Question
How do we perform sensory re-education after a nerve injury?
Answer
Sensory Re-education
What exactly is sensory re-education? Here we have it in kind of a two-phase approach. For the early phase, what I want you think about is a pencil with an eraser. Basically the goal of early phase re-education or teaching the hand how to feel again is the idea that we want to re-educate perception and correct localization.
Early Phase
Early phase is supposed to be started when the patient can feel 30 cps vibration, which is a larger tuning fork and/or moving touch has returned. Basically we are going to progress the patient through moving touch and constant touch, and then through the higher level or the smaller tuning fork of vibration. You ask the patient to pair with a friend, family member, or yourself. They close their eyes and that person touches their hand with a Q-tip or a pencil eraser which seems to be a good texture for them. You touch them, ask the patient to point to it, and if they do not point correctly, then you re-point or put their finger where it is supposed to be. This goes on until the patient can accurately identify every place you touch on their hand. You are retraining or showing them this is not where I touched you, I touched you here. Then they look at it as you touch them again.
Late Phase
Late phase typically begins when they can perceive that smaller tuning fork. For tactile agnosis or object recognition, I have found the easiest way to do this is with a pillowcase. I usually start with plastic silverware because nothing is going to be sharp. I put a spoon, fork, and knife in the pillowcase. Other large items that are good for late phase sensory re-education are things like a comb, a toothbrush, etc. As you move towards smaller objects, I put in things like a paperclip, safety pin or different coins. Some other cool things that I have seen is using children's blocks that have the raised letters on them to see the patient can feel the letter and tell you what the letter is . I have also used cards that had raised letters on them that the patient could actually feel to tell you what the letter was. Different shapes are good as well, like circles, squares, triangles, or any type of those things. Then you keep progressing to different objects and different textures, and have the patients describe those.
Editor’s note: This Ask the Expert was adapted from the course, ‘The Hand 101’ that is available in text and video course formats.
