Effects of Motor Learning After Upper Limb Peripheral Nerve Injury

Not Applicable

Completed

• Conditions: Peripheral Nerve Injury at Forearm Level (Diagnosis)
• Interventions: Other: conventional physical therapy; Other: mirror therapy

• Registration Number: NCT04087577
• Lead Sponsor: Chang Gung Memorial Hospital

Brief Summary

The outcome of peripheral nerve injury is related to age, level of injury, the injured nerve, the severity of injury, and the timing and the type of surgery interventions. In addition, high-level peripheral nerve injury would not full recovery, and the prognosis is determined by the nerve regeneration.

Conventional physical therapy includes electrical stimulation for denervated muscles, and soft tissue massage, joint range of motion exercises to maintain the flexibility of the affected joint, muscle or connected tissues. However, the nerve regeneration takes several months in high-level median, ulnar or radial nerve injury. Prolonged median or ulnar nerves injury may interfere intrinsic muscular function, and radial nerve injury causes drop hand. Earlier nerve regeneration or motor training is essential for the patients to return to normal life and increase their quality of life

Detailed Description

The outcome of peripheral nerve injury is related to age, level of injury, the injured nerve, the severity of injury, and the timing and the type of surgery interventions. In addition, high-level peripheral nerve injury would not full recovery, and the prognosis is determined by the nerve regeneration.

Conventional physical therapy includes electrical stimulation for denervated muscles, and soft tissue massage, joint range of motion exercises to maintain the flexibility of the affected joint, muscle or connected tissues. However, the nerve regeneration takes several months in high-level median, ulnar or radial nerve injury. Prolonged median or ulnar nerves injury may interfere intrinsic muscular function, and radial nerve injury causes drop hand. Earlier nerve regeneration or motor training is essential for the patients to return to normal life and increase their quality of life. This research aims to explore the effects of mirror therapy for peripheral nerve injury. We will enroll 60 patients who suffer from median, ulnar or radial nerve injury at the level of elbow or proximal forearm. The subjects will be randomized into the mirror-therapy group or the control group. Each group will receive conventional physical therapy (i.e., electrical stimulation, joint range of motion exercise, muscle strengthening training, sensory reeducation training). The mirror-therapy group would be supplemented by motor learning by mirror therapy. The measurements include joint range of motion, pain status, sensibility, grip strength, pinch strength, hand function test and the Disabilities of the Arm, Shoulder and Hand (DASH). Demographic information will be collected and analyzed by the independent t-tests. The outcome variables taken during the three and six months after the interventions would be included. One-way ANOVA are used to compare the difference between measurements. This study may offer an evidence based results to explore the effects of mirror therapy for peripheral nerve regeneration and motor learning.

Study Timeline

• Study First Submitted: 2019-08-26
• Study First Submitted QC: 2019-09-11
• Study First Posted: 2019-09-12
• Study Start: 2019-12-19
• Status Verified: 2020-07
• Primary Completion: 2021-02-28
• Study Completion: 2021-02-28
• Last Update Submitted: 2021-07-29
• Last Update Posted: 2021-08-02

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 8

Inclusion Criteria

• Willing to sign the inform consent
• Sufficiently communicate in the Chinese language
• Be able to follow instructions
• Newly median, ulnar, or radial nerve repair at forearm level in recent 3 weeks

Exclusion Criteria

• Pregnant or breast-feeding woman
• Central nervous disease
• A history of nerve entrapment syndrome in recent 1 year
• Patients with a history of latent neuropathy, such as diabetes, dialysis, and tumor
• Unable to communicate or comprehend the questionnaires

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
experimental group	mirror therapy	conventional physical therapy with mirror therapy
control group	conventional physical therapy	conventional physical therapy
experimental group	conventional physical therapy	conventional physical therapy with mirror therapy

Primary Outcome Measures

Name	Time	Method
change from baseline in Semmes-Weinstei monofilaments (SWM) at 3 and 6 months	baseline, 3 months, 6 months	force in grams
change from baseline in grip power at 3 and 6 months	baseline, 3 months, 6 months	grip power in kilograms
change from baseline in two-point discrimination (2PD) at 3 and 6 months	baseline, 3 months, 6 months	S0-4, higher score indicates better outcome

Secondary Outcome Measures

Name	Time	Method
functional MRI activation	3 months	movement and sensory tests to calcuate z-score by software
change from baseline in upper-extremity functional outcomes at 3 and 6 months	baseline, 3 months, 6 months	The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire ranges from 0-100. Lower score indicates better outcomes.
Minnesota rate of manipulation tests	baseline, 3 months and 6 months	Manipulation tests in seconds
Purdue Pegboard Test	baseline, 3 months and 6 months	Manipulation tests in seconds

Trial Locations

Locations (2)

Department of Plastic and Reconstructive Surgery Rehabilitation Center, Chung Gung Memorial Hospital; 🇨🇳 Taoyuan, Taiwan

Chang Gung Memorial Hospital; 🇨🇳 Taoyuan, Taiwan