Donor Activation Focused Rehabilitation Approach

Kahn, Lorna C.; Moore, Amy M.

doi:10.1016/j.hcl.2015.12.014

Cited by 56 publications

(46 citation statements)

References 22 publications

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“…Still, waiting for a muscle function to recover is one of the greatest challenges for a patient after undergoing nerve transfer surgery. Especially in the early post-operative phase patients may be frustrated and/or depressed when no motor activity is seen (Kahn and Moore, 2016). This time period, where the patient feels that “nothing happens,” is possibly shortened with the use of sEMG feedback as faint muscle activity is visualized before it is visible or even palpable.…”

Section: Discussionmentioning

confidence: 99%

“…As this may be contra-intuitive for the patient without profound knowledge of the underlying anatomy, perioperative patient education is crucial. It ensures that they understand the consequence of nerve injury, the surgical procedure of the nerve transfer and the expected recovery (Novak and Von Der Heyde, 2013; Kahn and Moore, 2016).…”

Section: Protocolsmentioning

confidence: 99%

“…In the nerve transfer patient, however, this biofeedback technique has not yet been described. Following nerve transfer surgery, the regeneration of motor axons requires a considerable period of time and patients will often struggle to attain control of volitional contractions in the re-innervated muscle (Kahn and Moore, 2016). Before visual or even palpable contractions occur sEMG can provide valuable feedback for the patient and guide rehabilitation focused on sensorimotor re-education.…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application

et al. 2018

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Motor recovery following nerve transfer surgery depends on the successful re-innervation of the new target muscle by regenerating axons. Cortical plasticity and motor relearning also play a major role during functional recovery. Successful neuromuscular rehabilitation requires detailed afferent feedback. Surface electromyographic (sEMG) biofeedback has been widely used in the rehabilitation of stroke, however, has not been described for the rehabilitation of peripheral nerve injuries. The aim of this paper was to present structured rehabilitation protocols in two different patient groups with upper extremity nerve injuries using sEMG biofeedback. The principles of sEMG biofeedback were explained and its application in a rehabilitation setting was described. Patient group 1 included nerve injury patients who received nerve transfers to restore biological upper limb function (n = 5) while group 2 comprised patients where biological reconstruction was deemed impossible and hand function was restored by prosthetic hand replacement, a concept today known as bionic reconstruction (n = 6). The rehabilitation protocol for group 1 included guided sEMG training to facilitate initial movements, to increase awareness of the new target muscle, and later, to facilitate separation of muscular activities. In patient group 2 sEMG biofeedback helped identify EMG activity in biologically “functionless” limbs and improved separation of EMG signals upon training. Later, these sEMG signals translated into prosthetic function. Feasibility of the rehabilitation protocols for the two different patient populations was illustrated. Functional outcome measures were assessed with standardized upper extremity outcome measures [British Medical Research Council (BMRC) scale for group 1 and Action Research Arm Test (ARAT) for group 2] showing significant improvements in motor function after sEMG training. Before actual movements were possible, sEMG biofeedback could be used. Patients reported that this visualization of muscle activity helped them to stay motivated during rehabilitation and facilitated their understanding of the re-innervation process. sEMG biofeedback may help in the cognitively demanding process of establishing new motor patterns. After standard nerve transfers individually tailored sEMG biofeedback can facilitate early sensorimotor re-education by providing visual cues at a stage when muscle activation cannot be detected otherwise.

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Section: Discussionmentioning

confidence: 99%

Section: Protocolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application

et al. 2018

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“…After 3 weeks, the patient is allowed passive range-of-motion, which is then advanced to begin functional relearning using a donor activation focused rehabilitation approach (DAFRA). 16 The principles of DAFRA rely on cortical plasticity, a Intraoperative handheld nerve stimulation demonstrated no activation of all quadricep muscles. The proximal femoral nerve was not identifiable in the pelvis.…”

Section: Postoperative Managementmentioning

confidence: 99%

Nerve transfers to restore femoral nerve function following oncologic nerve resection

O’Brien

West

Zewdu

et al. 2021

Journal of Surgical Oncology

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Introduction Advances in the care of soft‐tissue tumors, including imaging capabilities and adjuvant radiation therapy, have broadened the indications and opportunities to pursue surgical limb salvage. However, peripheral nerve involvement and femoral nerve resection can still result in devastating functional outcomes. Nerve transfers offer a versatile solution to restore nerve function following tumor resection. Methods Two cases were identified by retrospective review. Patient and disease characteristics were gathered. Preoperative and postoperative motor function were assessed using the Medical Research Council Muscle Scale. Patient‐reported pain levels were assessed using the numeric rating scale. Results Nerve transfers from the obturator and sciatic nerve were employed to restore knee extension. Follow up for Case 1 was 24 months, 8 months for Case 2. In both patients, knee extension and stabilization of gait without bracing was restored. Patient also demonstrated 0/10 pain (an average improvement of 5 points) with decreased neuromodulator and pain medication use. Conclusion Nerve transfers can restore function and provide pain control benefits and ideally are performed at the time of tumor extirpation. This collaboration between oncologic and nerve surgeons will ultimately result in improved functional recovery and patient outcomes.

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“…[1][2][3][4][5] Advances in microsurgical techniques have made nerve repair and reconstruction possible in these patients over a span of 30 years' Recent evidencebased rehabilitation methods have led to better functional recovery post reconstructive surgeries. [1][2][3][4][5] Reconstructive surgeons often measure success of surgery and post-surgical recovery in TBPI by improvements in motor function. 6 While these are quantitative measures of recovery, important aspects such as an individual's perception of the quality of life are often forgotten.…”

Section: Introductionmentioning

confidence: 99%

Patients’ perception of quality of life after traumatic brachial plexus injury – a qualitative study

Verma¹,

Yardi

Puri

et al. 2019

Hand Therapy

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Introduction: Advancements in reconstructive surgery for traumatic brachial plexus injury explain the need for better rehabilitation programmes. Therefore, an understanding of an individual patient's perception through their journey of treatment for a traumatic brachial plexus injury is needed. Methods: Thirteen patients with traumatic brachial plexus injury were selected using non-probability purposive sampling. Data were collected in the form of in-depth face-to-face interviews in a clinic setting of a tertiary government hospital using an explorative qualitative method. An interview guide comprising open-ended, nondirective semi structured questions was used and data were analyzed using an interpretative phenomenological approach. Results: Eleven subthemes under the overarching theme of patient perception were identified. These subthemes illustrate perception of each individual participants' journey of treatment for traumatic brachial plexus injury. Conclusion: Our study following a qualitative approach throws light on the impact of injury and an adult individual's perception and may thereby help to develop a more comprehensive and holistic approach towards patient care.

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Donor Activation Focused Rehabilitation Approach

Cited by 56 publications

References 22 publications

Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application

Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application

Nerve transfers to restore femoral nerve function following oncologic nerve resection

Patients’ perception of quality of life after traumatic brachial plexus injury – a qualitative study

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