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Sensory reeducation following peripheral nerve injury Mayumi Nakada 1 1Department of Occupational Therapy, School of Health and Social Services, Saitama Prefectural University Keyword: 末梢神経損傷 , 知覚検査 , 知覚再教育 , pp.633-639
Published Date 2003/8/10
DOI https://doi.org/10.11477/mf.1431100346
  • Abstract
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 The first published program of sensory reeducation following peripheral nerve repair was that of Wynn Parry in 1966. In 1974, Dellon presented a structured retraining program that defines sensory reeducation in terms of specific techniques to assist the sensory cortex in interpreting the altered profile in sensory impulses it receives after an intervention in the peripheral system.

 Sensory reeducation programs are based on the assumption that patient with a regenerating peripheral nerve begins to demonstrate less recovery than patient's potential. The reason for this underachievement is the patient's inability to interpret the altered impulses. This alteration in perception of precise touch occurs along the entire sensory pathway. At the periphery there are ①degeneration of receptors, ②reduction in nerve fibers, ③erroneous reinnervation, ④establishment of erroneous receptive fields, ⑤cross innervation, ⑥reduced conduction velocity, ⑦changes in sizes of receptive fields. Centrally, investigation has shown, there are ①abnormal receptive fields, ②abnormal topographical organization. Clinically, the patient demonstrates partial tactile sensitivity, poor ability to localize, and impaired ability to identify textures, forms and objects.

 The purpose of sensory reeducation is to correctly interpret pattern of abnormal sensory input. The goal is to increase cortical map representation for involved skin surfaces to improve spatial discrimination. The timing for the programs is determined by the pattern of sensory recovery.

 The most common sensory reeducation programs utilized in hand rehabilitation following a nerve injury are ①correction of faulty localization:the goals are to reeducate specific perception and relearn how to identify the difference between moving touch and constant touch, and pressure, and correction of false localization, ②recognition of materials and objects:the goal is the recovery of functional tactile gnosis.

 Exercises should be graded beginning with the discrimination of larger objects, with greater differences among them in size, shape, texture and weight, progressing to more subtle differences. As the patient improves, more difficult program, such as correction of the pattern of prehension in the hand, control of precise force for grasping objects and maintenance of grasping force during movement of more proximal joints are introduced.

 In reporting results of sensory reeducation, they have demonstrated that patients undergoing a formal program achieved a higher level of functional sensation in less time than those not engaged in retraining.


Copyright © 2003, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1243 印刷版ISSN 0001-8724 医学書院

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