Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

Mayara H Paula, Rafael I Barbosa, Alexandre M Marcolino, Valéria M C Elui, Birgitta Rosén, Marisa C R Fonseca, Mayara H Paula, Rafael I Barbosa, Alexandre M Marcolino, Valéria M C Elui, Birgitta Rosén, Marisa C R Fonseca

Abstract

Background: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results.

Objective: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair.

Method: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention.

Results: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed.

Conclusion: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Trial registration: ClinicalTrials.gov NCT01215760.

Figures

Figure 1. - (A) Mirror placed in…
Figure 1. - (A) Mirror placed in front of the patient with tactile stimuli with textures on the first post operative week for the Mirror Therapy group; (B) Mirror placed in front of the patient with tactile stimuli with textures after cast removal for the Mirror Therapy group.
Figure 2. - Flowchart of the group…
Figure 2. - Flowchart of the group randomization of the RCT

References

    1. Rosberg HE, Carlsson KS, Dahlin LB. Prospective study of patients with injuries to the hand and forearm: costs, function, and general health. Scand J Plast Reconstr Surg Hand Surg. 2005;39(6):360–369.
    1. Jaquet J-B, Luijsterburg AJM, Kalmijn S, Kuypers PDL, Hofman A, Hovius SER. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma. 2001;51(4):687–692.
    1. Lundborg G. Brain plasticity and hand surgery: an overview. J Hand Surg [Br] 2000;25(3):242–252.
    1. Plüss NG, Hufschmid U, Santschi L, Grünert J. Mirror therapy in hand rehabilitation: a review of the literature, the st gallen protocol for mirror therapy and evaluation of a case series of 52 patients. Hand Ther. 2008;13:4–11.
    1. Rosen B, Lundborg G. Enhanced sensory recovery after median nerve repair using audio-tactile interaction. A randomized multicenter study. J Hand Surg Eur. 2006;32(1):31–37.
    1. Rostami HR, Arefi A, Tabatabaei S. Effect of mirror therapy on hand function in patients with hand orthopaedic injuries: a randomized controlled trial. Disabil Rehabil. 2013;35(19):1647–1651.
    1. Deconinck FJA, Smorenburg AR, Benham A, Ledebt A, Feltham MG, Savelsbergh GJ. Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair. 2015;29(4):349–361.
    1. Rosén B, Lundborg G. Early use of artificial sensibility to improve sensory recovery after repair of the median and ulnar nerve. Scand J Plast Reconstr Surg Hand Surg. 2003;37(1):54–57.
    1. Rosén B, Lundborg G. Training with a mirror in rehabilitation of the hand. Scand J Plast Reconstr Surg Hand Surg. 2005;39(2):104–108.
    1. Svens B, Rosen B. Early sensory re-learning after median nerve repair using mirror training and sense substitution. J Hand Ther. 2009;14(3):75–82.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148(4):60–66.
    1. Vordemvenne T, Langer M, Ochman S, Raschke M, Schult M. Long-term results after primary microsurgical repair of ulnar and median nerve injuries. A comparison of common score systems. Clin Neurol Neurosurg. 2007;109(3):263–271.
    1. Rabelo RB, Fonseca MCR, Mazzer N, Elui VMC, Barbieri CH. Mobilidade articular dos dedos não lesados pós-reparo em lesão dos tendões flexores da mão. Rev Bras Fisioter. 2007;11(5):377–382.
    1. Rosén B. "Sensory re-education" after nerve repair. Sweden: Department of Hand Surgery, Malmö University Hospital; 2006.
    1. Rosén B, Lundborg G. A model instrument for the documentation of outcome after nerve repair. J Hand Surg Am. 2000;25A(3):535–543.
    1. Lundborg G, Rosén B. Hand function after nerve repair. Acta Physiol (Oxf) 2007;189(2):207–217.
