The role of sensory re-education of the brain in functional restoration of the hand after median nerve re-attachment
Keywords:
Median nerve, re-education, microsurgical technique
Abstract
PURPOSE: The aim of this study is to prove the role of sensory re-education of patients after the restoration of complete, distal damage to the median nerve, through comparative tests between a group of retrained patients and a group of patients who did not participate into a similar re-education program.
PATIENTS - METHOD: In this study, a comparative evaluation of 63 patients (51 men and 12 women with a mean age of 38 years (20 -51)) with complete, distal median nerve transection and surgical restoration was performed among a group of patients who had sensory re-education and a group without re-education. Evaluation was done through re-education tests that began after successful reattachment and nerve regeneration. The clinical evaluation took place after 18 months, 3 years and 6 years.
RESULTS: From the statistical analysis, the conclusions obtained were that the individuals in the re-educationgroup displayed superiority in the sensoryrehabilitation and functional ability of the hand in a shorter time compared to the non-re-education group, in all the tests, especially in the test concerning the ability of recognition and location of the stimuli in the hand.
CONCLUSIONS: The damage to the median nerve leaves a significant sensory and functional disorder in the hand. Surgical restoration alone is not sufficient for the functional rehabilitation of the hand, which requires sensoryre-education in order to produce better results in a shorter time.
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References
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29. Chen ZW, Meyer VE, Kleinert HE. Present indications and contra-indications for replantation as reflected by long-term functional results. OrthopClin North Am 1981;12:849–870.
30. Glickman LT, Mackinnon SE. Sensory recovery following digital replantation. Microsurgery 1990;11:236–242.
31. Dellon AL, Curtis RM, Edgerton MT. Evaluating recovery of sensation in the hand following nerve injury. Johns Hopkins Med J 1972;130:235–243.
32. Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. PlastReconstrSurg1974;53:297–305.
33. Wynn Parry CB, Salter M. Sensory reeducation after median nerve lesion. Hand 1976;8:250–257.
34. Hirasawa Y, Katsumi Y, Tokioka T. Evaluation of sensibility after sensory reconstruction of the thumb. J Bone Joint Surg 1985;67B:814–819.
35. Mailänder P, Berger A, Schaller E, Ruhe K. Results of primary nerve repair in the upper extremity. Microsurgery 1989;10:147–150
36. Merzenich MM, Jenkins WM. Reorganization of cortical representations of the hand following alternations of skin inputs induced by nerve injury, skin island transfers, and experience. J Hand Ther1993;6:89–104.
37. Novak CB, Mackinnon SE, Kelly L. Correlation of two-point dis-crimination and hand function following median nerve injury. Ann PlastSurg1993;31:495–498.
38. Polatkan S, Orhun E, Polatkan O, Nuzumlali E, Bayri O. Evaluation of the improvement of sensibility after primary median nerve repair at the wrist. Microsurgery 1998;18:192–196.
39. Dellon AL. Sensory recovery in replanted digits and transplanted toes: a review. J ReconstrMicrosurg1986;2:123–129
40. Dannenbaum RM, Jones LA. The assessment and treatment of patients who have sensory loss following cortical lesions. J Hand Ther1993;6:130–138.
41. Moberg E. Criticism and study of methods for examining sensibility in the hand. Neurology 1962;12:8–19.
42. Nolan M F. Two-point discrimination assessment in the upper limb in young adult men and women. PhysTher1982;62:965–969.
43. Jerosch-Herold C.Should sensory function after median nerve injury and repair be quantified using two-point discrimination as the critical measure? Scand J PlastReconstrSurg Hand Surg2000;34:339– 343
44. Marsh D. The validation of measures of outcome following suture of divided peripheral nerves supplying the hand. J Hand Surg 1990;15B:25–34.
45. Moberg E. Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg 1958;40B:454–476.
46. Weber E. Ueber den Tastsinn. ArchAnatPhysiol, Wissen Med 1835;1:152–159.
47. Tinel J.“Tingling” signs with peripheral nerve injuries. 1915. J Hand Surg 2005;30B:87–89.
48. Moberg E. Reconstructive hand surgery in tetraplegia, stroke and cerebral palsy. Some basic concepts in physiology and neurology. J Hand Surg1976;1:29–34.
49. Moberg E. Two-point discrimination test. A valuable part of hand surgical rehabilitation e.g. in tetraplegia. Scand J Rehab Med 1990;22:127–134.
50. Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg 1964;46A:817–825.
51. Keunen R, Sloof A. Sensibility testing after nerve grafting. ClinNeurologNeurosurg1983;85:93–99.
52. Rosén B. Recovery of sensory and motor function after nerve repair: a rationale for evaluation. J Hand Ther1996;9:315–327.
