton R. Neurological prognosis after traumatic quadriplegia. J Neurosurg. 1979;50(5):611–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Marina RJ, Rider-Foster D, Maissel G, et al. Superiority of motor level over single neurological level in categorizing patients. Paraplegia. 1995;33:510–3.CrossRefGoogle Scholar
  11. 11.
    McDowell CL, Moberg EA, House JH. Proceedings: second international conference on surgical rehabilitation of the upper limb in tetraplegia. J Hand Surg Am. 1986;11:604–8.CrossRefGoogle Scholar
  12. 12.
    Hentz VR, Leclercq C. Surgical rehabilitation of the upper limb in tetraplegia. Philadelphia, PA: W. B. Saunders Company; 2002.Google Scholar
  13. 13.
    Moberg E, Freehafer AA, Lamb DK, et al. International federation of societies or surgery of the hand: a report from the committee on spinal injuries 1980. Scand J Rehabil Med. 1982;14:3–5.Google Scholar
  14. 14.
    Mulcahey MJ, Hutchinson D, Kozin S. Assessment of upper limb in tetraplegia: considerations in evaluation and outcomes research. J Rehabil Res Dev. 2007;44:91–102.PubMedCrossRefGoogle Scholar
  15. 15.
    Whiteneck G, Adler C, Biddle AK, et al. Outcomes following traumatic spinal cord injury: clinical practice guidelines for health–care professionals. Consortium for Spinal Cord Medicine Clinical Practice Guidelines. Washington: Paralyzed Veterans of America; 1999.Google Scholar
  16. 16.
    Spooren AI, Janssen-Potten YJ, Kerckhofs E, et al. Outcome of motor training programmes on arm and hand functioning in patients with cervical spinal cord injury according to different levels of the ICF: a systematic review. J Rehabil Med. 2009;41:497–505.PubMedCrossRefGoogle Scholar
  17. 17.
    World Health Organization. International Classification of Impairments, Disabilities and Handicaps: a manual classification relating to the consequences of diseases. Geneva: WHO; 1980.Google Scholar
  18. 18.
    World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO; 2002.Google Scholar
  19. 19.
    Dunn JA, Sinnott KA, Bryden AM, et al. Measurement issues related to upper limb interventions in persons who have tetraplegia. Hand Clin. 2008;24(2):161–8.PubMedCrossRefGoogle Scholar
  20. 20.
    World Health Organization. ICF: International classification of functioning, disability and health. Geneva: World Health Organisation; 2001.Google Scholar
  21. 21.
    Ditunno Jr JF, Cohen ME, Hauck WW, Jackson AB, Sipski ML. Recovery of upper-extremity strength in complete and incomplete tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2000;81:389–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Beekhuizen KS. New perspectives on improving upper extremity function after spinal cord injury. J Neurol Phys Ther. 2005;29:157–62.PubMedCrossRefGoogle Scholar
  23. 23.
    Marino RJ, Ditunno Jr JF, Donovan WH, Maynard Jr F. Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehabil. 1999;80:1391–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Kirshblum S, Millis S, McKinley W, Tulsky D. Late neurologic recovery after traumatic spinal cord injury. Arch Phys Med Rehabil. 2004;85:1811–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Ditunno JF, Burns AS, Marino RJ. Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. J Rehabil Res Dev. 2005;42 Suppl 1:35–42.PubMedGoogle Scholar
  26. 26.
    Spooren AIF, Janssen-Potten YJM, Snoek GJ, Ijzerman MJ, Kerckhofs E, Seelen H. Rehabilitation outcome of upper extremity skilled performance in persons with cervical spinal cord injuries. J Rehabil Med. 2008;40:637–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Sollerman C, Ejeskar A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg. 1995;29:167–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Kalsi-Ryan S, Curt A, Fehlings MG, et al. Assessment of the hand in tetraplegia using the graded redefined assessment of strength sensibility and prehension (GRASSP): impairment versus function. Top Spinal Cord Inj Rehabil. 2009;14(4):34–46.CrossRefGoogle Scholar
  29. 29.
    Stroh Wuolle K, van Doren CL, Thrope GB, et al. Development of a quantitative Hand Grasp and Release Test for patients with tetraplegia using a hand neuroprosthesis. J Hand Surg. 1994;19A:209–18.CrossRefGoogle Scholar
  30. 30.
    Mulcahey MJ, Smith BT, Betz RR. Psychometric rigor of the Grasp and Release Test for measuring functional limitation of persons with tetraplegia: a preliminary analysis. J Spinal Cord Med. 2004;27(1):41–6.PubMedGoogle Scholar
  31. 31.