    1. Bell-Krotoski J. Skirven TM, Lee Osterman A, Fedorczyk J, Amadio PC. Rehabilitation of the hand and upper extremity. 6th . St. Louis: Mosby; 2011. Sensibility testing with the Semmes-Weinstein monofilaments; pp. 132–151.
    1. Rosén B, Lundborg G. A new tactile gnosis instrument in sensibility testing. J Hand Ther. 1998;11(4):251–257.
    1. Rosén B. Inter-tester reliability of a tactile gnosis test: the STI-test. Br J Hand Ther. 2003;8(3):98–101.
    1. Moberg E. Two-point discrimination test: a valuable part of hand surgical rehabilitation, e.g. in tetraplegia. Scand J Rehabil Med. 1990;22(3):127–134.
    1. Sollerman C, Ejeskär A. Sollerman hand functional test: a standardized method and its use in tetraplegic patients. Reconstr Surg Hand Surg. 1995;29(2):167–176.
    1. Orfale AG, Araújo PMP, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the disabilities of the arm, shoulder and hand questionnaire. Braz J Med Biol Res. 2005;38(2):293–302.
    1. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–159.
    1. Rosén B, Lundborg G. The long-term recovery curve in adults after median or ulnar nerve repair: a reference interval. J Hand Surg [Br] 2001;26(3):196–200.
    1. Novak CB, Anastakis DJ, Beaton DE, Katz J. Patient-reported outcome after peripheral nerve injury. J Hand Surg Am. 2009;34(2):281–287.
    1. Callahan AD. Skirven TM, Lee Osterman A, Fedorczyk JM, Amadio PC. Rehabilitation of the hand and upper extremity. 6th . St. Louis: Mosby; 2011. Sensibility assessment for nerve lesions in continuity and nerve lacerations; pp. 65–88.
    1. Jerosch-Herold C. Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness. J Hand Surg [Br] 2005;30(3):252–264.
    1. Dellon AL. A numerical grading scale for peripheral nerve function. J Hand Ther. 1993;6(2):152–161.
    1. Novak CB, von der Heyde RL. Evidence and techniques in rehabilitation following nerve injuries. Hand Clin. 2013;29(3):383–392.
    1. Jerosch-Herold C. Sensory relearning in peripheral nerve disorders of the hand: a web-based survey and delphi consensus method. J Hand Ther. 2011;24(4):292–299.
    1. Rosén B, Bjorkman A, Boeckstyns M. Differential recovery of touch thresholds and discriminative touch following nerve repair with focus on time dynamics. Hand Ther. 2014;19(3):59–63.
    1. Miller LK, Chester R, Jerosch-Herold C. Effects of sensory reeducation programs on functional hand sensibility after median and ulnar repair: a systematic review. J Hand Ther. 2012;25(3):297–207.
    1. Rosén B, Vikström P, Turner S, McGrouther DA, Selles RW, Schreuders TA. Enhanced early sensory outcome after nerve repair as a result of immediate post-operative re-learning: a randomized controlled trial. J Hand Surg [Br] 2014;7:1–9.
    1. Anastakis DJ, Malessy MJA, Chen R, Davis KD, Mikulis D. Cortical plasticity following nerve transfer in the upper extremity. Hand Clin. 2008;24(4):425–444.
    1. Gurbuz H, Aktas S, Calpur OU. Clinical evaluation of ulnar nerve repair at wrist level. Arch Orthop Trauma Surg. 2004;124(1):49–51.
    1. Fonseca MCR, Mazzer N, Barbieri CH, Elui VMC. Hand injuries: a retrospective study. Rev Bras Ortop. 2006;41:181–186.
    1. Lundborg G, Rosen B, Dahlin J, Holmberg J, Rosen I. Tubular repair of the median or ulnar nerve in the human forearm: a 5 year follow up. J Hand Surg [Br] 2004;29(2):100–107.
    1. Abraha I, Cherubini A, Cozzolino F, De Florio R, Luchetta ML, Rimland JM. Deviation from intention to treat analysis in randomized trials and treatment effect estimates: meta-epidemiological study. BMJ. 2015;350:h2445–h2445.
    1. Foley NC, Zettler L, Salter KL, Bhogal SK, Teasell RW, Speechley M. In a review of stroke rehabilitation studies, concealed allocation was under reported. J Clin Epidemiol. 2009;62(7):766–770.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner