title: Enhanced early sensory outcome after nerve repair as a result of immediate post-operative re-learning: a randomized controlled trial.
abstract: We assessed the use of guided plasticity training to improve the outcome in the first 6 months after nerve repair. In a multicentre randomized controlled trial, 37 adults with median or ulnar nerve repair at the distal forearm were randomized to intervention, starting the first week after surgery with sensory and motor re-learning using mirror visual feedback and observation of touch, or to a control group with re-learning starting when reinnervation could be detected. The primary outcome at 3 and 6 months post-operatively was discriminative touch (shape texture identification test, part of the Rosen score). At 6 months, discriminative touch was significantly better in the early intervention group. Improvement of discriminative touch between 3 and 6 months was also significantly greater in that group. There were no significant differences in motor function, pain or in the total score. We conclude that early re-learning using guided plasticity may have a potential to improve the outcomes after nerve repair. LEVEL OF EVIDENCE II.
authors.affiliation: Department of Hand Surgery, Lund University, Malmö, Sweden birgitta.rosen@med.lu.se.
authors.forename: B
authors.initials: B
authors.lastname: Rosén
authors.affiliation: Department of Hand Surgery, Lund University, Malmö, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Vikström
authors.affiliation: University Hospital of South Manchester/University of Manchester, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Turner
authors.affiliation: University Hospital of South Manchester/University of Manchester, Manchester, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: McGrouther
authors.affiliation: Department of Plastic & Reconstructive Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: Selles
authors.affiliation: Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands.
authors.forename: T A R
authors.initials: TA
authors.lastname: Schreuders
authors.affiliation: Department of Hand Surgery, Lund University, Malmö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Björkman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056228:Feedback, Sensory; D005260:Female; D005500:Follow-Up Studies; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries*; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology; D059348:Peripheral Nerve Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D014110:Touch / Q000502:physiology; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries*; D055815:Young Adult
keywords: Nerve repair; mirror visual feedback; re-learning; rehabilitation; targeted plasticity