Sensory Re-Education after Nerve Repair: Aspects of Timing

Zusammenfassung

Die Wiederkehr der funktionellen Sensibilität nach Nervendurchtrennung und -wiederherstellung ist oft unbefriedigend. Hier setzen wir den Zeitpunkt für das Wiedererlernen der Sensorik an, was ein Wiedererlernen und Modulieren des veränderten sensorischen Kodes aus der Hand nach einer derartigen Verletzung beinhaltet. Ein derartiges Training benutzt die Fähigkeit für das kortikale funktionelle Re-Modelling, das sowohl beim jugendlichen als auch beim erwachsenen Gehirn vorhanden ist. Das sensorische Wiedererlernen wird traditionell nicht eingesetzt, bevor nicht die Reinnervation der Hand erfolgt ist, und dieser späte Beginn des Trainings kann ein erklärender Faktor für die schlechten funktionellen Ergebnisse nach Nervenreparatur sein. Da die funktionellen Veränderungen der Reorganisation des Kortex nach den Veränderungen des peripheren Inputs sehr schnelle Prozesse sind, nehmen wir an, dass diese spezifische Intervention sehr früh in der Rehabilitationsphase eingesetzt werden sollte - schon in der Initialphase nach der Nervenreparatur, wenn noch keine Axone die asensible Hand erreicht haben. Das Ziel besteht darin, die zentrale funktionelle Reorganisation, die auf eine De-Afferenzierung in Verbindung mit einer Nervenverletzung und -reparatur erfolgt, zu vermeiden, zu minimieren und zu modulieren. Diese frühzeitige Intervention kann durch den Einsatz einer künstlichen Sensibilität bereits am ersten postoperativen Tag erfolgen. Entsprechend dieser Technik, die auf Sinnesunterstützung und dem Einsatz der multimodalen Fähigkeit des Gehirns beruht, nehmen Miniaturmikrophone an den Fingerspitzen der asensiblen Hand das Reibegeräusch auf, das durch die aktive Berührung erzeugt wird. Diese vibro-taktilen Signale werden stereophon in vibro-akustische Signale umgewandelt und führen so zu einem alternativen Feedback, der hypothetisch helfen soll, die kortikale Projektion der Hand zu erhalten oder wiedereinzurichten.

Abstract

The recovery of functional sensibility after nerve transection and repair is often disappointing. Here we address the timing of sensory re-education that aims at re-learning and modulating the changed sensory code from the hand after such an injury. Such training utilises the capacity for cortical functional re-modelling which characterises the young as well as the adult brain. Sensory re-education is traditionally not introduced until there is reinnervation in the hand, and such a late onset of training may be one explanatory factor for the poor functional results after nerve repair. Since functional reorganisation changes of the cortex occurring after changes in peripheral input are very fast processes, we suggest that this specific intervention should be introduced very early in the rehabilitation phase - already in the initial phase after nerve repair when no axons have yet arrived to the asensible hand. The goal is to avoid, minimise and modulate the central functional re-organisation which follows the de-afferentiation associated with nerve injury and repair. This early intervention can be done with the use of artificial sensibility the first post-operative day. According to this technique, based on sense substitution and utilising the multimodal capacity of the brain, miniature microphones on the fingertips of the asensible hand pick up the friction sound generated by active touch. The vibro-tactile signals are stereophonically transposed to vibro-acoustic signals, thereby providing an alternate feed-back which hypothetically helps to maintain or re-establish the cortical hand map.

Nervenreparatur - funktionelle Sensibilität - sensorisches Wiedererlernen - künstliche Sensibilität

Nerve repair - functional sensibility - sensory re-education - artificial sensibility

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