Journal of hand therapy : official journal of the American Society of Hand Therapists · 2015
The optimization of peripheral nerve recovery using cortical reorganization techniques: A retrospective study of wrist level nerve repairs.
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Walbruch Bonnie, Kalliainen Loree
Аннотация
STUDY DESIGN: Retrospective case series.
INTRODUCTION: Outcomes following peripheral nerve repairs have not significantly improved over the past few decades. A new protocol using cortical reorganization techniques was developed with the goal of improving nerve recovery in the hand.
PURPOSE OF THE STUDY: To determine if early sensory re-education using cortical reorganization techniques improved sensory outcomes in the hand after repair of wrist-level nerve injuries.
METHODS: A retrospective study was completed of wrist-level peripheral nerve repairs in patients who underwent a sensory re-education protocol which included cutaneous anesthesia, tactile stimulation, and sensory and motor imagery. Data for static 2-point discrimination, Semmes Weinstein monofilament assessments and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected.
RESULTS: At four months post-repair, three of seven of the median nerve lacerations had static 2-point discrimination of 7 mm or less in at least one digit. Using the Semmes Weinstein monofilaments, 9 of 11 nerve repairs felt the 4.31 filament (protective) or better by eleven months with five able to perceive the 2.83 filament (normal) in that time frame.
CONCLUSIONS: This limited retrospective study suggests that early sensory re-education using cortical reorganization techniques may improve sensory outcomes. A larger scale study is indicated to confirm our findings.
LEVEL OF EVIDENCE: IV.
INTRODUCTION: Outcomes following peripheral nerve repairs have not significantly improved over the past few decades. A new protocol using cortical reorganization techniques was developed with the goal of improving nerve recovery in the hand.
PURPOSE OF THE STUDY: To determine if early sensory re-education using cortical reorganization techniques improved sensory outcomes in the hand after repair of wrist-level nerve injuries.
METHODS: A retrospective study was completed of wrist-level peripheral nerve repairs in patients who underwent a sensory re-education protocol which included cutaneous anesthesia, tactile stimulation, and sensory and motor imagery. Data for static 2-point discrimination, Semmes Weinstein monofilament assessments and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected.
RESULTS: At four months post-repair, three of seven of the median nerve lacerations had static 2-point discrimination of 7 mm or less in at least one digit. Using the Semmes Weinstein monofilaments, 9 of 11 nerve repairs felt the 4.31 filament (protective) or better by eleven months with five able to perceive the 2.83 filament (normal) in that time frame.
CONCLUSIONS: This limited retrospective study suggests that early sensory re-education using cortical reorganization techniques may improve sensory outcomes. A larger scale study is indicated to confirm our findings.
LEVEL OF EVIDENCE: IV.