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

Rosén, Birgitta; Björkman, Anders; Lundborg, Göran

doi:10.1016/j.jhsb.2005.10.017

Cited by 84 publications

(61 citation statements)

References 24 publications

(45 reference statements)

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“…In contrast, TFD with an anesthetic cream could be used during the whole training period of CIMT with longer follow-up periods. Rosén et al (2006) showed improved sensory relearning in nerve-injured patients 6 weeks after a daily treatment with TFD over a period of 2 weeks. Hand motor practice during a single pharmacologically induced anesthesia resulted in improved motor function in stroke patients 2 weeks after treatment (Muellbacher et al, 2002).…”

Section: Effectiveness Of Temporary Functional Deafferentationmentioning

confidence: 90%

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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Section: Effectiveness Of Temporary Functional Deafferentationmentioning

confidence: 90%

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

et al. 2012

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“…2 Anesthetizing the forearm also was shown to yield better motor and sensory results in denervated hands. 50 It is interesting to note that a hypothesis that might explain this result could be called "controlled plasticity," meaning that anesthetizing the adjacent cortex might impede any invasion of the really deafferentiated cortex by nondeafferentiated cortex, as normally occurs during brain plasticity.…”

Section: Fig 10mentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

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“…Indeed, there are ongoing efforts to modify transcallosal activity in patients suffering from peripheral nerve injury. For instance, improvement in tactile discrimination of the injured hand was found after decreasing afferent inputs from the intact hand using constraint induced therapy (CIT) (22), using nerve blocking (23), and directly inhibiting neuronal networks through transcranial magnetic stimulation (TMS) (24,25). Still, these rehabilitation approaches are neither precise nor neuronalspecific, and they cannot be repeated often.…”

mentioning

confidence: 99%

Optogenetic-guided cortical plasticity after nerve injury

Downey

Bar‐Shir

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Peripheral nerve injury causes sensory dysfunctions that are thought to be attributable to changes in neuronal activity occurring in somatosensory cortices both contralateral and ipsilateral to the injury. Recent studies suggest that distorted functional response observed in deprived primary somatosensory cortex (S1) may be the result of an increase in inhibitory interneuron activity and is mediated by the transcallosal pathway. The goal of this study was to develop a strategy to manipulate and control the transcallosal activity to facilitate appropriate plasticity by guiding the cortical reorganization in a rat model of sensory deprivation. Since transcallosal fibers originate mainly from excitatory pyramidal neurons somata situated in laminae III and V, the excitatory neurons in rat S1 were engineered to express halorhodopsin, a light-sensitive chloride pump that triggers neuronal hyperpolarization. Results from electrophysiology, optical imaging, and functional MRI measurements are concordant with that within the deprived S1, activity in response to intact forepaw electrical stimulation was significantly increased by concurrent illumination of halorhodopsin over the healthy S1. Optogenetic manipulations effectively decreased the adverse inhibition of deprived cortex and revealed the major contribution of the transcallosal projections, showing interhemispheric neuroplasticity and thus, setting a foundation to develop improved rehabilitation strategies to restore cortical functions.recovery | amputation A lthough 20 million Americans suffer from peripheral nerve injury caused by trauma, metabolic, endocrine, and autoimmune disorders, there are few strategies to promote recovery. Surgical nerve repair and training of the injured limb are the classical rehabilitation approaches. Nevertheless, the clinical outcome in adults is generally poor, with persisting sensory dysfunction and pain (1).Recent evidence suggests that sensory dysfunctions caused by nerve injury should be attributable not only to the functional, cellular, and biochemical events occurring in peripheral nerve but also functional and anatomical changes occurring in cerebral cortical representations. It is well-documented in humans (2), non-human primates (3), cats (4), and rodents (5-7) that peripheral nerve injury can lead to expansion of neighboring cortical representation of peripheral regions within the affected (deprived) hemisphere (intrahemispheric neuroplasticity). Peripheral nerve injury and direct cortical lesions have been shown to also modify functional communication between cortical hemispheres (interhemispheric neuroplasticity) (8-19). Specifically, peripheral inputs normally evoking neuronal responses in the contralateral hemisphere cause inappropriate functional responses in the ipsilateral hemisphere. Previously, using singleunit electrophysiology recordings and juxtacellular labeling, it was shown that the inappropriate ipsilateral functional magnetic resonance imaging (fMRI) responses observed in deprived primary somatosensory cor...

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

Cited by 84 publications

References 24 publications

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

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

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Optogenetic-guided cortical plasticity after nerve injury

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