The Sensor Glove in Preoperative Conditioning and Postoperative Rehabilitation

  • Göran Lundborg
  • Birgitta Rosén


Hand transplantation represents a unique situation from the biological, clinical, psychological and cognitive point of view. The transplanted hand has to be accepted by the recipient, and the recipient’s nerve fibres have to reinnervate nervous pathways, muscles and sensory receptor organs of the donor’s hand. Various factors influencing the nerve regeneration process in such a situation has been discussed elsewhere [1]. However, the sensory motor functions of the transplanted hand are dependent not only on peripheral events in the transplanted body part, but establishment of central projections of the transplanted hand in the motor as well as somatosensory cortex is essential for the functional outcome. The original amputation injury has — in itself — induced extensive cortical reorganisations in the amputee’s brain with disappearance of the hand representation, and functional recovery in the transplanted hand requires reestablishment of hand projectional areas in the motor and somatosensory cortex.


Somatosensory Cortex Premotor Cortex Hand Representation Sensory Recovery Hand Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Dahlin LB, Lundborg G (2006) From silent neuroma to reactivation of axonal growth: how a peripheral nerve can start to regenerate into a transplanted hand. In: Lanzetta M, Dubernard JM (eds) Hand Transplantation. Springer Berlin Heidelberg New YorkGoogle Scholar
  2. 2.
    Merzenich MM, Kaas JH, Sur M et al (1978) Double representation of the body surface within cytoarchitectonic areas 3b and 1 in “S1” in the owl monkey (Aotus trivirgatus). J Comp Neurol 181:41–7PubMedCrossRefGoogle Scholar
  3. 3.
    Merzenich MM, Nelson RJ, Kaas JH et al (1987) Variability in hand surface representations in areas 3b and 1 in adult owl and squirrel monkeys. J Comp Neurol 258:281–297PubMedCrossRefGoogle Scholar
  4. 4.
    Merzenich MM, Jenkins WM (1993) Reorganization of cortical representations of the hand following alterations of skin inputs induced by nerve injury, skin island transfers, and experience. J Hand Ther 6:89–104PubMedGoogle Scholar
  5. 5.
    Kaas JH (1997) Topographic maps are fundamental to sensory processing. Brain Res 44:107–112Google Scholar
  6. 6.
    Penfield W, Boldrey E (1937) Somatic motor and sensory representations in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389–443CrossRefGoogle Scholar
  7. 7.
    Hansson T, Brismar T (1999) Tactile stimulation of the hand causes bilateral cortical activation: a functional magnetic resonance study in humans. Neurosci Lett 271:29–32PubMedCrossRefGoogle Scholar
  8. 8.
    Bodegard A, Ledberg A, Geyer S et al (2000) Object shape differences reflected by somatosensory cortical activation. J Neurosci 20:RC51PubMedGoogle Scholar
  9. 9.
    Bodegård A, Geyer S, Naito E et al (2000) Somatosensory areas in man activated by moving stimuli. Neuroreport 11:187–191PubMedCrossRefGoogle Scholar
  10. 10.
    Ehrsson HH, Fagergren A, Jonsson T et al (2000) Cortical activity in precision-versus power-grip tasks: an fMRI study. J Neurophysiol 83:528–536PubMedGoogle Scholar
  11. 11.
    Kaas J (1991) Plasticity of sensory and motor maps in adult mammals. Ann Rev Neurosci 14:137–168PubMedCrossRefGoogle Scholar
  12. 12.
    Chen R, Cohen LG, Hallett M (2002) Nervous system reorganization following injury. Neuroscience 111:761–773PubMedCrossRefGoogle Scholar
  13. 13.
    Wall JT, Xu J, Wang X (2002) Human brain plasticity: an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body. Brain Res Rev 39:181–215PubMedCrossRefGoogle Scholar
  14. 14.
    Merzenich MM, Nelson RJ, Stryker MS et al (1984) Somatosensory cortical map changes following digit amputation in adult monkeys. J Comp Neurol 224:591–605PubMedCrossRefGoogle Scholar
  15. 15.
    Weiss T, Miltner W, Huonker R et al (2000) Rapid functional plasticity of the somatosensory cortex after finger amputation. Exp Brain Res 134:199–203PubMedCrossRefGoogle Scholar
  16. 16.
