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PURPOSE: Peripheral nerve injuries are a distinct group of injuries that are commonly caused by motor vehicle accidents, falls, industrial accidents, household accidents, and penetrating trauma (Kamble et al., 2019). A peripheral nerve injury can affect an individual’s daily occupations and routines due to unrelenting pain, loss of sensation, and/or burning sensations. Peripheral nerve injuries can result in motor loss and subsequent muscle imbalance which can create functional loss (Chae et al., 2020). The purpose of this systematic review was to provide occupational therapists with evidence supporting the use of interventions to increase the functional use of the upper extremity after peripheral nerve injury.
DESIGN: We conducted a systematic review and included studies relevant to peripheral nerve injury, functional use of the upper extremity, and interventions within the scope of occupational therapy. All articles included were published within the last decade.
METHOD: We reviewed 31 titles and abstracts from MEDLINE, CINAHL, Embase, and Scopus databases and retrieved 11 full-text articles. Six met inclusion criteria. To determine the strength of evidence, we used the U.S. Preventative Services Task Force levels of certainty and grade definitions.
RESULTS: Three themes emerged: mirror therapy, sensory re-education, and the use of an orthosis. Three level I studies, and one level II study reported on the effectiveness of mirror therapy interventions. These studies provide moderate strength of evidence supporting the use of mirror therapy for improving upper limb function after peripheral nerve injury. One level II study reported on the effectiveness of sensory re-education interventions. Based on this study, sensory re-education is another supported intervention for improving functional outcomes of the upper limb after a peripheral nerve injury. However, this is based on low strength of evidence. One level IV study reported on the effectiveness of orthosis interventions. Using a volar wrist orthosis to enhance upper limb functional use is supported for treatment of Carpal Tunnel Syndrome but is found to be disadvised for ulnar nerve injuries, based on low strength of evidence provided by this study. More evidence is needed to determine the effectiveness of this intervention.
CONCLUSION: Based on moderate level of evidence, mirror therapy is a recommended intervention for improving functional outcomes of the upper limb after a peripheral nerve injury. These findings suggest that occupational therapists should be well-educated and trained in mirror therapy procedures and protocols in order to provide best practice to increase functional use of the upper limb after peripheral nerve injury. Sensory re-education is another recommended intervention to improve functional outcomes of the upper limb after a peripheral nerve injury that can be considered on a case-by-case basis. Due to limited literature, future research in the area of peripheral neuropathy interventions within the scope of occupational therapy should focus on increasing sample size using high quality study designs and developing a more standardized mirror therapy protocol.
Clarkson, Shayleigh; Fisher, Allison; McFadden, Sean; Swanson, Payton; Whitlow, Molly; and Smallfield, Stacy, "Occupational Therapy Interventions to Optimize Functional Use of the Upper Extremity After Peripheral Nerve Injury: A Systematic Review" (2022). Student Systematic Reviews: Occupational Therapy. 4.