Patients with complete paralysis have been given fresh hope after a pioneering new nerve surgery helped restore movement in hands and elbows.
Australian surgeons were able to attach nerves connected to working muscles just above the spinal injury, to nerves attached to the paralysed muscle below it.
The working nerves were able to "reanimate" the paralysed muscle in people with tetraplegia, the paralysis of the upper and lower limbs.
After two years of physical therapy, the adults were able to open and close their hands to pick up objects and reach out their arms.
They can now feed themselves, brush their teeth and hair, put on makeup, write, use tools and handle money.
Thirteen patients with complete paralysis took part in the surgery with success.
The study was published in the Lancet and is the largest of its kind. Researchers hailed the "major advance" in restoring hand and arm function.
Some 16 people with an average age of 27 took part. Those involved had suffered spinal cord damage to the neck less than 18 months prior to the study, largely in accidents involving traffic or sport.
Some 59 nerve transfers were completed as part of their surgery.
For 10 people they combined the surgery with traditionally-used tendon transfers, with different styles of reconstruction bringing specific strengths to each hand.
Nerve transfers allow for more natural and precise movement, while tendon transfers help restore power and heavy lifting ability.
Unfortunately the surgery did not work in three patients. Two of those participants experienced a permanent decrease in sensations and two a temporary decrease in wrist strength which was fixed with further surgery.
Dr Natasha van Zyl from Austin Health in Melbourne, who led the research, said: "For people with tetraplegia, improvement in hand function is the single most important goal.
"We believe that nerve transfer surgery offers an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions to perform everyday tasks, and giving them greater independence and the ability to participate more easily in family and work life.
"What's more, we have shown that nerve transfers can be successfully combined with traditional tendon transfer techniques to maximise benefits.
"When grasp and pinch was restored using nerve transfers in one hand and tendon transfers in the other, participants consistently reporting that they liked both hands for different reasons and would not choose to have two hands reconstructed in the same way."
A 30-year-old male patient describes how the procedure has effected his ability to control his arms and hands
Tendon transfers have been used to reconstruct upper limb function prior to this break-through technique. The traditional method allows working muscles "surgically re-sited" to replaced paralysed ones.
The nerve transfer surgery allows for the direct reanimation of the paralysed muscle, can reanimate more than one muscle and means less recovery time.
It should be performed within six to 12 months of the paralysis and it can take months for nerve regrowth into the paralysed muscle to occur.
The team say more research is needed to identify who is most likely to benefit from the technique.