The Role of Cortical Reorganization in Nerve Transfers
摘要
Cortical plasticity refers to the brain’s inherent ability to modify its functional and structural neural organization based on internal and external influences such as sensorimotor learning, age, injury, and recovery. Following nerve transfer surgery, cortical reorganization can be considered both a process and an outcome of rehabilitation. Remapping at the cortical level is required for the donor muscle to obtain motor control over recipient muscle. Therapists may employ various strategies to increase cortical plasticity, therefore improving patient learning and skill acquisition following upper extremity nerve transfer. Strategies include graded motor imagery, sensory reeducation, bilateral movements, biofeedback, and neuromuscular electrical stimulation. Therapists should be familiar with contraindications associated with electrical modalities. Higher-level research is needed to provide guidelines and demonstrate the effectiveness of neuromuscular feedback devices on patient outcomes in the brachial plexus population.