The effects of sensory re-education on hand function recovery after peripheral nerve repair: A systematic review

Abstract

BACKGROUND: Peripheral nerve injury can result in both sensory and motor deficits, and these impairments can last for a long period after nerve repair. OBJECTIVE: To systematically review the effects of sensory re-education (SR) on facilitating hand function recovery after peripheral nerve repair. METHODS: This systematic review was limited to articles published from 1970 to 20 December 2020. Electronic searching was performed in CINAHL, Embase, PubMed, Web of Science, and Medline databases to include trials investigating the effects of SR training on hand function recovery after peripheral nerve repair and included only those studies with controlled comparisons. RESULTS: Sixteen articles were included in final data synthesis. We found that only four studies could be rated as having good quality and noted obvious methodological limitations in the remaining studies. The current evidence showed that early SR with mirror visual feedback and the combinational use of classic SR and topical temporary anesthetic seemed to have long- and short-term effects, respectively on improving the sensibility and reducing the disabilities of the hand. The evidence to support the effects of conventional classical SR on improving hand functions was not strong. CONCLUSIONS: Further well-designed trials are needed to evaluate the effects of different SR techniques on hand function after nerve repair over short- and long-term periods.

Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol

“…Outcomes following nerve transfers in other domains of peripheral nerve surgery have been demonstrated to be optimized by targeting central cortical re-mapping through sensory reeducation: a foundational and fundamental component of rehabilitation following nerve repairs. [15][16][17] These same lessons may be applicable in phalloplasty to yield new strategies to further optimize sensory outcomes following this procedure.…”

“…In the first phase, the initial draft of the protocol was constructed by the senior author and a peripheral nerve therapist, based on a typical framework used for sensory re-education following peripheral nerve repair. 16 , 17 In phase 2, a multi-disciplinary team was identified and recruited to incorporate expert opinions and insights across different relevant scopes of practice. This team included a phalloplasty and peripheral nerve surgeon, a peripheral nerve therapist, two pelvic floor physiotherapists, a sexual therapist, a urologist specializing in sexual medicine, and a reconstructive urologist.…”

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

“…Sensory deficits were also encountered by several reports after performing other techniques of nerve repair mentioned earlier, which flags the importance of possible future complications such as plantar ulcers. 13 , 26 During the early regeneration process after the procedure, fluid permeation from the surrounding tissue was the primary nutrient mode of transport for the graft. Micro-vessels started to grow on both ends of the graft and penetrated the nerve matrix along the long axis.…”

Traumatic peripheral nerve injuries: diagnosis and management

“…A graded approach to exercise is required to avoid excessive fatigue of weak muscles postreinnervation, restore strength in unaffected muscles suffering from disuse atrophy and unlearn compensatory movement patterns to restore optimal function [98,107 ▪ ]. Fatigue is complex, mediated by central as well as peripheral mechanisms, and impacts reinnervated muscle function, even when they are able to generate adequate force [108–110].…”

“…Unfortunately, the evidence for these techniques remains limited [92]. Motor re-education techniques are utilized to relearn patterns of movement, improve muscle imbalance and facilitate re-mapping of motor cortex [98][99][100][101]. This is particularly relevant following nerve transfer procedures, after which the muscle is reinnervated from a new proximal nerve source (the donor nerve), which requires corresponding motor cortical remapping [86, 99,100,102,103].…”