Acute improvement of hand sensibility after selective ipsilateral cutaneous forearm anaesthesia

Björkman, Anders; Rosén, Birgitta; Lundborg, Göran

doi:10.1111/j.1460-9568.2004.03742.x

Cited by 71 publications

(69 citation statements)

References 33 publications

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“…This result is in accordance with improvements from other kinds of TFD found in healthy subjects 25,30,31,44 or ischemic TFD in stroke patients. 27 Animal and human experiments have demonstrated a reorganization of somatosensory receptive fields at different levels of the somatosensory system starting minutes after a pharmacological deafferentation.…”

Section: Discussionsupporting

confidence: 79%

Deafferentation of the Affected Arm

Weiß

Sens

Teschner

et al. 2011

Stroke

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Background and Purpose-Reduced somatosensation is a common impairment after stroke. This somatosensory deficit is known to be a reliable predictor of poor rehabilitation outcome. Several methods of physical therapy have addressed this problem, but with only moderate success. Here, we used a new neural plasticity-based approach, ie, a simple, inexpensive, pharmacologically induced temporary functional deafferentation (TFD) of the forearm to investigate whether TFD might result in beneficial effects on the somatosensory sensibility and motor capacity of the stroke-affected hand. Methods-Examination was performed over 2 consecutive days of an efficient rehabilitation program for stroke patients referred to as constraint-induced movement therapy. Patients were deafferented on one of these days but not on the other (placebo session). The order of deafferentation and nondeafferentation was counterbalanced across patients. TFD of the stroke-affected forearm was realized using an anesthetic cream. Somatosensory abilities were assessed by a Grating orienting task, and a shape-sorter drum task was used to test motor performance. Both tests were performed each day before and after the constraint-induced movement therapy training session. Results-We found significantly better outcomes for Grating orienting task and shape-sorter drum task after TFD on the forearm as compared to placebo, indicating increased somatosensory abilities and motor performance in stroke patients using the simple TFD procedure. Conclusions-The

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Section: Discussionsupporting

confidence: 79%

Deafferentation of the Affected Arm

Weiß

Sens

Teschner

et al. 2011

Stroke

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“…This is in accordance with previous results in healthy subjects demonstrating somatosensory improvements following TFD with anesthetic cream (Björkman et al, 2004a;Björkman et al, 2009) as well as with other kinds of TFD (Werhahn et al, 2002b;Weiss et al, 2004). Furthermore, different types of TFD were also shown to enhance the somatosensory sensibility of the stroke-affected hand in stroke patients (Voller et al, 2006;Weiss et al, 2011).…”

Section: Effects Of Tfd On Sensory Functionsupporting

confidence: 80%

Effects of Temporary Functional Deafferentation on the Brain, Sensation, and Behavior of Stroke Patients

et al. 2012

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Following stroke, many patients suffer from chronic motor impairment and reduced somatosensation in the stroke-affected body parts. Recent experimental studies suggest that temporary functional deafferentation (TFD) of parts of the stroke-affected upper limb or of the less-affected contralateral limb might improve the sensorimotor capacity of the stroke-affected hand. The present study sought evidence of cortical reorganization and related sensory and motor improvements following pharmacologically induced TFD of the stroke-affected forearm.Examination was performed during 2 d of Constraint-Induced Movement Therapy. Thirty-six human patients were deafferented on the stroke-affected forearm by an anesthetic cream (containing lidocaine and prilocaine) on one of the 2 d, and a placebo cream was applied on the other. The order of TFD and placebo treatment was counterbalanced across patients. Somatosensory and motor performance were assessed using a Grating orienting task and a Shape-sorter-drum task, and with somatosensory-evoked magnetic fields. Evoked magnetic fields showed significant pre-to postevaluation magnitude increases in response to tactile stimulation of the thumb of the stroke-affected hand during TFD but not following placebo treatment. We also observed a rapid extension of the distance between cortical representations of the stroke-affected thumb and little finger following TFD but not following placebo treatment. Moreover, somatosensory and motor performance of the stroke-affected hand was significantly enhanced during TFD but not during placebo treatment. Thus, pharmacologically induced TFD of a stroke-affected forearm might improve the somatosensory and motor functions of the stroke-affected upper limb, accompanied by cortical plasticity.

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“…Tourniquet-induced anaesthesia, where the whole contralateral hand is anaesthetized and motor control is also lost, is a difficult method to use in a clinical setting, mostly because it causes pain. Selective deafferentation of the flexor aspect of the forearm in healthy persons has been shown to, significantly, improve hand function in the same side (Bjo¨rkman et al, 2004a) and is, here, shown to have an effect, also, in nerve-injured patients. This method has clear advantages over tourniquetinduced anaesthesia.…”

Section: Article In Pressmentioning

confidence: 90%

Improved Sensory Relearning after nerve Repair Induced by Selective Temporary Anaesthesia – A New Concept in Hand Rehabilitation

Rosén

Björkman

Lundborg

2006

Journal of Hand Surgery

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The outcome after nerve repair in adults is generally poor. We hypothesized that forearm deafferentation would enhance the sensory outcome by increasing the cortical hand representation. A prospective, randomized, double-blind study was designed to investigate the effects of cutaneous forearm anaesthesia combined with sensory re-education on the outcome after ulnar or median nerve repair. During a 2 week period, a local anaesthetic cream (EMLA (n = 7) or placebo (n=6) was applied repeatedly onto the flexor aspect of the forearm of the injured arm and combined with sensory re-education. Evaluation of sensory function was carried out at regular intervals and at 4 weeks after the last EMLA/placebo session. The EMLA group showed significant improvement compared to placebo in perception of touch/pressure, tactile gnosis and in the summarized outcome after 6 weeks. These results suggest that cutaneous forearm anaesthesia of the injured limb, in combination with sensory re-education, can enhance sensory recovery after nerve repair.

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Acute improvement of hand sensibility after selective ipsilateral cutaneous forearm anaesthesia

Cited by 71 publications

References 33 publications

Deafferentation of the Affected Arm

Deafferentation of the Affected Arm

Effects of Temporary Functional Deafferentation on the Brain, Sensation, and Behavior of Stroke Patients

Improved Sensory Relearning after nerve Repair Induced by Selective Temporary Anaesthesia – A New Concept in Hand Rehabilitation

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