Dissertation committee:
Παναγιώτης Παπαγγελόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Σπυρίδων Πνευματικός, Καθηγητής, Ιατρική, ΕΚΠΑ
Όλγα Σαββίδου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Ανδρέας Μαυρογένης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Ιωάννης Βλάμης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Βασίλειος Κοντογεωργάκος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Δημήτριος Μαστρόκαλος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
It is well known that neurological injuries are really serious situations for the patients and particularly intractable problems for the therapists, as they result in dysfunction of various extent, regardless of the treatment. Restoration of the neurological injuries has been a subject of study in the scientific community .Progress in microsurgery technique has offered the opportunity of significant improvement in the restoration of the neurological injuries of the peripheral nerves, while at the same time various studies in different fields of the nervous system have shown many unknown aspects of the structure and function of the peripheral and central nervous system in the microscopic, cellular or molecular level.
However, the neurological injuries and their restoration are still a field of study and discussion among scientists.
Regarding neurological injuries with sensory loss, it is widely accepted that these kind of damage is serious, with many intense, dysfunctional problems for the patients despite the fact that the nerve has been restored. In particular, Median nerve injuries cause great loss of the functionality of the hand, since it is known that the hand functions properly only if it can “see”. That is, when its sensory ability is intact.
The nerve treatment restores the sensory ability of the hand, but the part of the brain that processes information has been disorganized, resulting in the loss of recognition and correlation of the stimuli of the hand. For the restoration of the functional sensibility of the hand, the following idea has been proposed: re-educating the central brain using different techniques in order to fully restore the sensibility in a methodical way.
The purpose of this study is to evaluate the functional outcome of patients with microsurgical repair of low median nerve complete transection and to compare the sensory outcomes in patients with, or without sensory re-education. 52 patients were studied with average age 36 years, with low median nerve complete transection in the wrist or dial forearm and epineural repair. Other damages of the hand were restored primarily at the same time. Postoperatively, a splint was used for four weeks for immobilization. After this time, the patients followed physical therapy for a month to restore motion. The mobility and muscle strength of the hand was restored in all the patients. Tinel’s sign was used as a prognostic sign to evaluate the progression of nerve regeneration that was integrated in 3-4 months after surgery. After regeneration, the patients were randomly divided into 2 groups. Group A patients were rehabilitated having taken part in a sensory re-education program, while group B patients had no further treatment.
Clinical evaluation took place at the time of 18Months, 36M, 72M after surgery and included the locognosia, (localization test) and the static and moving 2-point discrimination test, as well as Moberg’s pick-up test.
The statistical analysis showed that there was no significant difference between the two groups regarding the static 2-point discrimination and the Moberg’s pick-up test at all the three stages of evaluation (ANOVA).
Regarding the moving 2-point discrimination, the statistical analysis at 18M, showed statistical trend in group A, but there was no significant difference at the evaluation of 36M and 72M.( x2-test)
Also, statistical trend in group A showed regarding the Moberg’s Pick-up test. (x2-test).
However, the statistical analysis showed significant difference regarding locognosia. (ANOVA and x2-test).
In conclusion, sensory re-education of the hand offers people the ability to develop the functional sensibility to the greatest extent, in shorter time especially as far as locognosia is concerned.
Necessity of the daily use of the hand works for the benefit of the reorganization of the brain through time, resulting in the gradual restoration of the functional sensibility of the hand satisfactorily.
This depends among others, on the habits, the profession or other activities of the patients. The further continual reorganization of the brain can last up to 6 years after the neurological repair.
For all these reasons, sensory re-education after low Median nerve complete transection and repair is considered essential, as it seems to increase the ability of locognosia significantly.
Keywords:
Sensory re-education, Median nerve, Microsurgery, Hand, Brain
