Cognitive re-education and early functional mobilisation in hand therapy after bilateral hand transplantation and heterotopic hand replantation--two case reports.
The main challenge for a successful hand therapy after heterotopic hand replantation is the reeducation of patients' sensory and motor perception. The case of a 28-year-old patient is described. After resection of a tumour and amputation of the elbow, tendons of the hand had to be joined to only three muscles of the upper arms. Elbow extension and flexion had to be trained to control the wrist, fingers, and thumb movements. In a similar way, the main focus after ortotopic hand transplantation lies on retraining the wrist, finger, and thumb functions. This is illustrated by a second case of a patient who had lived for 5 years with myoelectric protheses on both lower arms and had forgotten these functions. The final aim in both cases was regaining of daily living and working skills. The therapy was started with fitting supporting thermoplastic splints. Early motioned passive and passive-assistive active mobilisation prevented tendons adherences and initiated hand-functions. An intense sensory remaining programme and cognitive therapeutic exercises ensured the sensory and motoric activation of the referring cortical hand areals. At conclusion of therapy it can be said that both patients have fully taken up their professional duties again and that they are able to manage successfully their activities of daily living on their own.
Piza-Katzer
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H
Department of Plastic and Reconstructive Surgery, LBI-of Quality Control of Plastic and Reconstructive Surgery, Medical University Innsbruck, Innsbruck, Austria. hildegunde.piza@i-med.ac.at
Estermann
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D
D000203:Activities of Daily Living; D000328:Adult; D001132:Arm / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology*; D006225:Hand / Q000503:physiopathology; D063987:Hand Transplantation; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D009068:Movement; D009473:Neuronal Plasticity; D012092:Replantation / Q000534:rehabilitation*; D012677:Sensation; D013997:Time Factors; D016042:Transplantation, Heterotopic / Q000534:rehabilitation*