    Fattal C. Motor capacities of upper limbs in tetraplegics: a new scale for assessment of the results of functional surgery on upper limbs. Spinal Cord. 2004;42(2):80–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Fleishman EA. Abilities and motor skill. In: Fleishman EA, editor. The structure and measurement of physical fitness. Englewood Cliffs, NJ: Prentice-Hall, Inc; 1964. p. 23–4.Google Scholar
  33. 33.
    Gloss DS, Wardle MG. Use of the Minnesota Rate of Manipulation Test for disability evaluation. Percept Mot Skills. 1982;55:527–32.PubMedCrossRefGoogle Scholar
  34. 34.
    Carroll D. A quantitative test of upper extremity function. J Chronic Dis. 1965;18:479–91.PubMedCrossRefGoogle Scholar
  35. 35.
    Carroll D. Hand function in quadriplegia. Md State Med J. 1967;16:107–8.PubMedGoogle Scholar
  36. 36.
    Tiffin J, Asher EJ. The Purdue Pegboard: norms and studies of reliability and validity. J Appl Psychol. 1948;32:234–47.PubMedCrossRefGoogle Scholar
  37. 37.
    Jebsen RH, Taylor N, Trieschmann RB, et al. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50:311–9.PubMedGoogle Scholar
  38. 38.
    Colyer RA, Kappelman B. Flexor pollicis longus tenodesis in tetraplegia at the sixth cervical level. A prospective evaluation of functional gain. J Bone Joint Surg Am. 1981;63:376–9.PubMedGoogle Scholar
  39. 39.
    Mulcahey MJ, Smith BT, Betz RR, et al. Outcomes of tendon transfer surgery and occupational therapy in a child with tetraplegia secondary to spinal cord injury. Am J Occup Ther. 1995;49:607–17.PubMedCrossRefGoogle Scholar
  40. 40.
    Kellor M, Frost J, Silberberg N, et al. Hand strength and dexterity. Am J Occup Ther. 1971;25:77–83.PubMedGoogle Scholar
  41. 41.
    Smith HB. Smith hand function evaluation. Am J Occup Ther. 1973;27:244–51.PubMedGoogle Scholar
  42. 42.
    Holser P, Fuchs E. Box and block test. In: Cromwell FS, editor. Occupational therapists manual for basic skills assessment: primary prevocational evaluation. Pasadena, CA: Fair Oaks Printing Company; 1960. p. 29–31.Google Scholar
  43. 43.
    Bell E, Juerk K, Wilson T. Hand skill measurement: a gauge for treatment. Am J Occup Ther. 1976;30:80–6.PubMedGoogle Scholar
  44. 44.
    Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4:483–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Post MW, van Asbeck FW, van Dijk AJ, et al. Dutch interview version of the Barthel Index evaluated in patients with spinal cord injuries. Ned Tijdschr Geneeskd. 1995;139:1376–80.PubMedGoogle Scholar
  46. 46.
    Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil. 1979;60:145–54.PubMedGoogle Scholar
  47. 47.
    Yarkony GM, et al. Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients. Arch Neurol. 1987;44:93–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Yarkony GM, et al. Functional skills after spinal cord injury rehabilitation: three-year longitudinal follow-up. Arch Phys Med Rehabil. 1988;69:111–4.PubMedGoogle Scholar
  49. 49.
    Muslumanoglu L, et al. Motor, sensory and functional recovery in patients with spinal cord lesions. Spinal Cord. 1997;35:386–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Hamilton BB, et al. A uniform national data system for medical rehabilitation. In: Fuhrer MJ, editor. Rehabilitation outcomes. Analysis and measurement. Baltimore, MD: Paul H. Brookes Publishing Co; 1987. p. 137–47.Google Scholar
  51. 51.
    Hamilton BB, Laughlin JA, Granger CV, Kayton RM. Interrater agreement of the seven level Functional Independence Measure (FIM). Arch Phys Med Rehabil. 1991;72:790.Google Scholar
  52. 52.
    Menter RR, et al. Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury. Paraplegia. 1991;29:613–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Hall KM, et al. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil. 1999;80:1471–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Warschausky S, Kay JB, Kewman DG. Hierarchical linear modelling of FIM instrument growth curve characteristics after spinal cord injury. Arch Phys Med Rehabil. 2001;82:329–34.PubMedCrossRefGoogle Scholar
  55. 55.
    Rogers JC, Figone JJ. Traumatic quadriplegia: follow-up study of self-care skills. Arch Phys Med Rehabil. 1980;61:316–21.PubMedGoogle Scholar
  56. 56.
    Catz A, et al. SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35:850–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Itzkovich M, Gelernter I, Biering-Sorensen F, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multicenter international study. Disabil Rehabil. 2007;29:1926–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Rudhe C, van Hedel H. Upper extremity function in persons with tetraplegia: relationships between strength, capacity and the spinal cord independence measure. Neurorehabil Neural Repair. 2009;23(5):413–21.PubMedCrossRefGoogle Scholar
  59. 59.