    Code RA, Eslin DE, Juliano SL (1992) Expansion of stimulus-evoked metabolic activity in monkey somatosensory cortex after peripheral denervation. Exp Brain Res 88:341–344PubMedCrossRefGoogle Scholar
  17. 17.
    Manger PR, Woods TM, Jones EG (1996) Plasticity of the somatosensory cortical map in macaque monkeys after chronic partial amputation of a digit. Proc R Soc Lond B Biol Sci 263:933–939CrossRefGoogle Scholar
  18. 18.
    Pons T, Preston E, Garraghty K (1991) Massive cortical reorganization after sensory deafferetiation in adult macaques. Science 252:1857–1860PubMedCrossRefGoogle Scholar
  19. 19.
    Kaas JH, Florence SL, Jain N (1999) Subcortical contributions to massive cortical reorganizations. Neuron 22:657–660PubMedCrossRefGoogle Scholar
  20. 20.
    Elbert T, Flor H, Birbaumer N et al (1994) Extensive reorganization of the somatosensory cortex in adult humans after nervous system injury. Neuroreport 5:2593–2597PubMedCrossRefGoogle Scholar
  21. 21.
    Ramachandran VS, Stewart M, Rogers-Ramachandran DC (1992) Perceptual correlates of massive cortical reorganization. Neuroreport 3:583–586PubMedCrossRefGoogle Scholar
  22. 22.
    Flor H, Elbert T, Wienbruch C et al (1995) Phantomlimb pain as a perceptual correlate of cortical organization following arm amputation. Nature 375:482–484PubMedCrossRefGoogle Scholar
  23. 23.
    Borsook D, Becerra L, Fishman S et al (1998) Acute plasticity in the human somatosensory cortex following amputation. Neuroreport 9:1013–1017PubMedCrossRefGoogle Scholar
  24. 24.
    Flor H, Elbert T, Muhlnickel W et al (1998) Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res 119:205–212PubMedCrossRefGoogle Scholar
  25. 25.
    Knecht S, Henningsen H, Elbert T et al (1995) Cortical reorganization in human amputees and mislocalization of painful stimuli to the phantom limb. Neurosci Lett 201:262–264PubMedCrossRefGoogle Scholar
  26. 26.
    Knecht S, Soros P, Gurtler S et al (1998) Phantom sensations following acute pain. Pain 77:209–213PubMedCrossRefGoogle Scholar
  27. 27.
    Knecht S, Henningsen H, Hohling C et al (1998) Plasticity of plasticity? Changes in the pattern of perceptual correlates of reorganization after amputation. Brain 121:717–24PubMedCrossRefGoogle Scholar
  28. 28.
    Birbaumer N, Lutzenberger W, Montoya P et al (1997) Effects of regional anesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci 17:5503–5508PubMedGoogle Scholar
  29. 29.
    Agius E, Cochard P (1998) Comparison of neurite outgrowth induced by intact and injured sciatic nerves: a confocal and functional analysis. J Neurosci 18:328–338PubMedGoogle Scholar
  30. 30.
    Wiberg M, Hazari A, Ljungberg C et al (2003) Sensory recovery after hand reimplantation: a clinical, morphological, and neurophysiological study in humans. Scand J Plast Reconstr Surg Hand Surg 37:163–173PubMedCrossRefGoogle Scholar
  31. 31.
    Brenneis C, Loscher WN, Egger KE et al (2005) Cortical motor activation patterns following hand transplantation and replantation. J Hand Surg [Br] 30:530–533Google Scholar
  32. 32.
    Lundborg G, Björkman A, Larsson EM et al (2005) Cortikal integrering av replanterad hand och osseointegrerad tumprotes-en fMRI studie. Swedish Medical Society Annual Meeting, Stockholm, 30 November to 2 December 2004. [Abstract]Google Scholar
  33. 33.
    Giraux P, Sirigu A, Schneider F et al (2001) Cortical reorganization in motor cortex after graft of both hands. Nat Neurosci 4:691–692PubMedCrossRefGoogle Scholar
  34. 34.
    Lanzetta M, Perani D, Anchisi D et al (2004) Early use of artificial sensibility in hand transplantation. Scan J Plast Reconstr Surg 38:106–111CrossRefGoogle Scholar
  35. 35.
