Enhanced sensory relearning after nerve repair by using repeated forearm anaesthesia: aspects on time dynamics of treatment

Lundborg, Göran; Björkman, Anders; Rosén, Birgitta

doi:10.1007/978-3-211-72958-8_26

Cited by 23 publications

(11 citation statements)

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“…Lundborg5 showed that cutaneous forearm anaesthesia repeated with a local anaesthetic agent resulted in much better recovery of tactile gnosis than that with placebo in patients with median or ulnar nerve injury and repair at the wrist level. Using task-based fMRI scans for patients with upper limb amputation unilaterally, Lotze21 indicated that wearing a myoelectric prosthesis frequently could refrain from shrinking of corresponding cortical sensorimotor areas of the hand and arm, as well as further expansion of non-deafferented areas; also, the maintenance of the original cortical representations was negatively correlated with phantom limb pain.…”

Section: Discussionmentioning

confidence: 99%

“…If, after repair, the transected nerve successfully regenerates and re-innervates its former targets, its original cortical area can be re-established, and this can be called phase-two reorganisation. In this stage, the original cortical representation will never be all re-established owing to misdirection of axonal regeneration in the repair site 5. In our former study of transhemispheric cortical reorganisation after contralateral C7 transfer in rats, we demonstrated that encroachment of hindlimb representations upon original forelimb representations was an important factor for prevention of transhemispheric cortical reorganisation 2.…”

Section: Introductionmentioning

confidence: 93%

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Sensorimotor cortical changes assessed with resting-state fMRI following total brachial plexus root avulsion

Qiu

Chen

Mao

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Sensorimotor cortical changes assessed with resting-state fMRI following total brachial plexus root avulsion

Qiu

Chen

Mao

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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“…Peripheral nerve injuries remain one of the most challenging surgical problems and may result in devastating function loss that can have profound social consequences Nerve injuries result not only in changes at the site of injury but also cause distal atrophy of target muscles or permanent loss of sensation. These injuries have been shown to cause long-lasting cortical reorganization [33,34]. Functional reorganization in the somatosensory and motor regions of the brain may explain the often disappointing results from severe peripheral nerve injuries and subsequent attempts at surgical repair.…”

Section: Interaction Between the Cns And Pns In Nerve Injury And Repairmentioning

confidence: 99%

Cortical plasticity induced by different degrees of peripheral nerve injuries: a rat functional magnetic resonance imaging study under 9.4 Tesla

Hettinger

Machol

et al. 2014

J Brachial Plex Peripher Nerve Inj

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BackgroundMajor peripheral nerve injuries not only result in local deficits but may also cause distal atrophy of target muscles or permanent loss of sensation. Likewise, these injuries have been shown to instigate long-lasting central cortical reorganization.MethodsCortical plasticity changes induced after various types of major peripheral nerve injury using an electrical stimulation technique to the rat upper extremity and functional magnetic resonance imaging (fMRI) were examined. Studies were completed out immediately after injury (acute stage) and at two weeks (subacute stage) to evaluate time affect on plasticity.ResultsAfter right-side median nerve transection, cortical representation of activation of the right-side ulnar nerve expanded intra-hemispherically into the cortical region that had been occupied by the median nerve representation After unilateral transection of both median and ulnar nerves, cortical representation of activation of the radial nerve on the same side of the body also demonstrated intra-hemispheric expansion. However, simultaneous electrical stimulation of the contralateral uninjured median and ulnar nerves resulted in a representation that had expanded both intra- and inter-hemispherically into the cortical region previously occupied by the two transected nerve representations.ConclusionsAfter major peripheral nerve injury, an adjacent nerve, with similar function to the injured nerve, may become significantly over-activated in the cortex when stimulated. This results in intra-hemispheric cortical expansion as the only component of cortical plasticity. When all nerves responsible for a certain function are injured, the same nerves on the contralateral side of the body are affected and become significantly over-activated during a task. Both intra- and inter-hemispheric cortical expansion exist, while the latter dominates cortical plasticity.

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“…The described alterations, with a reduced activation of certain brain areas with atrophy of the gray substance as well as the disorganization of reorganization, are rapid. Thus, these changes may also be the target for the factor timing after nerve injury and repair and reconstruction, since they can be considered in the new rehabilitation strategies (Lundborg, Bjorkman, & Rosen, 2007;Weibull et al, 2008). The timing for introduction of training after nerve repair has been highlighted and has focused on the importance of immediate sensory relearning .…”

Section: Cerebral Plasticity -The Importance Of Timing In Rehabilitationmentioning

confidence: 99%

The Role of Timing in Nerve Reconstruction

Dahlin

2013

International Review of Neurobiology

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The surgeon, who treats nerve injuries, should have knowledge about how peripheral nerves react to trauma, particularly an understanding about the extensive pathophysiological alterations that occur both in the peripheral and in the central nervous system. A large number of factors influence the functional outcome, where the surgeon only can affect a few of them.In view of the new knowledge about the delicate intracellular signaling pathways that are rapidly initiated in neurons and in non-neuronal cells with the purpose to induce nerve regeneration, the timing of nerve repair and reconstruction after injury has gained more interest. It is crucial to understand and to utilize the inborn mechanisms for survival and regeneration of neurons and for activation, survival and proliferation of the Schwann cells and other cells that are acting after a nerve injury. Thus, experimental and clinical data clearly point towards the advantage of early nerve repair and reconstruction of injuries. Following an appropriate diagnosis of a nerve injury, the nerve should be promptly repaired or reconstructed, and new rehabilitation strategies should early be initiated. Considering nerve transfers in the treatment arsenal can shorten the time of nerve reinnervation of muscle targets. Timing of nerve repair and reconstruction is crucial after nerve injury.

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Enhanced sensory relearning after nerve repair by using repeated forearm anaesthesia: aspects on time dynamics of treatment

Cited by 23 publications

References 50 publications

Sensorimotor cortical changes assessed with resting-state fMRI following total brachial plexus root avulsion

Sensorimotor cortical changes assessed with resting-state fMRI following total brachial plexus root avulsion

Cortical plasticity induced by different degrees of peripheral nerve injuries: a rat functional magnetic resonance imaging study under 9.4 Tesla

The Role of Timing in Nerve Reconstruction

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