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Donegan T, Ryan BE, Sanchez-Vives MV, Świdrak J. Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality. Front Hum Neurosci 2022; 16:1024910. [PMID: 36466621 PMCID: PMC9714822 DOI: 10.3389/fnhum.2022.1024910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/18/2022] [Indexed: 08/12/2023] Open
Abstract
Chronic neuropathic pain is highly disabling and difficult to treat and manage. Patients with such conditions often report altered bodily perceptions that are thought to be associated with maladaptive structural and functional alterations in the somatosensory cortex. Manipulating these altered perceptions using body illusions in virtual reality is being investigated and may have positive clinical implications for the treatment of these conditions. Here, we have conducted a narrative review of the evidence for the types of bodily distortions associated with a variety of peripheral and central neuropathic pain conditions. In addition, we summarize the experimental and clinical studies that have explored embodiment and body transformation illusions in immersive virtual reality for neuropathic pain relief, which are thought to target these maladaptive changes, as well as suggesting directions for future research.
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Affiliation(s)
- Tony Donegan
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Brenda E. Ryan
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria V. Sanchez-Vives
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Justyna Świdrak
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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2
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Abstract
BACKGROUND Patients with brachial plexus avulsion (BPA) usually experience phantom sensations and phantom limb pain (PLP) in the deafferented limb. It has been suggested that evoking the sensation of touch in the deafferented limb by stimulating referred sensation areas (RSAs) on the cheek or shoulder might alleviate PLP. However, feasible rehabilitation techniques using this approach have not been reported. OBJECTIVE The present study sought to examine the analgesic effects of simple electrical stimulation of RSAs in BPA patients with PLP. METHODS Study 1: Electrical stimulation of RSAs for 60 minutes was conducted for six BPA patients suffering from PLP to examine short-term analgesic effects. Study 2: A single case design experiment was conducted with two BPA patients to investigate whether electrical stimulation of RSAs was more effective for alleviating PLP than control electrical stimulation (electrical stimulation of sites on side opposite to the RSAs), and to elucidate the long-term effects of electrical stimulation of RSAs. RESULTS Study 1: Electrical stimulation of RSAs evoked phantom touch sensations in the deafferented limb, and significantly alleviated PLP (p < 0.05). Study 2: PLP was alleviated more after electrical stimulation on RSAs compared with control electrical stimulation (p < 0.05). However, the analgesic effects of electrical stimulation on RSAs were observed only in the short term, not in the long term (p > 0.05). CONCLUSIONS Electrical stimulation of RSAs not only evoked phantom touch sensation but also alleviated PLP in the short term. The results indicate that electrical stimulation of RSAs may provide a useful practical rehabilitation technique for PLP. Future studies will be required to clarify the mechanisms underlying immediate PLP alleviation via electrical stimulation of RSAs.
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Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Daisuke Shimizu
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yuki Nishi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
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Abstract
Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is a common chronic pain condition with major impact on quality of life. Examples include trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia, and central poststroke pain. Most patients complain of an ongoing or intermittent spontaneous pain of, for example, burning, pricking, squeezing quality, which may be accompanied by evoked pain, particular to light touch and cold. Ectopic activity in, for example, nerve-end neuroma, compressed nerves or nerve roots, dorsal root ganglia, and the thalamus may in different conditions underlie the spontaneous pain. Evoked pain may spread to neighboring areas, and the underlying pathophysiology involves peripheral and central sensitization. Maladaptive structural changes and a number of cell-cell interactions and molecular signaling underlie the sensitization of nociceptive pathways. These include alteration in ion channels, activation of immune cells, glial-derived mediators, and epigenetic regulation. The major classes of therapeutics include drugs acting on α2δ subunits of calcium channels, sodium channels, and descending modulatory inhibitory pathways.
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Affiliation(s)
- Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Rohini Kuner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
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Zink PJ, Philip BA. Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review. Am J Occup Ther 2020; 74:7401205030p1-7401205030p15. [PMID: 32078514 DOI: 10.5014/ajot.2020.036665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. Study Selection and Data Collectio : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.
