Contents of rehabilitation treatment at different times

  I. Median nerve injury 1. After the repair, the wrist joint is fixed in the flexed position for 3 weeks, followed by gradual extension of the wrist joint to the normal position (about 4-6 weeks).  2.Active activity training.  3.Visualization to protect the sensory loss area.  4.Use of daily living aids, e.g., wearing a pair of finger splints to prevent first finger web contracture and to provide a pair of finger grasp Wang Bo, Department of Rehabilitation, Songwon City Hospital of Traditional Chinese Medicine, for grip function.  5, sensory retraining: sensory retraining is an integral part of the overall rehabilitation program for patients with peripheral nerve injury. It enables patients to achieve their maximum potential in functional sensory recovery.  (1) Basic principle: after peripheral nerve injury, due to the immaturity of the spinal cord, sensory conduction is slowed down, coupled with the misalignment of nerve terminals, which prevents many new axon buds from growing into the original myelin sheath, and thus there is abnormal sensation and sensory deficit in certain areas. By using the principles of sensory learning (i.e., concentration, feedback, memory, and reinforcement), the patient can generate a link in the brain between the sensation of such abnormal stimuli and the pattern of response to the surface shape of an object that already existed in the brain before the injury, further training the patient to develop a heightened proprioceptive awareness. With this approach, sensory recovery is better and is related to the recognition of the shape, size, and weight of the object. The goal of localization training is to link tactile and visual stimuli to form a new touch-vision pattern.  The sequence of sensory recovery in the hand is: pain and warmth, 30 Hz vibration, mobility touch, constant touch, 256 Hz vibration, and discrimination. Therefore, the sensory training procedure is divided into early and late stages. The early phase focuses on pain, warmth, touch, and orientation and orientation training. The later phase focuses on discriminative sensory training. The early phase of sensory training can be started 8 weeks after the repair of the median and ulnar nerves in the wrist. If sensory hypersensitivity is present, desensitization therapy should be placed before sensory training procedures.  (2) Training methods: First, patients should be asked to draw the sensory deficit area on their hands; sensory evaluation should be performed before training; sensory training procedures can be started when the protective sensation (pain) is restored; evaluation after sensory training should be performed once a month; sensory training should not be too long or too much, but 3 times a day for 10-15 min each time is appropriate.  ①Localization sensory training: The therapist trains the patient in a quiet room. A 30-Hz tuning fork is used to let the patient know when and at what part of the body the mobility tactile sensation begins. The patient is then touched with a pencil eraser head along the area that needs to be in training, from near to far. The patient observes the training process with his eyes open, then closes his eyes and focuses on the sensations he perceives, and later opens his eyes to confirm and practice with his eyes closed. This is repeated until the patient is able to determine the stimulus site more accurately. When the patient is able to perceive a moving fingertip touch, constant touch practice can begin. A 256-Hz tuning fork is used as a guide marker to determine when to begin training. Tap pressure with a pencil eraser head, starting with higher pressure and then gradually reducing it. After the eyes-closed-eyes-open-eyes-closed training procedure, the learning is repeated until the patient can accurately identify the stimulus site.  ②Discrimination training: Once the patient has a sense of orientation, discrimination training can be started. At first, the patient should identify the surface of objects with large differences in thickness, and gradually progress to the surface of objects with small differences. For each training session, the eye closure-eye opening-eye closing method is used. Using feedback, the training was repeatedly reinforced.  (iii) Assessment of the effect of sensory training: There is no precise method. Clinical assessment is based on certain parameters. These parameters include: a reduction in the number of errors in localization; the ability to complete more “paired” tests or recognition trials within a limited time frame; a reduction in the time to complete each training session; an increase in two-point recognition; and an increase in the patient’s ability to perform activities of daily living and tasks. One of the most important assessment criteria is the patient’s increased ability to use their hands at work and in leisure activities. Functional reconstruction surgery may be considered for those who are not expected to recover neurologically.  Special emphasis should be placed on the fact that after formal sensory retraining is completed and the patient resumes active activities, the later stages of sensory training are maintained by the patient’s continued use of his or her own hands. This may take a long time.  Second, the rehabilitation treatment of ulnar nerve injury 1, wear MP joint block splint to prevent ring and pinky claw finger deformity.  2.Protect the area of skin sensory loss at the ulnar margin of the hand with visual substitution and protection.  3.For those who do not recover the nerve, consider the reconstruction of intrinsic muscle function surgery.  Third, the rehabilitation of radial nerve injury treatment 1, the use of wrist joint immobilization splint, maintain wrist joint extension, metacarpophalangeal joint extension, thumb external booth. Prevent overdrawing of the extensor muscle. Assist the grip and relaxation function of the hand.  2. Train the muscles through activities, such as grasping and relaxation movements.  3.If necessary, wrist extension, thumb extension and finger extension functional reconstruction surgery can be performed.