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Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.

by RosÃ©n B, Lundborg G
Journal of hand surgery (Edinburgh, Lothian)

Article Abstract:

The "Sensor Glove System" offers an alternate afferent inflow from the hand early after nerve repair in the forearm, mediated through the hearing sense, implying that deprivation of one sense can be compensated by another sense. This sensory "by-pass" was used early after repair of the median nerve with the intention of improving recovery of functional sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. In a prospective multicentre clinical study, one group (n=14) started early after surgery with sensory re-education using the Sensor Glove System and the control group (n=12) received conventional sensory re-education, starting 3 months postoperatively. The patients were checked regularly during a 1-year period, with focus on recovery of tactile gnosis. After 12, months, tactile gnosis was significantly better in the Sensor Glove System group. This highlights the timing for introduction of training after nerve repair, focusing on the importance of immediate sensory re-learning.

Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.

By: Anonymous - Tue 2/27/2007 PM

This non-blinded, randomized study investigated the effect a â€œsensor gloveâ€ had on sensory outcomes at 12-months in patients with surgically repaired nerve injuries in the forearm. It included 30 patients from 6 centers in Sweden over an 18-year period. Four patients were lost to follow-up. All patients started conventional visual-tactile sensory re-education at 3 months, however, the experimental group also underwent auditory-tactile re-education using the sensor glove during the first three months (i.e., before sensation returned). The sensor glove had numerous small microphones that transmitted sounds from different textures to headphones. The premise was that auditory stimuli localized to the hand wound perhaps maintain the somatosensory cortical map, and thereby optimize subsequent re-education. The experimental group demonstrated statistically improved tactile gnosis using the shape-texture identification test (STI), but not with static 2-point discrimination.

Concerns with this study: Only the control group included patients with simultaneous median and ulnar nerve injuries (33%) (Does dual injury further promote somatosensory disorganization after injury, possibly leading to a worse outcome?). The ranges of STI test outcomes in both groups overlapped; this in conjunction with the small number of patients in each group brings up the possibility of statistical error (in either direction). Also, I was curious if the follow-up STI testing was performed with earplugs, so as to prevent auditory identification in the â€œtrainedâ€ experimental group. Nevertheless, the results appear real (having a strong p value): meaning the authorâ€™s novel premise and treatment approach may improve outcomes. Both larger clinical studies, as well as an fMRI study demonstrating that the sensor glove in fact preserves (at least to some degree) the somatosensory cortical map after nerve repair, are indicated.

Source: http://peripheralnervesurgery.blogspot.com/in...

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