Nerve Repair: Correlation of Restitution of Functional Sensibility with Specific Cognitive Capacities

Rosén, Birgitta; Lundborg, Göran; Dahlin, Lars B.; Holmberg, Jan; Karlson, Björn

doi:10.1016/0266-7681(94)90209-7

Cited by 80 publications

(54 citation statements)

References 22 publications

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“…Indeed, even after re-sutured accidentally severed nerves and subsequent significant re-innervation of biological sensors-that reasonably should be vastly superior to any artificial intraneural sensory feedback-functional results are unsatisfactory unless the patient is in the early teens or younger (Lundborg 2003). This implies that even under 'ideal' conditions, the limiting factor in sensory relearning is the patients' ability to reinterpret sensory information (Rosén et al 1994). Using sensory systems that are not normally engaged in the task further taxes the cognitive system of the patient (Chatterjee et al 2008;Cipriani et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Humans can integrate feedback of discrete events in their sensorimotor control of a robotic hand

et al. 2014

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Providing functionally effective sensory feedback to users of prosthetics is a largely unsolved challenge. Traditional solutions require high band-widths for providing feedback for the control of manipulation and yet have been largely unsuccessful. In this study, we have explored a strategy that relies on temporally discrete sensory feedback that is technically simple to provide. According to the Discrete Event-driven Sensory feedback Control (DESC) policy, motor tasks in humans are organized in phases delimited by means of sensory encoded discrete mechanical events. To explore the applicability of DESC for control, we designed a paradigm in which healthy humans operated an artificial robot hand to lift and replace an instrumented object, a task that can readily be learned and mastered under visual control. Assuming that the central nervous system of humans naturally organizes motor tasks based on a strategy akin to DESC, we delivered short-lasting vibrotactile feedback related to events that are known to forcefully affect progression of the grasplift-and-hold task. After training, we determined whether the artificial feedback had been integrated with the sensorimotor control by introducing short delays and we indeed observed that Correspondence to: Christian Cipriani, ch.cipriani@sssup.it. Jacob L. Segil and Francesco Clemente have contributed equally to this work.Conflict of interest CC hold shares in Prensilia S.R.L., the company that manufactures robotic hands as the one used in this work, under the license to Scuola Superiore Sant'Anna. U.S. Department of Veterans AffairsPublic Access Author manuscript Exp Brain Res. Author manuscript; available in PMC 2015 December 01. VA Author ManuscriptVA Author Manuscript VA Author Manuscript the participants significantly delayed subsequent phases of the task. This study thus gives support to the DESC policy hypothesis. Moreover, it demonstrates that humans can integrate temporally discrete sensory feedback while controlling an artificial hand and invites further studies in which inexpensive, noninvasive technology could be used in clever ways to provide physiologically appropriate sensory feedback in upper limb prosthetics with much lower band-width requirements than with traditional solutions.

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Section: Discussionmentioning

confidence: 99%

Humans can integrate feedback of discrete events in their sensorimotor control of a robotic hand

et al. 2014

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“…The so-called Lundborg Hand Clinic uses this reeducation. 36 It showed promising results and an increase in functional nerve recovery after reconstruction. Early-phase sensory reeducation proved to be vital to guide the patient in the recovery of tactilegnosis.…”

Section: Solutionsmentioning

confidence: 97%

Poor results after nerve grafting in the upper extremity: Quo vadis?

Meek¹,

Coert²,

Robinson³

2005

Microsurgery

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The clinical success of peripheral nerve grafting in the upper extremity was evaluated retrospectively in 41 patients. This study comprises a 10-year follow-up in a single institution. Donor and acceptor site morbidity as well as functional nerve recovery were evaluated. Thirty-one men and 10 women were included. Autologous nerve grafts were used for reconstruction of digital nerves in 17 patients, ulnar nerves in 12 patients, median nerves in 10 patients, radial nerve in 1 patient, and both the radial and median nerve in 1 patient. The length of nerve grafts ranged from 1-12.5 cm (mean, 4.8 cm). The follow-up period ranged from 18 months to 10 years. Acceptor site-related problems were noted in 51%% (n = 21) of patients. Donor-site morbidity was seen in 4 patients (10%%). The return of function was scored as "good" in 3 (7%%), "fair" in 11 (27%%), and "bad" in 27 (66%%) patients. The outcome of autologous nerve grafts in this small group of patients treated by several surgeons was unfavorable in terms of function. Recent experimental and clinical studies with biodegradable nerve guides for the repair of peripheral nerve gaps showed superior results in comparison to classic nerve grafts.

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“…The examinations were performed at 2, 4, 6, 8, 12, 16, 20, and 24 months postoperatively for each patient with lesions located at the distal level, at 2, 4, 8, 12, 18, 24, 36, and 48 months postoperatively for lesions located at mid-forearm and at 3,6,12,24,36,48,60, and 72 months postoperatively for lesions located at the proximal level. So, there were eight evaluations during the followup period individualized for each group of patients.…”

Section: Assessment Of Patientsmentioning

confidence: 99%

Repair of complete nerve lacerations at the forearm: An outcome study using Rosén–Lundborg protocol

et al. 2010

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A comparison of outcomes based on a scoring system for assessments, described by Rosén and Lundborg, after sharp complete laceration of median and/or ulnar nerves at various levels in the forearm was carried out. There were 66 males (90.4%) and 7 females (9.6%), with a mean age of 31 years (range: 14-62 years). The patients were categorized into three groups according to the type of nerve injury. The median nerve was injured in 25 cases (group M, 34.3%), the ulnar in 27 (group U, 36.9%), and both the nerves in 21 (group MU, 28.8%). The demographic data of the patients and the mechanism of injury were recorded. We also examined the employment status at the time of the injury and we estimated the percentage of patients who returned to their work after trauma. In all cases, a primary epineural repair was performed. Concomitant injuries were repaired in the same setting. The mean period of time between injury and surgery was 5.3 hours (range: 2-120 hours). A rehabilitation protocol and a reeducation program were followed in all cases. The mean follow-up was 3 years (range: 2-6 years), with more distal injuries having a shorter follow-up period. The total score was 2.71 in group M (range: 0.79-2.99) and 2.63 in group U (range: 0.63-3), with no significant differences observed. There was a significant difference between these two groups and group MU (total score 2.03, range: 0.49-2.76, P = 0.02). Up to the last follow-up, 61 patients (83.5%) had returned to their previous work. The Rosén-Lundborg model can be a useful and simple tool for the evaluation of the functional outcome after nerve injury and repair temporally reflecting the processes of regeneration and reinnervation.

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Nerve Repair: Correlation of Restitution of Functional Sensibility with Specific Cognitive Capacities

Cited by 80 publications

References 22 publications

Humans can integrate feedback of discrete events in their sensorimotor control of a robotic hand

Humans can integrate feedback of discrete events in their sensorimotor control of a robotic hand

Poor results after nerve grafting in the upper extremity: Quo vadis?

Repair of complete nerve lacerations at the forearm: An outcome study using Rosén–Lundborg protocol

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