Rehabilitation Following Peripheral Nerve Injury

Abstract

The impact of a peripheral nerve injury (PNI) on an individual’s function ranges from moderate and temporary to significant and life changing, depending upon the severity and location of the injury and patient-specific factors. The functional loss that results from a PNI can be sensory, motor or sensory, and motor in nature. The quality of life (QoL) for these patients is substantially reduced with approximately 25% of patients still out of the workforce 1.5 years after surgery (as cited by Davis et al. [5]). Not only do patients lose function, unfortunately they may also gain function in the form of persistent pain, hyperesthesia, hyperalgesia, or allodynia. Rehabilitation following injury to a peripheral nerve is essential to optimize function and outcomes. Clinical studies have demonstrated that patients that receive hand therapy tailored to their needs have better outcomes, for example, for sensory function, than patients that do not receive treatment [3, 17]. Rehabilitation of PNI in the upper extremity is performed by occupational and physical therapists; many of these therapists have the additional qualification of “hand therapist,” which indicates additional training in this specialty practice area of both professions. Worldwide, there are about 8500 therapists that practice “hand therapy” [9]. The hand therapist tailors the treatment in response to the functional loss that the patient presents with. Not only functional loss will be addressed in therapy. The so-called gain in function, mainly in sensory input as hyperesthesia, hyperalgesia, or allodynia, will be addressed in therapy as well. Thus, the course of therapy may be highly variable between patients: some need functional therapy and intense sensory rehabilitation, and for others afflicted with intense pain, pain treatment and education about pain management will be given a greater priority in therapy.