Patients' views on early sensory relearning following nerve repair—a Q-methodology study

Vikström, Pernilla; Carlsson, Ingemar; Rosén, Birgitta; Björkman, Anders

doi:10.1016/j.jht.2017.07.003

“…Within therapy, patient education is a critical step as the patient needs to understand the rather complex surgical procedure and be educated on activities improving the health status in order to be actively involved in the long rehabilitation process 8,13,37 . There is broad agreement that repetition is fundamental and daily home exercises are needed to reinforce a well-established cortical representation of the hand 8,34,38,39 .…”

Section: Discussionmentioning

confidence: 99%

Structured Motor Rehabilitation After Selective Nerve Transfers

Sturma¹,

Hruby²,

Farina³

2019

JoVE

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After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning. Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation. Video Link The video component of this article can be found at https://www.jove.com/video/59840/ 9 , movements associated with ulnar nerve activity (such as hand closing or ulnar abduction of the wrist) are used for the activation of the biceps muscle directly after re-innervation. However, exercises based on this approach can be performed in other body parts as well. If special considerations are necessary to implement this in other body parts (e.g., the lower extremity), this is pointed out within the protocol. Independent from the body part affected, therapy sessions should not exceed 30 min as muscles become easily fatigued shortly after reinnervation 8 and successful training requires a patient's full commitment and focus.

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“…Within therapy, patient education is a critical step as the patient needs to understand the rather complex surgical procedure and be educated on activities improving the health status in order to be actively involved in the long rehabilitation process 8, 13,37 . There is broad agreement that repetition is fundamental and daily home exercises are needed to reinforce a well-established cortical representation of the hand 8,34,38,39 .…”

Section: Discussionmentioning

confidence: 99%

Structured Motor Rehabilitation After Selective Nerve Transfers

Sturma

¹

,

Hruby

²

,

Farina

³

2019

JoVE

2

0

View full text Add to dashboard Cite

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

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“…In a previous study, we found that at least 27% of patients lacked the motivation to perform their early relearning or needed more support to complete their relearning programme (Vikström et al., 2017). We do not know to what extent the results could be further improved with more individualized training.…”

Section: Discussionmentioning

confidence: 99%