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Affiliation(s)
- Patrick J Zink
- Patrick J. Zink, MSOT, is Occupational Therapist, Select Physical Therapy, Kansas City, MO. At the time of the study, he was Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Osumi M, Sano Y, Ichinose A, Wake N, Yozu A, Kumagaya SI, Kuniyoshi Y, Morioka S, Sumitani M. Direct evidence of EEG coherence in alleviating phantom limb pain by virtual referred sensation: Case report. Neurocase 2020; 26:55-59. [PMID: 31762364 DOI: 10.1080/13554794.2019.1696368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Virtual reality (VR) systems have been integrated into rehabilitation techniques for phantom limb pain (PLP). In this case report, we used electroencephalography (EEG) to analyze corticocortical coherence between the bilateral sensorimotor cortices during vibrotactile stimulation in conjunction with VR rehabilitation in two PLP patients. As a result, we observed PLP alleviation and increased alpha wave coherence during VR rehabilitation when stimulation was delivered to the cheek and shoulder (referred sensation areas) of the affected side. Vibrotactile stimulation with VR rehabilitation may enhance the awareness and movement of the phantom hand.
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Affiliation(s)
- Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Yuko Sano
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Akimichi Ichinose
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Naoki Wake
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Arito Yozu
- Center of Medical Science, Ibaraki Prefectural University of Health Science, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yasuo Kuniyoshi
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Pazzaglia M, Leemhuis E, Giannini AM, Haggard P. The Homuncular Jigsaw: Investigations of Phantom Limb and Body Awareness Following Brachial Plexus Block or Avulsion. J Clin Med 2019; 8:E182. [PMID: 30717476 DOI: 10.3390/jcm8020182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023] Open
Abstract
Many neuropsychological theories agree that the brain maintains a relatively persistent representation of one’s own body, as indicated by vivid “phantom” experiences. It remains unclear how the loss of sensory and motor information contributes to the presence of this representation. Here, we focus on new empirical and theoretical evidence of phantom sensations following damage to or an anesthetic block of the brachial plexus. We suggest a crucial role of this structure in understanding the interaction between peripheral and central mechanisms in health and in pathology. Studies of brachial plexus function have shed new light on how neuroplasticity enables “somatotopic interferences”, including pain and body awareness. Understanding the relations among clinical disorders, their neural substrate, and behavioral outcomes may enhance methods of sensory rehabilitation for phantom limbs.
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Pazzaglia M, Scivoletto G, Giannini AM, Leemhuis E. My hand in my ear: a phantom limb re-induced by the illusion of body ownership in a patient with a brachial plexus lesion. Psychological Research 2018; 83:196-204. [DOI: 10.1007/s00426-018-1121-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
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Pazzaglia M, Galli G, Lucci G, Scivoletto G, Molinari M, Haggard P. Phantom limb sensations in the ear of a patient with a brachial plexus lesion. Cortex 2018; 117:385-395. [PMID: 30293692 DOI: 10.1016/j.cortex.2018.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/22/2018] [Accepted: 08/25/2018] [Indexed: 12/18/2022]
Abstract
Referred phantom sensations are frequently reported following a peripheral injury. However, very few cases describe such sensations of the ear, and it remains unclear how the aural nerve territory can be remapped to one specific peripheral nerve region. We report on a patient with brachial plexus avulsion who underwent sensory testing and was asked to report the location of the stimulated site and any other sensations experienced. The patient spontaneously described the sensation of his arm being separate from his body. Despite visual input, he felt that his fist was closed, with his thumb pointing inward. Importantly, he felt clear and reproducible sensations from the affected arm when the ipsilateral ear was touched. These referred sensations were noted just 15 days after sustaining the injury. The arm nerve territory was systematically remapped to a specific aural nerve territory by applying both manual and electrical stimulation. Stimulation of the external ear, which is innervated by the vagus nerve, showed high spatial specificity for the dorsal and volar skin surfaces of the limb, and clearly delineated digits. Somatosensory-evoked potentials indicated that cortical adaptation in the somatosensory stream transferred a spatially organized map of the limb to the skin of the outer ear. This referral of sensations to the ear, as distinct from the face, provides evidence of highly specific topographical reorganization of the central nervous system following peripheral injury. Rapid map changes in the phantom sensation to the ear as a function of stimulation of vagus nerve suggest that the reorganization process can occur in cortex rather than in the brainstem.
