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Tyler S. Cole, Kaith K. Almefty, Jakub Godzik, Amy H. Muma, Randall J. Hlubek, Eduardo Martinez-del-Campo, Nicholas Theodore, U. Kumar Kakarla and Jay D. Turner

C ervical spondylotic myelopathy (CSM) is the primary cause of spinal cord dysfunction in adults. 16 It typically has an insidious onset with symptoms that include hand numbness, hand weakness, loss of manual dexterity, gait difficulty, imbalance, and urinary symptoms such as urgency or hesitancy. The diminished hand strength and dexterity associated with CSM are key contributors to disability. Surgical decompression is the mainstay treatment for CSM and has been shown to improve hand function, but a majority of studies rely primarily on health-related quality

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Akio Morita, Shigeo Sora, Mamoru Mitsuishi, Shinichi Warisawa, Katopo Suruman, Daisuke Asai, Junpei Arata, Shoichi Baba, Hidechika Takahashi, Ryo Mochizuki and Takaaki Kirino

R obotic manipulator systems have been introduced in various surgical fields 4, 10 not only to enhance the surgeon's dexterity in less invasive surgical procedures, but also to increase the safety and accuracy of surgery. Using mechanical devices that can only be furnished by robotic systems, these systems also make possible tasks that previously were impossible. 6, 10 An additional benefit lies in the fact that the robotic system can be telecontrolled. 18 The amount of surgical education and skill development provided to clinicians may soon become limited

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Bizhan Aarabi, Melvin Alexander, Stuart E. Mirvis, Kathirkamanathan Shanmuganathan, David Chesler, Christopher Maulucci, Mark Iguchi, Carla Aresco and Tiffany Blacklock

dysfunction. 2 , 33 With either conservative or surgical management, a significant proportion of patients with ATCCS due to spinal stenosis recover their motor strength, but lack of manual dexterity, bladder dysfunction, and painful dysesthesias make their activities of daily living unacceptably cumbersome. 2 , 10 In a multicenter prospective collaborative study of ASIA motor score recovery in spinal cord injury associated with cervical spondylosis (within the National Model Spinal Cord Injury System program), Waters et al. 57 proposed that these patients can expect

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Anders Behrens, Eva Elgh, Göran Leijon, Bo Kristensen, Anders Eklund and Jan Malm

is instructed to push 1 of 2 buttons indicated by an arrow. The arrow appears at random intervals between 5 and 15 seconds. The median reaction time is measured. Manual Dexterity In the 4-finger tapping test, the patient is required to tap on a small keyboard with digits 2–5. The correct order of taps is (digits) 2-3-4-5-4-3-2-3, etc. The number of correct taps over 5 trials is scored. Depression CoGNIT includes an assessment of depressive symptoms, the Geriatric Depression Scale (GDS), which consists of 20 “yes” or “no” questions regarding mood. 29 A test was

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Valeria Cavazzuti, Edwin G. Fischer, Keasley Welch, James A. Belli and Ken R. Winston

projected for 10 to 20 msec each on a screen in the center of the patient's visual field as well as in each hemifield. The technique utilized an electric shutter mounted on a standard Kodak Carousel projector. The duration of exposure required for the perception of each stimulus, and the degree of correctness, were recorded. Motor Tasks . A series of simple dexterity tests, such as placing pegs in a pegboard, threading beads, and performing rapid alternating movements, and the Thurstone tapping test 29 were administered. For the wrist rotation tasks, we used an

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Alexandre C. Carpentier, R. Todd Constable, Michael J. Schlosser, Alain de Lotbinière, Joseph M. Piepmeier, Dennis D. Spencer and Issam A. Awad

, presented with deficits in dexterity of the hand and fingers, but no gross weakness in grip strength. Based on the results of these pilot studies, we elected to sort the fMR imaging results systematically into a classification scheme reflecting different patterns of cortical plasticity within the motor strip. For this we focused only on the hand motor area, included various lesions located within two gyri of the CS, and performed a number of quantitative and statistical analyses on the activation patterns observed. Cortical plasticity in the motor area has been described

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Indira Devi Bhagavatula, Dhaval Shukla, Nishanth Sadashiva, Praveen Saligoudar, Chandrajit Prasad and Dhananjaya I. Bhat

in the recovery of dexterity after stroke and SCI, possibly through corticospinal and corticorubral projections to spinal motor neurons in the midcervical segments. 26 , 32 Regarding the posterior shift of activation toward the PoCG, previous studies have already documented the posterior spread of activation with the recovery of limb motor function or increased VOA following injury. 10 , 23 Given the existing literature, we can accept that there is compensatory expansion and increased cortical representation of the hand area preoperatively. However

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Ellen L. Larson, Katherine B. Santosa, Susan E. Mackinnon and Alison K. Snyder-Warwick

include this interval. 26 Since no spontaneous recovery was possible in this case, further delay was unnecessary. In fact, the short injury-to-transfer interval likely contributed to the patient’s excellent functional recovery. This novel set of median to radial nerve transfers restored wrist and finger extension, dexterity, and sensation. The donor nerves were chosen such that all major motions retained at least one innervated muscle; thus, his only deficits were slight ulnar deviation on wrist flexion and absent function in the anterior PL muscle. The success of this

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Garnette R. Sutherland, Sanju Lama, Liu Shi Gan, Stefan Wolfsberger and Kourosh Zareinia

manipulator displays the tool holder assembly and attached bipolar forceps. The left manipulator shows penetration of the sterile drape by the upper and lower tool holders and tool roll gear. NeuroArm works in tandem with a surgical assistant. An experienced surgical assistant provides the dexterity that the robot currently lacks. The operating surgeon communicates with the surgical assistant via headset, so that the movements of neuroArm are coordinated with the actions of the surgical assistant ( Fig. 4 ). The presence of the assistant compensates for the surgical

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Dennis L. Johnson, Mary Ann McCabe, H. Stacy Nicholson, Amy L. Joseph, Pamela R. Getson, Julianne Byrne, Cynthia Brasseux, Roger J. Packer and Gregory Reaman

23%, but when motor skills were also required (Benton Visual Retention Test: copying designs), 54% of the subjects were impaired. Fine motor dexterity and speed (Purdue Pegboard) were moderately to severely impaired in an even greater proportion of patients (10 cases (77%) for the preferred hand and 11 (85%) for the nonpreferred hand). Motor dexterity and speed were significantly associated with a history of shunt placement; children who did not undergo shunting performed poorer with both the preferred and the nonpreferred hand than those who did. Attention and