    Taricco M, Apolone G, Colombo C, et al. Functional status in patients with spinal cord injury: a new standardized measurement scale. Gruppo Interdisciplinare Valutazione Interventi Riabilitativi. Arch Phys Med Rehabil. 2000;81:1173–80.PubMedCrossRefGoogle Scholar
  60. 60.
    Thrope G, Stroh K, Baco A. Standardized object test for quantitative assessment of hand grasp function using the C.W.R.U. upper extremity neuroprosthesis. In: Presperin JJ, editor. New Orleans, LA: Proceedings of the RESNA; 1989. p. 181–2.Google Scholar
  61. 61.
    Vanden Berghe A, Van Laere M, Hellings S, Vercauteren M. Reconstruction of the upper extremity in tetraplegia: functional assessment, surgical procedures and rehabilitation. Paraplegia. 1991;29:103–12.PubMedCrossRefGoogle Scholar
  62. 62.
    Thorsen R, Ferrarin M, Spadone R, Frigo C. Functional control of the hand in tetraplegics based on residual synergistic EMG activity. Artif Organs. 1999;23:470–3.PubMedCrossRefGoogle Scholar
  63. 63.
    Gresham GE, et al. Quadriplegia Index of Function. Arch Phys Med Rehabil. 1980;61:493.Google Scholar
  64. 64.
    Labi MLC, et al. Quadriplegia Index of Function: one-year follow-up. Arch Phys Med Rehabil. 1981;62:532–3.Google Scholar
  65. 65.
    Gresham GE, et al. The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients. Paraplegia. 1986;24:38–44.PubMedCrossRefGoogle Scholar
  66. 66.
    Yavuz N, Tezyurek M, Akyuz M. A comparison of two functional tests in quadriplegia: the quadriplegia index of function and the functional independence measure. Spinal Cord. 1998;36:832–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Stroh K, Van Doren C, Thrope G, Wijman C. Common object test: a functional assessment for quadriplegic patients using an F.N.S. hand system. In: Presperin JJ, editor. New Orleans, LA: Proceedings of the RESNA; 1989. p. 387–8.Google Scholar
  68. 68.
    Spooren AI, Janssen-Potten YJ, Post MW, Kerckhofs E, Nene A, Seelen HA. Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test. Spinal Cord. 2006;44:772–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Lieshout GV, editor. User manual Van Lieshout Test. Hoensbroek: iRv; 2003.Google Scholar
  70. 70.
    Post MW, Van Lieshout G, Seelen HA, Snoek GJ, Ijzerman MJ, Pons C. Measurement properties of the short version of the VanLieshout test for arm/hand function of persons with tetraplegia after spinal cord injury. Spinal Cord. 2006;44:763–71.PubMedCrossRefGoogle Scholar
  71. 71.
    Land NE, Odding E, Duivenvoorden HJ, Bergen MP, Stam HJ. Tetraplegia hand activity questionnaire (THAQ): the development, assessment of arm-hand-function-related activities in teraplegic patients with spinal cord injury. Spinal Cord. 2004;42(5):294–301.PubMedCrossRefGoogle Scholar
  72. 72.
    Anderson K, Aito S, Atkins M, et al. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med. 2008;31(2):133–44.PubMedCentralPubMedGoogle Scholar
  73. 73.
    Frese E, Brown M, Norton BI. Clinical reliability of manual muscle testing. Middle trapezius and gluteus medius muscles. Phys Ther. 1987;67(7):1072–6.PubMedGoogle Scholar
  74. 74.
    Medical Research Council. Aids to the investigation of the peripheral nervous system memorandum no 45. London: Her Majesty’s Stationery Office; 1976.Google Scholar
  75. 75.
    Herbison GJ, Isaac Z, Cohen ME, Ditunno Jr JF. Strength post-spinal cord injury: myometer vs manual muscle test. Spinal Cord. 1996;34(9):543–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Savic G, Bergström EM, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444–51.PubMedCrossRefGoogle Scholar
  77. 77.
    Noreau L, Vachon J. Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord. 1998;36:716–23.PubMedCrossRefGoogle Scholar
  78. 78.
    Schwartz S, Cohen ME, Herbison GJ, Shah A. Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry. Arch Phys Med Rehabil. 1992;73:1063–8.PubMedGoogle Scholar
  79. 79.
    Sisto SA, Dyson-Hudson T. Dynamometry testing in spinal cord injury. J Rehabil Res Dev. 2007;44(1):123–36.PubMedCrossRefGoogle Scholar
  80. 80.
    Marciello MA, et al. Wrist strength measured by myometry as an indicator of functional independence. J Neurotrauma. 1995;12:99–106.PubMedCrossRefGoogle Scholar
  81. 81.
