Effects of Motor Learning After Upper Limb Peripheral Nerve Injury

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effects of Motor Learning After Upper Limb Peripheral Nerve Injury

Conditions
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Peripheral Nerve Injury at Forearm Level (Diagnosis)

Intervention / Treatment
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* Other: conventional physical therapy
* Other: mirror therapy


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: experimental group<br>conventional physical therapy with mirror therapy | Other: conventional physical therapy<br>* 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, sensory relearning<br>Other: mirror therapy<br>* mirror therapy<br>|
| Active Comparator: control group<br>conventional physical therapy | Other: conventional physical therapy<br>* 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, sensory relearning<br>|

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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peripheral nerve injury, motor learning, mirror therapy, physical therapy