Hand Therapy > Volume 14, Number 3 > Pp. 75-82

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Early sensory re-learning after median nerve repair using mirror training and sense substitution

Birgit Svens ^*  and Birgitta Rosén 

^* Occupational Therapy Department, Royal Adelaide Hospital, Adelaide, Australia; Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden

Correspondence: Birgit Svens, Occupational Therapy Department, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email: birgit.svens{at}health.sa.gov.au

Background. The design and protocol of sensory re-education programmes has not changed over the last decades – a fact that may appear surprising when considering the enormous advances in neuroscience, cognitive science and brain imaging techniques that have increased our understanding of brain plasticity. A multitude of intrinsic and extrinsic factors influence the functional outcome after a nerve repair. Timing of when the sensory re-learning is begun is one of them.

Methods. Here we present a case following median nerve repair, where sensory re-education was introduced in the second week following surgery, i.e. long before any signs of nerve regeneration in the hand and fingers (Phase 1 sensory re-learning). The aim was to activate and maintain the cortical hand representation areas for median nerve innervated parts of the hand. Mirror training and a new method with auditory input that substitute temporary missing sensory input were used. For evaluation, the Model Instrument for Outcome after Nerve Repair was utilized.

Results. There was an improvement in overall score especially in the sensory domain of the Model Instrument for Outcome after Nerve Repair over the 25 months and this exceeded the upper limit of the 95% reference interval for an adult population.

Conclusions. The excellent outcome in this case adds to other studies indicating that very early introduction of sensory re-learning can greatly enhance the outcome following nerve repair.

Key Words: Nerve repair • brain plasticity • mirror training • audio-tactile interaction

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