While the nerve is regenerating, or if nerve recovery is incomplete
• Inspect skin regularly; provide prompt treatment of wounds or blisters
• Compensate for dryness with massage creams or oils
In the upper extremity
• Avoid handling hot, cold, sharp, or abrasive objects
• Avoid sustained grasps; change use of tools frequently
• Redistribute hand pressure by building up the size of the handles
• Wear protective gloves
In the lower extremity
• Wear protective shoes that fit properly
• Inspect feet regularly for pressure points (reddened area) and modify shoes or provide protection if they occur
• Do not walk barefoot, especially in the dark or on rough surfaces
• Shift weight frequently when standing for long periods

• Use multiple types of textures or contact for sensory stimulation (cotton, rough material, sandpaper of various grades, Velcro). The textures can be wrapped around dowel rods for finger manipulation or stroking along skin. Contact particles such as cotton balls, beans, macaroni, sand, or other material with various degrees of roughness can be placed in tubs or cans where the patient can run the hand or foot through the material. Have the patient begin manipulating or placing the extremity in the least irritating texture for 10 minutes. As tolerance improves, progress to the next texture of slightly more irritating but tolerable stimulus. Maximum progress occurs when the most irritating texture is tolerated.

• Vibration can also be used. Pattern of recovery after nerve injury is pain (hypersensitivity), perception of slow vibration (30 cps), moving touch, constant touch, rapid vibration (256 cps), and awareness from proximal to distal.
• Discriminative sensory re-education. This is the process of retraining the brain to recognize a stimulus once the hypersensitivity diminishes. Begin by using a moving touch stimulus, such as the eraser end of a pencil, and stroke over the area. The patient first watches, then closes his or her eyes and tries to identify where touch occurred. Progress from stroking to using constant touch. When the patient is able to localize constant touch, progress to identification of familiar objects of various sizes, shapes, and textures. For the hand, use familiar household and personal care objects, such as keys, eating utensils, blocks, toothbrush, and safety pins. For the feet, have the patient walk on various surfaces, such as grass, sand, wood, pebbles, and uneven surfaces.
• Patient education. Instruct the patient to resume use of the extremity gradually while monitoring pain, swelling, or any discoloration; if necessary, modify or temporarily avoid any aggravating activities. While the nerve is recovering or if nerve recovery is incomplete, teach the patient preventive care to avoid injury

Chronic Phase
When the potential for reinnervation has peaked and there are minimal or no signs of reinnervation, emphasize training for compensatory function. The person will probably have to continue to wear the supportive splint or brace, and preventive care must continue indefinitely.
Neural Tensions Disorders

Normally, the nervous system has considerable mobility to adapt to the wide range of movements imposed on it by daily activities. Still, there are sites where nerves are vulnerable to increased pressure or tension, especially when excessive or repetitive stresses or strains are imposed on the tissues surrounding the nerves or on the nerves themselves. If a nerve is compressed as it passes near a bony structure or through a confined space, undue tension may be placed on it as movement occurs proximal or distal to that site. This may be magnified if there is adhesive scar tissue or swelling that restricts mobility. When examining a patient, the therapist needs to be alert to symptoms described by the patient and be able to understand and interpret positive signs that are detected with testing maneuvers. This section summarizes the tests of provocation and describes the techniques that have been reported to mobilize components of the nervous system in order to improve the patient’s outcome.

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