    Rizzolatti G, Fadiga L, Gallese V et al (1996) Premotor cortex and the recognition of motor actions. Brain Res Cogn Brain Res 3:131–141PubMedCrossRefGoogle Scholar
  36. 36.
    Rizzolatti G, Craighero L (2004) The mirror-neuron system. Annu Rev Neurosci 27:169–192PubMedCrossRefGoogle Scholar
  37. 37.
    Hauk O, Johnsrude I, Pulvermuller F (2004) Somatotopic representation of action words in human motor and premotor cortex. Neuron 41:301–307PubMedCrossRefGoogle Scholar
  38. 38.
    Keysers C, Wicker B, Gazzola V et al (2004) A touching sight: SII/PV activation during the observation and experience of touch. Neuron 42:335–346PubMedCrossRefGoogle Scholar
  39. 39.
    Hansson T, Björkman A, Nylander L et al (2005) Activation of the primary somatosensory cortex during stereoscopic observation of tactile stimulation of the hand. Proceedings, 10th FESSH Congress, GöteborgGoogle Scholar
  40. 40.
    Lundborg G (2004) Nerve injury and repair. Regeneration, reconstruction and cortical re-modelling, 2nd Edn. Elsevier, PhiladelphiaGoogle Scholar
  41. 41.
    Bavelier D, Neville HJ (2002) Cross-modal plasticity: where and how? Nat Rev Neurosci 3:443–452PubMedGoogle Scholar
  42. 42.
    Lundborg G, Rosén B, Lindberg S (1999) Hearing as substitution for sensation — a new principle for artificial sensibility. J Hand Surg [Am] 24:219–224CrossRefGoogle Scholar
  43. 43.
    Lundborg G, Bjorkman A, Hansson T et al (2005) Artificial sensibility of the hand based on cortical audiotactile interaction:A study using functional magnetic resonance imaging. Scand J Plast Reconstr Surg Hand Surg 39:370–372PubMedCrossRefGoogle Scholar
  44. 44.
    Rosén B, Lundborg G (2003) Early use of artificial sensibility to improve sensory recovery after repair of the median and ulnar nerve. Scand J Plast Reconstr Surg Hand Surg 37:54–57PubMedGoogle Scholar
  45. 45.
    Lundborg G, Rosén B (2003) Enhanced sensory recovery after median nerve repair: Effects of early postoperative artificial sensibility using the sensor glove system. J Hand Surg [Am] 28[Suppl. 1]:38–39Google Scholar
  46. 46.
    Lanzetta M, Dubernard JM, Owen ER et al (2001) Surgical planning of human hand transplantation. Transplant Proc 33:683PubMedCrossRefGoogle Scholar
  47. 47.
    Lanzetta M, Nolli R, Borgonovo A et al (2001) Hand transplantation: ethics, immunosuppression and indications. J Hand Surg [Br] 26:511–516Google Scholar
  48. 48.
    Dellon AL (ed) (1981) Sensibility and re-education of sensation in the hand. Williams & Wilkins, BaltimoreGoogle Scholar
  49. 49.
    Wynn-Parry CB, Salter M (1976) Sensory re-education after median nerve lesions. Hand 8:250–257CrossRefGoogle Scholar
  50. 50.
    Bell-Krotoski J (2002) Sensibility testing with the Semmes-Weinstein monofilament. In: Mackin C, Callahan AD, Skirven TM et al (eds) Rehab of the hand and upper extremity, 5th Edn. Mosby, St. Louis, pp 194–213Google Scholar
  51. 51.
    American Society for Hand Therapists (ASHT) (1992) Clinical assessment recommendation, 2nd Edn. American Society for Hand TherapistsGoogle Scholar
  52. 52.
    Rosén B, Lundborg G (1998) A new tactile gnosis instrument in sensibility testing. J Hand Ther 11:251–257PubMedGoogle Scholar
  53. 53.
    Perani D, Brunelli GA, Tettamanti M et al (2001) Remodelling of sensorimotor maps in paraplegia: a functional magnetic resonance imaging study after a surgical nerve transfer. Neurosci Lett 303:62–66PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Göran Lundborg
    • 1
  • Birgitta Rosén
    • 1
  1. 1.Department of Hand SurgeryMalmö University HospitalMalmöSweden

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