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Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
| | | | - Giuliana Lucci
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
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Yuan Y, Xu XY, Lao J, Zhao X. Proteomic analysis of trans-hemispheric motor cortex reorganization following contralateral C 7 nerve transfer. Neural Regen Res 2018; 13:331-339. [PMID: 29557385 PMCID: PMC5879907 DOI: 10.4103/1673-5374.226429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Previous studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth associated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function (including neuron differentiation and development, axonogenesis, and guidance), microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light (NFL) and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteomic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer.
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Affiliation(s)
- Yin Yuan
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve & Microsurgery, Shanghai, China
| | - Xiu-Yue Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve & Microsurgery, Shanghai, China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve & Microsurgery, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve & Microsurgery, Shanghai, China
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Tihanyi BT, Ferentzi E, Beissner F, Köteles F. The neuropsychophysiology of tingling. Conscious Cogn 2017; 58:97-110. [PMID: 29096941 DOI: 10.1016/j.concog.2017.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/18/2022]
Abstract
Tingling is a bodily sensation experienced under a variety of conditions from everyday experiences to experimental and therapeutic situations. It can be induced by both peripheral or afferent (external stimulation, peripheral pathology) and higher cognitive (expectation) processes. The paper summarizes the current scientific knowledge on the neurophysiological and psychological concomitants of the tingling sensation. Four possible models are identified and presented: the afferent, the attention-disclosed, the attention-evoked, and the efferent model. Of these, only the attention-disclosed model, i.e., attention discloses the sensation by opening the gate for suppressed sensory information, appears to be able to explain every aspect of the tingling phenomenon. Terminological issues and the possible role of the tingling phenomenon in medically unexplained symptoms, nocebo and placebo reactions, and body-oriented therapeutic interventions are also discussed.
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Affiliation(s)
- Benedek T Tihanyi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary; Doctoral School of Psychology, ELTE Eötvös Loránd University, Hungary
| | - Eszter Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary; Doctoral School of Psychology, ELTE Eötvös Loránd University, Hungary
| | - Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
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Ichinose A, Sano Y, Osumi M, Sumitani M, Kumagaya SI, Kuniyoshi Y. Somatosensory Feedback to the Cheek During Virtual Visual Feedback Therapy Enhances Pain Alleviation for Phantom Arms. Neurorehabil Neural Repair 2017; 31:717-725. [DOI: 10.1177/1545968317718268] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Patients who suffer from phantom limb pain can perceive tactile stimuli applied to the cheek on their affected side as if it were coming from their phantom limb, a phenomenon called “referred sensation.” Objectives. To investigate the analgesic effect produced by tactile feedback provided to the cheek during neurorehabilitation using visual feedback. Methods. Nine participants with phantom upper limb pain performed virtual reality neurorehabilitation exercises in which they repeatedly touched a target object with a virtual representation of their affected limb. We applied tactile feedback to their cheek when their virtual affected limb touched a virtual object (Cheek Condition). We also included 2 control conditions where tactile feedback was either applied to their intact hand (Intact Hand Condition) or not applied at all (No Stimulus Condition). We evaluated pain intensity on an 11-point rating scale and pain quality using the short-form McGill Pain Questionnaire before and after each rehabilitation condition. Results. The median pain-reduction rate in the Cheek Condition (33.3 ± 24.4%) was significantly higher than in the Intact Hand Condition (16.7 ± 12.3%) and the No Stimulus Condition (12.5 ± 13.5%; P < .05). Even patients who did not feel referred sensations reported significant pain reduction after the Cheek Condition. Conclusions. The analgesic effect of neurorehabilitative visual feedback during phantom limb movement is significantly improved by applying somatosensory feedback to the cheek on the affected side. Further studies are needed to extend these findings to objective pain measures and to elucidate the neural mechanisms that underlie the analgesic effect.
