© Stefan Voitl

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what a functional hand is? Our colleague Wolfgang Illek has been paralysed from the neck down following a bike accident and explains it.   


The words still reverberate in my ears to this day: “Mr Illek, we need to mask your fingers in order to shorten your tendons.” I was laying in the ICU with a spinal cord injury – dazed by medication and mortally afraid of what those words meant. I actually told the therapists to stop.

A little later, in rehab, the mechanics of the so-called functional hand were explained to me calmly. As a quadriplegic I am paralysed from the 5th cervical vertebra down, meaning I can no longer move my hands and fingers. My wrist and fingers would have become deformed and bent over time.

The concept of the functional hand originates from occupational therapy. Tendons and ligaments are deliberately shortened. This is achieved through special positioning techniques, muscle training, or with the help of straps, adhesive tapes, and splints. My own functional hand was fully developed after three months. My fingers contract when I tilt my wrist upwards – it’s called the Tenodesis Effect. The movement creates a loose fist. The reverse movement opens my fingers again.

This makes it easier for me to grasp and hold certain objects. For example, it allows me to brush my teeth alone, hold a glass of water, and use cutlery. I can reach for my mobile phone and eat an apple without assistance. All these little things wouldn’t be possible without a functional hand and would make everyday life even more difficult. 

If, by the way, I should ever regain functions in my fingers, the shortened tendons can be carefully stretched back into their original state.