53. Honner R, Fragiadakis EG, Lamb DW. An investigation of the factors affecting the results of digital nerve division. Hand 1970;2:21–30.
54. Kaas JH, Merzenich MM, Killacky HP. The reorganization of somatosensory cortex following peripheral nerve damage in adult and developing mammals. Ann Rev Neurosci1983;6:325–356.
55. Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. PlastReconstr Surg. 1974 Mar;53(3):297-305.
2. Wang L, Conner JM, Nagahara AH, Tuszynski MH. Rehabilitation drives enhancement of neuronal structure in functionally relevant neuronal subsets. Proc Natl AcadSci U S A. 2016 Mar 8;113(10):2750-5. doi: 0.1073/pnas.1514682113. Epub 2016 Feb 22.
3. Meek MF, Coert JH, Wong KH. Recovery of touch after median nerve lesion and subsequent repair. Microsurgery. 2003;23(1):2-5.
4. Luhmann HJ, Sinning A, Yang JW, Reyes-Puerta V, Stüttgen MC, Kirischuk S, Kilb W. Spontaneous Neuronal Activity in Developing Neocortical Networks: From Single Cells to Large-Scale Interactions. Front Neural Circuits. 2016 May 24;10:40. doi: 10.3389/fncir.2016.00040. eCollection 2016.
5. Rode G, Rossetti Y, Boisson D. Prism adaptation improves representational neglect. Neuropsychologia. 2001;39(11):1250-4.
6. Shieh SJ, Chiu HY, Hsu HY. Long-term effects of sensory reedu-cation following digital replantation and revascularization. Microsurgery 1998;18:334–336.
7. Spicher C, Kohut G. [A significant increase in superficial sensation, a number of years after a peripheral neurologic lesion, using transcutaneous vibratory stimulation]. Ann Chir Main Memb Super. 1997;16(2):124-9. French.
8. Wei FC, Ma HS. Delayed sensory reeducation after toe-to-hand transfer. Microsurgery 1995;16:583– 585.
9. Shieh SJ, Chiu HY, Lee JW, Hsu HY. Evaluation of the effectiveness of sensory reeducation following digital replantation and revascularization. Microsurgery 1995;16:578–582.
10. von Wartburg U.[After care and rehabilitation following surgery of peripheral nerves]. SchweizRundsch Med Prax. 1991 Oct 8;80(41):1109-12. German.
11. Imai H, Tajima T, Natsumi Y. Successful reeducation of functional sensibility after median nerve repair at the wrist. J Hand Surg 1991;16A:60–65.
12. Brown CJ, Mackinnon SE, Dellon AL, Bain JR. The sensory potential of free flap donor sites. Ann PlastSurg1989;23:135–140.
13. Tajima T, Imai H. Results of median nerve repair in children. Microsurgery 1989;10:145–146.
14. Imai H, Tajima T, Natsuma Y. Interpretation of cutaneous pressure threshold (Semmes-Weinstein monofilament measurement) following median nerve repair and sensory reeducation in the adult. Microsurgery. 1989;10(2):142-4.
15. Dannenbaum R M,Dykes R W. Sensory loss in the hand after sensory stroke: therapeutic rationale. Arch Phys Med Rehabil1988;69:833–839.
16. Comtet JJ. [Sensitivity: physiology, examination, principles of rehabilitation of sensation]. Ann Chir Main. 1987;6(3):230-8. Review. French.
17. Dellon AL. Functional sensation and its reeducation. ClinPlastSurg1984;11:95–99.
18. Dellon AL, Jabaley ME. Reeducation of sensation in the hand following nerve suture. ClinOrthop1982;163:75–79.
19. Frykman GK, Waylett J. Rehabilitation of peripheral nerve injuries. OrthopClin North Am. 1981 Apr;12(2):361-79.
20. Dellon AL. The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg1978;3:474–481.
21. Hsu HY, Shieh SJ, Kuan TS, Yang HC, Su FC, Chiu HY, Kuo LC. Tactile Test Predicts Sensorimotor Control Capability of Hands for Patients With Peripheral Nerve Injury. Arch Phys Med Rehabil. 2016 Jun;97(6):983-90. d oi: 10.1016/j.apmr.2016.01.008. Epub 2016 Jan 30.
22. Meek MF, Coert JH, Wong KH. Recovery of touch after median nerve lesion and subsequent repair. Microsurgery. 2003;23(1):2-5.