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Affiliation(s)
| | - Yuko Sano
- The University of Tokyo, Tokyo, Japan
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Rosén B, Vikström P, Turner S, McGrouther DA, Selles RW, Schreuders TAR, Björkman A. Enhanced early sensory outcome after nerve repair as a result of immediate post-operative re-learning: a randomized controlled trial. J Hand Surg Eur Vol 2015; 40:598-606. [PMID: 25294735 DOI: 10.1177/1753193414553163] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 09/02/2014] [Indexed: 02/03/2023]
Abstract
We assessed the use of guided plasticity training to improve the outcome in the first 6 months after nerve repair. In a multicentre randomized controlled trial, 37 adults with median or ulnar nerve repair at the distal forearm were randomized to intervention, starting the first week after surgery with sensory and motor re-learning using mirror visual feedback and observation of touch, or to a control group with re-learning starting when reinnervation could be detected. The primary outcome at 3 and 6 months post-operatively was discriminative touch (shape texture identification test, part of the Rosen score). At 6 months, discriminative touch was significantly better in the early intervention group. Improvement of discriminative touch between 3 and 6 months was also significantly greater in that group. There were no significant differences in motor function, pain or in the total score. We conclude that early re-learning using guided plasticity may have a potential to improve the outcomes after nerve repair. LEVEL OF EVIDENCE II.
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Affiliation(s)
- B Rosén
- Department of Hand Surgery, Lund University, Malmö, Sweden
| | - P Vikström
- Department of Hand Surgery, Lund University, Malmö, Sweden
| | - S Turner
- University Hospital of South Manchester/University of Manchester, Manchester, UK
| | - D A McGrouther
- University Hospital of South Manchester/University of Manchester, Manchester, UK
| | - R W Selles
- Department of Plastic & Reconstructive Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T A R Schreuders
- Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - A Björkman
- Department of Hand Surgery, Lund University, Malmö, Sweden
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Osumi M, Okuno H, Nishigami T, Ueta K, Morioka S. Tactile localization training for pain, sensory disturbance, and distorted body image: a case study of complex regional pain syndrome. Neurocase 2015; 21:628-34. [PMID: 25274322 DOI: 10.1080/13554794.2014.961482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This report presents a case of complex regional pain syndrome. The patient presented with severe pain, sensory disturbance, and distorted body image at the site of initial injury and other body sites. Tactile localization training (TLT) at only the site of initial injury decreased severe pain at the site of initial injury and the secondary affected sites, whereas TLT at secondary affected sites had no effect. These results highlighted the importance of assessing changes in patients' pain processes to determine the part of the body where TLT should be applied.
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Affiliation(s)
- Michihiro Osumi
- a Department of Neurorehabilitation, Graduate School of Health Sciences , Kio University , Kitakatsuragi-gun, Nara , Japan
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14
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Birznieks I, Logina I, Wasner G. Somatotopic mismatch following stroke: a pathophysiological condition escaping detection. BMJ Case Rep 2012; 2012:bcr-2012-006304. [PMID: 23045439 DOI: 10.1136/bcr-2012-006304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical evaluation of somatosensory deficits in stroke patients is very limited and usually does not include testing of somatotopic organisation, which is a prerequisite for meaningful interpretation of sensory input and sensorimotor control. Detailed tactile testing of the left hand of a 54-year-old patient suffering from sensory deficit and central pain after a right-sided stroke revealed severe distortion of somatotopic sensory maps as evidenced by incorrect localisation of the point stimuli. Unlike previously reported gross somatotopic remapping taking place within reduced representational space after lesion, this is the first case report revealing chaotic scrambled somatosensory maps. While the incidence of such scrambled somatotopic representation of tactile input is not yet known in stroke patients, current observations indicate that in-depth investigations of somatotopic organisation of affected area may reveal the underlying cause for various functional deficits including central pain. Thus, new rehabilitation strategies may need to be developed specifically for such patients.
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Affiliation(s)
- Ingvars Birznieks
- School of Science and Health, University of Western Sydney, Penrith, New South Wales, Australia.
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Finnerup NB, Nikolajsen L, Jensen TS. Are we neglecting spinal reorganization following nerve damage? Pain 2012; 153:269-272. [DOI: 10.1016/j.pain.2011.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/20/2011] [Accepted: 10/21/2011] [Indexed: 10/15/2022]
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