The stages of rehabilitation following motor nerve transfer surgery

Hill, Joshua L; Turner, Lewis C; Jones, Richard D.; Jimulia, Devanshi T; Miller, Caroline; Power, Dominic

doi:10.4103/jmsr.jmsr_79_18

Cited by 8 publications

(25 citation statements)

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“…Therefore, the aim of the presented protocol was to provide detailed instructions for post-surgical rehabilitation to embrace cortical changes and enhance surgical outcomes. In contrast to other protocols 9,36 , visualization of muscular activity via surface EMG biofeedback is a key element in the presented protocol.…”

Section: Discussionmentioning

confidence: 99%

Structured Motor Rehabilitation After Selective Nerve Transfers

Sturma¹,

Hruby²,

Farina³

2019

JoVE

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After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning. Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation. Video Link The video component of this article can be found at https://www.jove.com/video/59840/ 9 , movements associated with ulnar nerve activity (such as hand closing or ulnar abduction of the wrist) are used for the activation of the biceps muscle directly after re-innervation. However, exercises based on this approach can be performed in other body parts as well. If special considerations are necessary to implement this in other body parts (e.g., the lower extremity), this is pointed out within the protocol. Independent from the body part affected, therapy sessions should not exceed 30 min as muscles become easily fatigued shortly after reinnervation 8 and successful training requires a patient's full commitment and focus.

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Section: Discussionmentioning

confidence: 99%

Structured Motor Rehabilitation After Selective Nerve Transfers

Sturma¹,

Hruby²,

Farina³

2019

JoVE

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“…In this phase, EMG-biofeedback is introduced with the goal to reach a threshold determined as a percentage of the maximum volitional contraction, which is typically set at 50% 26. The threshold is gradually increased, as well as the number of repetitions, as the patient progresses 13,16…”

Section: Rehabilitation Following Nerve Transfermentioning

confidence: 99%

“…Functional activities are implemented with the use of MI, working on mentally replicating the various tasks patients need to return to. At this stage, exercises are transitioned to against gravity, and resistance is slowly introduced as patient improves 3,4,13,14,16,27,35…”

Section: Rehabilitation Following Nerve Transfermentioning

confidence: 99%

“…While protecting the nerve coaptation, patients are instructed in retrograde massage, use of compression stockings and positioning for edema control, and range of motion exercises to maintain mobility. 10,13 If, before surgery, patients used static progressive or dynamic orthoses to regain motion, or static or dynamic orthoses to facilitate function (eg, anti-claw orthosis for ulnar neuropathy, dynamic finger extension orthosis for radial nerve palsy), these may be reinstituted in this phase, as long as they do not impose tension on the neurorraphy.…”

Section: Phase 1: Protective Phasementioning

confidence: 99%

“…26 The threshold is gradually increased, as well as the number of repetitions, as the patient progresses. 13,16 Exercises in this phase are always performed in gravityeliminated positions, with or without the assistance of either dynamic-assist orthosis or sling/suspension systems, as seen in Figures 3 and 4, respectively. (At our center, the sling/ suspension system is made of fabric slings connected via ropes and carabiners to a suspended grid attached to the ceiling; details in Fig.…”

Section: Phase 3: Reeducation Phasementioning

confidence: 99%

See 2 more Smart Citations

Rehabilitation Following Nerve Transfer Surgery

Larocerie-Salgado¹,

Chinchalkar²,

Ross³

et al. 2021

Techniques in Hand &Amp; Upper Extremity Surgery

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Nerve transfer surgery is an important new addition to the treatment paradigm following nerve trauma. The following rehabilitation plan has been developed over the past 15 years, in an interdisciplinary, tertiary peripheral nerve program at the "Roth|McFarlane Hand and Upper Limb Centre." This center evaluates more than 400 patients with complex nerve injuries annually and has been routinely using nerve transfers since 2005. The described rehabilitation program includes input from patients, therapists, physiatrists, and surgeons and has evolved based on experience and updated science. The plan is comprised of phases which are practical, reproducible and will serve as a framework to allow other peripheral nerve programs to adapt and improve the "Roth|McFarlane Hand and Upper Limb Centre" paradigm to enhance patient outcomes.

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