Post-Oberlin procedure cortical neuroplasticity in traumatic injury of the upper brachial plexus

Sousa, Ana Caroline Siquara de; Guedes-Corrêa, José Fernando

doi:10.1590/0100-3984.2015.0082

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Hence, we can infer that a portion of corticospinal projections initially connects both the ulnar (donor nerve) and the musculocutaneous nerves (acceptor nerve). Detectable reactivation of the cortical area during flexion of the injured elbow in the patients who had undergone Oberlin's operation was similar to that observed in a healthy volunteer [ 63 ]. Meanwhile, corticospinal neurons are found to exhibit heterogeneous correlations, with movement which includes silent, indiscriminately active, movement-active, and quiescence-active states [ 64 ].…”

Section: Cns Plasticity After Peripheral Nerve Transfersupporting

confidence: 70%

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

Shen¹

2022

Neural Plasticity

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Peripheral nerve injury can lead to partial or complete loss of limb function, and nerve transfer is an effective surgical salvage for patients with these injuries. The inability of deprived cortical regions representing damaged nerves to overcome corresponding maladaptive plasticity after the reinnervation of muscle fibers and sensory receptors is thought to be correlated with lasting and unfavorable functional recovery. However, the concept of central nervous system plasticity is rarely elucidated in classical textbooks involving peripheral nerve injury, let alone peripheral nerve transfer. This article is aimed at providing a comprehensive understanding of central nervous system plasticity involving peripheral nerve injury by reviewing studies mainly in human or nonhuman primate and by highlighting the functional and structural modifications in the central nervous system after peripheral nerve transfer. Hopefully, it will help surgeons perform successful nerve transfer under the guidance of modern concepts in neuroplasticity.

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Section: Cns Plasticity After Peripheral Nerve Transfersupporting

confidence: 70%

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

Shen¹

2022

Neural Plasticity

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“…This in turn would lead to a change in the cortical representation of the uninjured limb. In this context, the ulnar to musculocutaneous nerve transfer, already associated to functional improvement of the affected limb (61) and possibly of cortical representation restoration (62), could play a role by reducing the tactile threshold impairment of the uninjured limb through callosal modulatory effects (38).…”

Section: Discussionmentioning

confidence: 99%

Unilateral Brachial Plexus Lesion Impairs Bilateral Touch Threshold

et al. 2019

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Unilateral brachial plexus injury (BPI) impairs sensory and motor functions of the upper limb. This study aimed to map in detail brachial plexus sensory impairment both in the injured and the uninjured upper limb. Touch sensation was measured through Semmes-Weinstein monofilaments at the autonomous regions of the brachial plexus nerves, hereafter called points of exclusive innervation (PEIs). Seventeen BPI patients (31.35 years±6.9 SD) and 14 age-matched healthy controls (27.57 years±5.8 SD) were tested bilaterally at six selected PEIs (axillary, musculocutaneous, median, radial, ulnar, and medial antebrachial cutaneous [MABC]). As expected, the comparison between the control group and the brachial plexus patients' injured limb showed a robust difference for all PEIs ( p ≤ 0.001). Moreover, the comparison between the control group and the brachial plexus uninjured limb revealed a difference for the median ( p = 0.0074), radial ( p = 0.0185), ulnar ( p = 0.0404), and MABC ( p = 0.0328) PEIs. After splitting the sample into two groups with respect to the dominance of the injured limb, higher threshold values were found for the uninjured side when it occurred in the right dominant limb compared to the control group at the median ( p = 0.0456), radial ( p = 0.0096), and MABC ( p = 0.0078) PEIs. This effect was absent for the left, non-dominant arm. To assess the effect of the severity of sensory deficits observed in the injured limb upon the alterations of the uninjured limb, a K-means clustering algorithm (k = 2) was applied resulting in two groups with less or more severe sensory impairment. The less severely affected patients presented higher thresholds at the median ( p = 0.0189), radial ( p = 0.0081), ulnar ( p = 0.0253), and MABC ( p = 0.0187) PEIs in the uninjured limb in comparison with the control group, whereas higher thresholds at the uninjured limb were found only for the median PEI ( p = 0.0457) in the more severely affected group. In conclusion, an expressive reduction in touch threshold was found for the injured limb allowing a precise mapping of the impairment caused by the BPI. Crucially, BPI also led to reduced tactile threshold in specific PEIs in the uninjured upper limb. These new findings suggest a superordinate model of representational plasticity occurring bilaterally in the brain after a unilateral peripheral injury.

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“…These findings provide additional support for the role of plasticity in attaining the excellent results that distal nerve transfers generally achieve. 10 …”

Section: Plasticity In Distal Nerve Transfers In Relation To Adjacencmentioning

confidence: 99%

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

Socolovsky

Malessy

Lopez

et al. 2017

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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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Post-Oberlin procedure cortical neuroplasticity in traumatic injury of the upper brachial plexus

Cited by 7 publications

References 8 publications

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

Unilateral Brachial Plexus Lesion Impairs Bilateral Touch Threshold

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

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