Peripheral Nerve Regeneration after Injury and Rehabilitation Managements.

Abstract

Peripheral nerves have a potency to regenerate vigorously after injury, but often it is difficult to achieve a sufficient functional recovery. Although advances in microsurgery and a better understanding of nerve regeneration have improved the outcomes of nerve repair, a delayed and misdirected reinnervation still be a problem hindering functional restoration. Rehabilitation managements of peripheral nerve injury, such as electrical stimulation, exercise training and other approaches, have been in clinical use, but their effects on promoting reinnervation remain controversial. In this paper we review the basic studies which have investigated the mechanisms and efficacies of electrical stimulation , exercise training and motor/sensory reeducation. Electrical stimulation could elicit effects on the regenerated nerves, but inappropriate stimulation conditions might disturb regeneration. Exercise training often improves functional recovery after nerve injury, but overloaded and forced exercise might have a detrimental effect. The peripheral axonal misdirection is reflected in a cortical reorganizational changes. Some studies have revealed beneficial changes in the cortical map after motor/sensory reeducation programs in monkeys with nerve injury, which may explain the improved functional outcomes after rehabilitation in humans. Key words:-•½ •_ OEo •Ä • ¶(peripheral nerve regeneration), ƒŠƒn ƒr ƒŠ ƒe •[ ƒV ƒ bilitation), "d ‹C Žh OEƒ(electrical stimulation), ‰^ "®-Ã-@(exercise t ing), 'm Šo •Ä ‹³ˆç‹³ˆç(sensory reeducation) ‚Í ‚ ¶ ‚ß ‚É-•½•_ OEo'¹••OE㠂ɂ͉ •· ‚È•_OEo•Ä• ¶ ‚ª‹N ‚±‚é ‚± ‚AE‚ª'm ‚ç‚ê ‚Ä‚¢ ‚邪, ‹@"\ ‰ñ•oe ‚ɂ‚¢‚Ä ‚Í-ž'« ‚Å ‚«‚éOE‹‰Ê ‚Å‚È‚¢ ‚± ‚AE‚ª '½‚¢. ‚»‚ÌOE´ˆö‚»‚ÌOE´ˆö ‚AE‚µ‚Ä•Ä • ¶ ‚Ì'x ‰" ‚â•s •³ Šm•«(‰ß OEë •_ OEo Žx"z)‚ª ‹" ‚° ‚ç‚ê ‚é. ‚±‚ê ‚ç‚Ì-â'è"_ ‚É'Î ‚µŠî'b ƒOEƒx ƒ‹‚Å ‚Í, •_ OEo •Ä • ¶ •E •L'· ‚ð'£•i‚· ‚éˆöŽq ‚Ì"¯'è ‚â, •W "I"Á ˆÙ•« ‚ÉŠÖ‚· ‚éOE¤‹ † ‚ª•Ï‹É "I ‚É•s‚í ‚ê, ˆê•"-Õ•° ‚Å ‚à‰ž-p ‚³‚ê‚Á ‚‚ ‚é. ˆê•û, •¨-•-Ã-@, ‰^"®-Ã-@ ‚AE‚¢ ‚Á‚½ ƒŠƒn ƒrƒŠƒe•[ ƒV ƒ ‡ƒ"(ˆÈ ‰º, ƒŠƒn)"I Žè'i ‚ª •_ OEo•Ä• ¶ ‚É-L-˜ ‚Å ‚ ‚é‚©"Û‚© ‚ɂ‚¢‚Ä ‚͈ê'è ‚µ‚¾ OE© ‰ð‚ª"¾ ‚ç‚ê‚Ä‚¨‚炸,‚ç‚ê‚Ä‚¨‚炸,-Õ•°•ê-Ê ‚Å ‚Í"ñŽŸ"I •áŠQ-\-h ‚Ì‚½‚߂̊֕߉Â"®ˆae OEP-û‚â'•‹ï ‚̕앬 ‚È ‚Ç‚Ì ‰î"ü‚ª ' †•S ‚AE‚È‚Á‚Ä‚¢ ‚é. ‚» ‚±‚Å-{•e ‚Å ‚Í, •¨-•-Ã-@(Žå ‚É"d ‹CŽh OEƒ), ‰^ "®-Ã-@, ‚¨‚ae‚Ñ‚¨‚ae‚Ñ' †•• •« 'ã •ž ‚AE‚µ‚Ä‚Ì‹Ø•Ä‹³ˆç ‚â'mŠo•Ä‹³ˆç ‚ª,-•½•_ OEo '¹••OEã ‚Ì•_OEo•Ä• ¶ ‚AE‚»‚Ì‹@"\ ‰ñ•oe ‚É-^ ‚¦ ‚é‰e ‹¿ ‚É ŠÖ ‚µ‚Ä, Šî'b "I‚È•ñ•• ‚ð' †•S ‚É‚Ü ‚AE‚ß,-Õ•° ‰ž-p 2002"N4OEŽ2"ú Žó •e *1•ì •è Žs-§ •ì •è •a ‰@ ƒŠƒn ƒr ƒŠ ƒe •[ ƒV ƒ ‡ ƒ"‰È/• §210-0013•_ "Þ •ì OE § •ì •è Žs •ì •è ‹ae •V •ì 'Ê12-1 Department of Rehabilitation, Kawasaki Municipal Hospital *2OEc 'é ‹` •m 'å ŠwˆãŠwˆã Šw •" ƒŠƒn ƒr ƒŠ ƒe •[ ƒV ƒ ‡ ƒ" ˆã Šw ‹³ Žº/• §160-8582"OE ‹ž "s