General Management Guidelines

Regardless of the cause of the sensory loss in the patient with an insensate extremity, it is important to increase the patient's awareness of potential injuries. For example, the patient should be instructed (1) not to use the insensate hand when cooking or smoking; (2) not to place the insensate extremity in hot water; and (3) to type on a manual typewriter or play a piano/guitar to avoid trauma to the hands.

In the patient with a functional impairment secondary to sensory loss, a rehabilitative process should be instituted. The objectives of sensory re-education are to improve the perception of sensory information arising from receptors in the hand and to improve motor skills. It is important for the patient to integrate the involved limb into normal movement patterns as early as possible.

The principle of sensory re-education focuses on allowing the patient to learn to make sense of unfamiliar somatic sensations through repeatedly matching them to vision and at the same time developing tactics of perception in the form of purposeful exploratory movements of the hand. One method illustrating the latter is to have patients attempt to differentiate objects from a background medium such as sand, rice, or beans. To re-educate moving touch perception, the patient can be asked to repeatedly discriminate between a square nut and a hexagonal one, each of which is rolled across the finger. Constant touch can be rehabilitated by having the patient discriminate between large and small nuts. As discrimination improves, smaller objects are used to increase the difficulty. y


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