23. Potentials evoked in human and monkey cerebral cortex by stimulation of the median nerve A review of scalp and intracranial recordings
24. Somatosensory evoked magnetic fields following median nerve stimulation RyusukeKakigi
25. Lundborg G, Rosén B. Sensory relearning after nerve repair. Lancet 2001;358:809–810.
26. Wall JT, Kaas JH, Sur M, Nelson RJ, Felleman DJ, Merzenich MM. Functional reorganization in somatosensory cortical areas 3b and 1 of adult monkeys after median nerve repair: possible relationships to sensory recovery in humans. J Neurosci1986;6:218–233.
27. Clark SA, Allard T, Jenkins WM, Merzenich MM. Receptive fields in the body-surface map in adult cortex defined by temporally correlated inputs. Nature 1988;332:444–445.
28. Dellon AL. Evaluation of sensibility and reeducation of sensation in the hand. Baltimore: Williamsand Wilkins,1981:115–140,169–246.
29. Chen ZW, Meyer VE, Kleinert HE. Present indications and contra-indications for replantation as reflected by long-term functional results. OrthopClin North Am 1981;12:849–870.
30. Glickman LT, Mackinnon SE. Sensory recovery following digital replantation. Microsurgery 1990;11:236–242.
31. Dellon AL, Curtis RM, Edgerton MT. Evaluating recovery of sensation in the hand following nerve injury. Johns Hopkins Med J 1972;130:235–243.
32. Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. PlastReconstrSurg1974;53:297–305.
33. Wynn Parry CB, Salter M. Sensory reeducation after median nerve lesion. Hand 1976;8:250–257.
34. Hirasawa Y, Katsumi Y, Tokioka T. Evaluation of sensibility after sensory reconstruction of the thumb. J Bone Joint Surg 1985;67B:814–819.
35. Mailänder P, Berger A, Schaller E, Ruhe K. Results of primary nerve repair in the upper extremity. Microsurgery 1989;10:147–150
36. Merzenich MM, Jenkins WM. Reorganization of cortical representations of the hand following alternations of skin inputs induced by nerve injury, skin island transfers, and experience. J Hand Ther1993;6:89–104.
37. Novak CB, Mackinnon SE, Kelly L. Correlation of two-point dis-crimination and hand function following median nerve injury. Ann PlastSurg1993;31:495–498.
38. Polatkan S, Orhun E, Polatkan O, Nuzumlali E, Bayri O. Evaluation of the improvement of sensibility after primary median nerve repair at the wrist. Microsurgery 1998;18:192–196.
39. Dellon AL. Sensory recovery in replanted digits and transplanted toes: a review. J ReconstrMicrosurg1986;2:123–129
40. Dannenbaum RM, Jones LA. The assessment and treatment of patients who have sensory loss following cortical lesions. J Hand Ther1993;6:130–138.
41. Moberg E. Criticism and study of methods for examining sensibility in the hand. Neurology 1962;12:8–19.
42. Nolan M F. Two-point discrimination assessment in the upper limb in young adult men and women. PhysTher1982;62:965–969.
43. Jerosch-Herold C.Should sensory function after median nerve injury and repair be quantified using two-point discrimination as the critical measure? Scand J PlastReconstrSurg Hand Surg2000;34:339– 343
44. Marsh D. The validation of measures of outcome following suture of divided peripheral nerves supplying the hand. J Hand Surg 1990;15B:25–34.
45. Moberg E. Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg 1958;40B:454–476.
46. Weber E. Ueber den Tastsinn. ArchAnatPhysiol, Wissen Med 1835;1:152–159.
47. Tinel J.“Tingling” signs with peripheral nerve injuries. 1915. J Hand Surg 2005;30B:87–89.
48. Moberg E. Reconstructive hand surgery in tetraplegia, stroke and cerebral palsy. Some basic concepts in physiology and neurology. J Hand Surg1976;1:29–34.
49. Moberg E. Two-point discrimination test. A valuable part of hand surgical rehabilitation e.g. in tetraplegia. Scand J Rehab Med 1990;22:127–134.
50. Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg 1964;46A:817–825.
51. Keunen R, Sloof A. Sensibility testing after nerve grafting. ClinNeurologNeurosurg1983;85:93–99.
52. Rosén B. Recovery of sensory and motor function after nerve repair: a rationale for evaluation. J Hand Ther1996;9:315–327.
53. Honner R, Fragiadakis EG, Lamb DW. An investigation of the factors affecting the results of digital nerve division. Hand 1970;2:21–30.
54. Kaas JH, Merzenich MM, Killacky HP. The reorganization of somatosensory cortex following peripheral nerve damage in adult and developing mammals. Ann Rev Neurosci1983;6:325–356.
55. Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. PlastReconstr Surg. 1974 Mar;53(3):297-305.
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2020-12-11
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