    Mulcahey MJ, Betz RR, Smith BT, Weiss AA. A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury. J Pediatr Orthop. 1999;19(3):319–28.PubMedGoogle Scholar
  82. 82.
    Van Tuijl JH, Janssen-Potten YJ, Seelen HA. Evaluation of upper extremity motor function tests in tetraplegics. Spinal Cord. 2002;40(2):51–64.PubMedCrossRefGoogle Scholar
  83. 83.
    May LA, Burnham RS, Steadward RD. Assessment of isokinetic and hand-held dynamometer measures of shoulder rotator strength among individuals with spinal cord injury. Arch Phys Med Rehabil. 1997;78:251–5.PubMedCrossRefGoogle Scholar
  84. 84.
    Mulcahey MJ, Betz RR, Kozin SH, Smith BT, Hutchinson D, Lutz C. Implantation of the Freehand System during initial rehabilitation using minimally invasive techniques. Spinal Cord. 2004;42(3):146–55.PubMedCrossRefGoogle Scholar
  85. 85.
    Smith BT, Mulcahey MJ, Betz RR. Quantitative comparison of grasp and release abilities with and without functional neuromuscular stimulation in adolescents with tetraplegia. Paraplegia. 1996;34(1):16–23.PubMedCrossRefGoogle Scholar
  86. 86.
    Peckham PH, Keith MW, Kilgore KL, Grill JH, Wuolle KS, Thrope GB, Gorman P, Hobby J, Mulcahey MJ, Carroll S, Hentz VR, Wiegner A, Implantable Neuroprosthesis Research Group. Efficacy of an implanted neuroprosthesis for restoring hand function in tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2001;82(10):1380–8.PubMedCrossRefGoogle Scholar
  87. 87.
    Kilgore KL, Peckham HP, Keith MW, Thrope GB, Wuolle KS, Bryden AM, Hart RL. An implanted upper-extremity neuroprosthesis. Follow-up of five patients. J Bone Joint Surg Am. 1997;79(4):533–41.PubMedGoogle Scholar
  88. 88.
    Post MWM, editor. Pilot-onderzoek Van Lieshout Test [The Van Lieshout Test: a pilot study]. Hoensbroek: iRv; 2000. (in Dutch).Google Scholar
  89. 89.
    Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1998;10:61–3.CrossRefGoogle Scholar
  90. 90.
    Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.PubMedGoogle Scholar
  91. 91.
    Marino RJ, et al. Assessing selfcare status in quadriplegia: comparison of the quadriplegic index of function (QIF) and the functional independence measure (FIM). Paraplegia. 1993;31:225–33.PubMedCrossRefGoogle Scholar
  92. 92.
    Marino RJ, Goin JE. Development of a short-form Quadriplegia Index of Function scale. Spinal Cord. 1999;37:289–96.PubMedCrossRefGoogle Scholar
  93. 93.
    Mulcahey MJ, Betz RR, Smith BT, Weiss AA, Davis SE. Implanted functional electrical stimulation hand system in adolescents with spinal injuries: an evaluation. Arch Phys Med Rehabil. 1997;78(6):597–607.PubMedCrossRefGoogle Scholar
  94. 94.
    Catz A, et al. The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord. 2001;39:97–100.PubMedCrossRefGoogle Scholar
  95. 95.
    Catz A, et al. The Catz-Itzkovich SCIM: a revised version of the spinal cord independence measure. Disabil Rehabil. 2001;23:263–8.PubMedCrossRefGoogle Scholar
  96. 96.
    Catz A, Itzkovich M, Tesio L, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45:275–91.PubMedCrossRefGoogle Scholar
  97. 97.
    Bryden AM, Sinnott KA, Mulcahey MJ. Innovative strategies for improving upper extremity function in persons with tetraplegia and considerations in measuring functional outcomes. Top Spinal Cord Inj Rehabil. 2005;10(4):75–93.CrossRefGoogle Scholar
  98. 98.
    Duruöz MT, Poiraudeau S, Fermanian J, et al. Development and validation of a Rheumatoid Hand Functional Disability Scale that assesses functional handicap. J Rheumatol. 1996;23:1167–72.PubMedGoogle Scholar
  99. 99.
    Mısırlıoğlu TÖ. The Duruöz Hand Index in tetraplegic patients: comparison of questioning with observational rating. Unpublished thesis of specialization in medicine, Istanbul University, Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation; 2011.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Şafak Sahir Karamehmetoğlu
    • 1
    Email author
  • Tuğçe Özekli Mısırlıoğlu
    • 1
  1. 1.Department of Physical Medicine and RehabilitationIstanbul University Cerrahpasa Medical Faculty, Cerrahpasa CaddesiIstanbulTurkey

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