Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial

Abstract

Background: Neuralgic amyotrophy (NA) is a common peripheral nerve disorder caused by auto-immune inflammation of nerves in the brachial plexus territory, characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Recent work has confirmed that NA patients with residual motor dysfunction have abnormal cerebral sensorimotor representations of their affected upper extremity. Objective: To determine whether abnormal cerebral sensorimotor representations associated with NA can be altered by specialized, multidisciplinary outpatient rehabilitation focused on relearning motor control. Methods: 27 NA patients with residual lateralized symptoms in the right upper extremity participated in a randomized controlled trial, comparing 17 weeks of multidisciplinary rehabilitation ( n = 16) to usual care ( n = 11). We used task-based functional MRI and a hand laterality judgment task, which involves motor imagery and is sensitive to altered cerebral sensorimotor representations of the upper extremity. Results: Change in task performance and related brain activity did not differ significantly between the multidisciplinary rehabilitation and usual care groups, whereas the multidisciplinary rehabilitation group showed significantly greater clinical improvement on the Shoulder Rating Questionnaire. Both groups, however, showed a significant improvement in task performance from baseline to follow-up, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. Conclusions: Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347).

Multimodal Rehabilitation Management of a Misunderstood Parsonage–Turner Syndrome: A Case Report during the COVID-19 Pandemic

“…Currently, in the literature, the rehabilitation process lacks certainty, but some elements seem effective and are widely used, such as neurodynamic techniques [ 20 ]. Recent studies have shown that a multidisciplinary approach appears valid in managing these patients, emphasizing the importance of sensorimotor recovery, including exercises for regaining upper limb proprioceptive abilities and motor imagery [ 9 , 10 ]. A factor that had a positive influence on the patient’s prognosis in this case report is his young age, motivation, active lifestyle, and adherence to the therapeutic plan (the patient attended all the scheduled sessions).…”

“…This aspect is crucial since 60% of patients have residual weakness 2–3 years after the onset of the disease; over 50% are limited by pain; 63% experience severe fatigue; and 82% face difficulties in daily activities [ 8 ]. Several strategies have recently been proposed for the rehabilitation of PTS patients, such as a structured multidisciplinary approach that has proven effective [ 9 , 10 ]. This case report shows, for the first time, through an objective strength evaluation system, how recovery can occur even after three years and the role that a progressive multimodal rehabilitation treatment can have in achieving outcomes.…”