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Sensory Reeducation

Sensory reeducation

Definition

Sensory reeducation is a therapeutic program using sensory stimulation to help sensory-impaired patients recover functional sensibility in the damaged area and learn adaptive functioning.

Purpose

Following disease, such as stroke, or accident, sensory reeducation helps patients with various forms of sensory loss and impairment retrain their sensory pathways, adapt to changed abilities, and regain function.

Precautions

There may be contraindications related to particular modalities used in sensory reeducation or related to coexisting conditions. For example, some coexisting conditions that may contraindicate electrical stimulation include thrombophlebitis, cardiac demand pacemaker, disturbances in cardiac rhythm, local inflammation or infection , or cancer . Extreme caution should be used when applying heat, cold, or electrical stimulation to sensory impaired areas to avoid possible damage due to the patient's inability to feel symptoms that may indicate dangerous temperature or stimulation levels.

A thorough medical history and examination should be conducted and any coexisting conditions noted and taken into consideration during treatment design and implementation. The patient should be educated and monitored to help prevent further damage to the sensory-impaired area.

Description

Sensory reeducation uses a variety of therapeutic, rehabilitation, and educational techniques to help sensory-impaired patients recover sensibility, fine discrimination abilities, and the ability to perform other tasks involved in daily living and work activities. In addition to actual loss of sensibility and related functional ability, paresthesias (abnormal sensations), such as numbness, tingling, or burning sensations, may be present. Some of the many possible causes of sensory impairment may include nerve damage, nerve repair surgery, stroke, aneurysm, other forms of central nervous system damage, and diabetes-related nerve impairment.

Many techniques of sensory stimulation are used to provide input to sensory receptors and pathways. Some forms of stimulation used include electrical stimulation; stroking the skin with textured, friction-producing items such as Velcro; and the use of specially modified tools and instruments (Dannenbaum). Other procedures and modalities that may be used include massage, vibration, pressure, biofeedback, various forms of movement and tactile stimulation, or other activities that require use of and attention to the senses. Sensory reeducation may be delivered in indirect ways as part of a larger therapeutic program, rather than being an independent, distinct therapy.

In addition to loss of tactile sensibility and related inability to distinguish heat, cold, textures, shapes, and other types of stimulation on the skin, losses related to other senses may also be addressed. One example is visual field impairment that may be caused by a stroke. Patients with visual field impairments might be taught to attend to the neglected side, or helped to use other senses to compensate for sensory impairment and loss.

Another form of impairment that may be treated with sensory reeducation is hypersensitivity, a condition in which a patient overreacts to mild forms of stimulation. One such condition is called regional pain syndrome. When treating such conditions tactile stimulation, weight bearing activities, and other forms of sensory reeducation are used to desensitize the patient's sensory responses and reduce perceived discomfort.

Among the goals of sensory reeducation is the retraining of neural pathways and responses to stimuli in order to restore the patient's sensory perception. Increased sensory input and activity may help to stimulate nerve regeneration and growth. In addition, previously unused neural connections may be trained to take over for damaged pathways. This neural plasticity can be used to the advantage of the patient with nerve damage or impairment.

Some scientists believe it may be possible for a remapping to occur in the brain so that connections between areas of the brain and certain parts of the body, as represented on Penfield maps, can adapt and change after nerve injury or amputation, causing new connections that relay sensation.

In general, in addition to actually retraining the senses and nervous system activities, much of sensory reeducation may focus on teaching the patient functional adaptation—new ways of using the abilities they have to compensate for sensory impairments and other disabilities. Adaptation may be used to help the patient function until full rehabilitation is achieved, but it may also be a permanent adaptation when full rehabilitation is not possible.

Preparation

The patient will be interviewed and examined by the therapist to determine the types and extent of sensory impairment. An individualized rehabilitation and sensory reeducation program will be designed in accord with the patient's needs, abilities, and goals.

Aftercare

Patients may continue to see their physician and therapist for follow-up exams and treatment after completion of initial sensory reeducation to record and maintain progress made.

Complications

The therapist should be alert to any possible complications related to the primary and coexisting conditions and associated with any of the modalities used. With careful diagnosis, treatment planning, and monitoring, complications should be minimal. Special caution and supervision should be used when working with sensoryimpaired patients.

Results

The patient should be helped to regain sensibility and related functions such as two-point discrimination and object recognition, and minimize discomfort. To the degree that full recover of sensibility is not possible, the patient should learn adaptive behaviors that will aid in function.

Health care team roles

The surgeon, neurologist, or primary physician may prescribe and monitor the therapy. Physical or occupational therapists and their assistants may perform sensory reeducation. Nurses and other hospital personnel may also be involved in the general rehabilitation and sensory reeducation of the patient, along with social workers, speech therapists, cognitive therapists, and other allied health care providers.


KEY TERMS


Functional sensibility —The ability to make fine sensory discriminations in order to carry out specific somatosensory tasks.

Paresthesia —The presence of unusual sensations, such as numbness, tingling, or burning.

Penfield maps —Graphical depictions of the connections between areas in the brain and body parts with which they communicate; created by Wilder Penfield.

Reeducation —Rehabilitation by special training, such as physical therapy, that helps to restimulate nerve connections associated with sensory perception and related functional ability.


Resources

BOOKS

APTA Guide to Physical Therapist Practice. 2nd ed. American Physical Therapy Association, 2001.

Callahan, A. D. "Methods of Compensation and Reeducation for Sensory Dysfunction." In Rehabilitation of the Hand: Surgery and Therapy, 4th ed. James M. Hunter, Evelyn J. Mackin, and Anne D. Callahan, editors. St. Louis: Mosby, 1995, 701-714.

Ramachandran, V. S., and Sandra Blakeslee. "Knowing Where to Scratch." Phantoms in the Brain. New York: William Morrow and Company, Inc., 1998, pp. 21-38.

Yekutiel, M. Sensory Re-Education of the Hand After Stroke. London: Whurr Publishers, 2000.

PERIODICALS

Imai, H., T. Tajima, and Y. Natsumi. "Successful Reeducation of Functional Sensibility after Median Nerve Repair at the Wrist." Journal of Hand Surgery 16, no. 1, (Jan.1991): 60-65.

Lundborg, G. "Brain Plasticity and Hand Surgery–An Overview." Journal of Hand Surgery 25B, no. 3 (2000): 242-252.

ORGANIZATIONS

American Physical Therapy Association (APTA). 1111 North Fairfax Street. Alexandria, VA 22314. (703) 684-2782.(800) 999-2782. <http://www.apta.org>.

OTHER

Dellon, A. Somatosensory Testing and Rehabilitation. Bethseda: The American Occupational Therapy Association, Inc., 1997.

"Indications, Contraindications, Warnings, and Precautions." <http://www.electromedicine.com/products/contwarn.html>.

Diane Fanucchi, C.M.T., C.C.R.A.

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