Masterclass handtherapie 'Brain and hand'

Hand and brain - an evidence-based rehabilitation approach to peripheral nerve injuries

This masterclass presents an evidence-based management of peripheral nerve injuries (PNI) based on neuroscientific research on the interaction between the hand and the brain from day one after an injury. Knowledge about the effect of a peripheral nerve injury on the CNS opens new perspectives to treatment by guided plasticity where rapid as well as slow plasticity mechanisms can be used therapeutically to support and improve function.

The brain has a tremendous capacity to undergo plastic reorganization and adapt, i.e. plasticity, due to environmental changes or injury. The plastic capacity decreases with age but is never lost. Following a peripheral nerve injury there is a within minutes-hours reorganization. Due to misdirection of regenerating axons the signalling from the hand to the brain is changed, resulting in a second line of reorganization in the brain. With the early and later reorganization in mind, the rehabilitation should also be divided in an initial period, phase 1, where no afferent signals are sent from the injured nerve to the brain. Phase 2 starts when axons have re-innervated their mechanoreceptors and muscles. The goal of relearning is to improve sensory and motor function by using the dynamic capacity of the brain, and it is thus our belief that the relearning should start immediately after nerve repair – in phase 1.