The optimization of peripheral nerve recovery using cortical reorganization techniques: A retrospective study of wrist level nerve repairs.
STUDY DESIGN
Retrospective case series.


INTRODUCTION
Outcomes following peripheral nerve repairs have not significantly improved over the past few decades. A new protocol using cortical reorganization techniques was developed with the goal of improving nerve recovery in the hand.


PURPOSE OF THE STUDY
To determine if early sensory re-education using cortical reorganization techniques improved sensory outcomes in the hand after repair of wrist-level nerve injuries.


METHODS
A retrospective study was completed of wrist-level peripheral nerve repairs in patients who underwent a sensory re-education protocol which included cutaneous anesthesia, tactile stimulation, and sensory and motor imagery. Data for static 2-point discrimination, Semmes Weinstein monofilament assessments and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected.


RESULTS
At four months post-repair, three of seven of the median nerve lacerations had static 2-point discrimination of 7 mm or less in at least one digit. Using the Semmes Weinstein monofilaments, 9 of 11 nerve repairs felt the 4.31 filament (protective) or better by eleven months with five able to perceive the 2.83 filament (normal) in that time frame.


CONCLUSIONS
This limited retrospective study suggests that early sensory re-education using cortical reorganization techniques may improve sensory outcomes. A larger scale study is indicated to confirm our findings.


LEVEL OF EVIDENCE
IV.
['Walbruch|Bonnie|B|', 'Kalliainen|Loree|L|']
D000328:Adult D001917:Brachial Plexus D002540:Cerebral Cortex D005260:Female D006225:Hand D006801:Humans D007092:Imagination D008297:Male D008875:Middle Aged D020127:Recovery of Function D012189:Retrospective Studies D012678:Sensation Disorders D014110:Touch D055815:Young Adult
Peripheral nerve Cortical reorganization nerve repair Sensory re-education