Manual Stimulation Improves Recovery of Function After Nerve Injury

[Christopher]

This research study suggests that "manual stimulation" (which I assume means massage) increases a deinnervated muscle's chance of recovery if massaged directly after injury up on to the eventual restorative surgery, better than muscles that didn't receive "manual stimulation".

Massaging a "dead muscle" or deinnervated muscle may help bring it necessary blood and "nutrition". One of the real areas of risk, from my understanding, is the muscle motor end plate. Which is the junction where the nerve connects to the muscle and the nerve impulse is translated into muscle action/movement. When the motor end plate atrophies, the muscle's ability to receive nerve impulses is reduced and which in turn limits the muscle's ability to function and grow (or return to its previous state).

The motor end plate (area where the nerve & muscle junction) has a limited time where it can survive and retain function when it has been deinnervated (my understanding is up to a maximum of two years). The greatest challenge is to get nerve impulses going thru the motor end plate as soon as possible to prevent it from atrophying/wasting at all, and hence limiting the muscle's best possible return of function.

So the below study is worth serious consideration, even though it's only done on rats.

If I was freshly injured and read this, I'd be massaging my whole arm repeatedly through each day after injury, until my muscles where working solidly again.

Christopher


http://nnr.sagepub.com/cgi/content/abstract/22/6/754?ct
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Manual Stimulation of the Suprahyoid-Sublingual Region Diminishes Polynnervation of the Motor Endplates and Improves Recovery of Function After Hypoglossal Nerve Injury in Rats

Emilia Evgenieva, PhD1, Patrick Schweigert2, Orlando Guntinas-Lichius, MD, PhD3, Stoyan Pavlov, MD4, Maria Grosheva, MD5, Srebrina Angelova, MD5, Michael Streppel, MD, PhD5, Andrey Irintchev, MD, PhD6, Emmanouil Skouras, MD7, Stefanie Kuerten, MD2, Nektarios Sinis, MD8, Sarah Dunlop, PhD9, Victoria Radeva, MD, PhD10, and Doychin N. Angelov, MD, PhD2*

1 Sofia University, Bulgaria, Faculty of Pre-School and Primary School Education
2 Department of Anatomy I University of Cologne, Germany
3 Department of Oto-Rhino-Laryngology, University of Jena, Germany
4 Department of Anatomy, Histology, Embryology, Medical University Varna, Bulgaria
5 Department of Oto-Rhino-Laryngology, University of Cologne, Germany
6 Centre for Molecular Neurobiology, University of Hamburg, Germany
7 Department of Trauma and Reconstructive Surgery, University of Cologne, Germany
8 Department of Hand, Plastic, and Reconstructive Surgery with Burn Unit, BG-Trauma Centre, University of Tuebingen, Tuebingen, Germany
9 School of Animal Biology and Western Australian Institute for Medical Research, The University of Western Australia
10 Faculty of Pre-School and Primary School Education, Sofia University, Bulgaria

* To whom correspondence should be addressed. E-mail: angelov.anatomie@uni-koeln.de.


Abstract
Background. Using the rat facial nerve axotomy model, the authors recently showed that manual stimulation of denervated whiskerpad muscles reduced the posttransectional polyinnervation at the neuromuscular junctions and promoted full recovery of vibrissal whisking. Objective. Prompted by implications for rehabilitation therapy, the authors examined whether manual stimulation of denervated supra- and infrahyoid muscles would also improve recovery after unilateral lesion on the hypoglossal nerve. Methods. Adult rats underwent transection of the right hypoglossal nerve. Half of the animals received no postoperative treatment, and the other half were subjected to daily manual stimulation of the suprahyoid/sublingual region for 2 months. Recovery was assessed by measuring the angle of tongue-tip deviation from the midline, degree of collateral axonal branching at the lesion site (counts after retrograde labeling with 2 fluorescent dyes), synaptic input to the hypoglossal motoneurons using synaptophysin immunocytochemistry, tongue-muscles motor representation in the cerebral cortex after c-Fos immunocytochemistry, and portion of polyinnervated neuromuscular junctions. Results. In animals receiving manual stimulation, the tongue-tip deviation was 37.0±49.37°, whereas values in control nonstimulated rats were significantly higher (50.1±9.01°; P<.05; mean±SD). Improved recovery was not associated with reduced collateral axonal branching; there were also no differences in tongue-muscles representation in the motor cortex. However, manual stimulation restored the total synaptic input to levels in intact animals and reduced the proportion of polyinnervated neuromuscular junctions compared with nonstimulated animals. Conclusion. The data show that manual stimulation of denervated muscles improves functional outcome following peripheral nerve injury. This suggests immediate potential for enhancing clinical rehabilitation strategies.

[GMcG]

Hi Christopher~
I'm printing this out and bringing it to my occupational therapist, proof to back up the 45 minutes of massage she does on my dead arm twice a week!! I wonder if it will help once my insurance company starts to stop paying?
Thanks, though!
~Genevieve

[Christopher]

Hey Genevieve!
Hope you're hanging in there. The waiting was the hardest part for me. It took patience to a new level. Love that "dead" arm of yours, it'll love you back for it... it might just take a good while though. Stay strong!

Chris

[GMcG]

Dear Christopher~
Did you read my terribly exciting news post a few weeks ago from the Mayo Clinic? I went back for my one year check-up and during my EMG they found activity! I had thought I felt something but was afraid to get my hopes up, for fear there would be no progress. My Dr. Shin put his arm right on my bicep and felt it twitch -- isn't that fabulous? I was so happy, I was an emotional wreck. I hadn't realized how much I was putting off hope. But really it all comes back to -- isn't that fabulous?
Genevieve