Torn tendons recover faster with imaginary training

After surgeons have repaired torn tendons in the hand and lower arm, patients require at least twelve weeks to recover. Dutch researcher Martin Stenekes discovered that imaginary training speeds up recovery, and published an article on the subject in Archives of Physical Medicine and Rehabilitation.

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Stenekes did an experiment with 28 patients, all of whom had been hospitalised because of recent injury. They were operated on and started on a recovery programme. During the first four weeks after an operation to repair finger tendons, patients are not allowed to use their fingers at all. In this period the researcher got half of his test subjects to do mental exercises.

The patients had to imagine that they were slowly bringing the fingers of their injured hand together, curling them into a fist and then bending their wrist. They had to retain this image for three seconds and then imagine that they were uncurling their wrist and stretching their fingers. In other words, the test subjects did mental wrist-curls.

The patients had to repeat the imaginary action ten times. This amounted to 1 session, and the subjects did 8 sessions each day.

When the four weeks were up the ‘real’ recovery programme started. In this period the researchers measured the progression of all test subjects with a kind of computer game. On a screen the patients saw one finger of a hand light up, and had to touch this with their own finger. The faster they were able to do so, the further they were on the road to recovery. The figure below shows that the group that had done mental training made quicker progress than the group that had not done this.

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The subjects that had done imagined training had more strength in their fingers than the ones who hadn’t. By the end of the experiment they were capable of moving 3.9 kg with their little finger, whereas the subjects in the other group could only manage 3.4 kg. However, the difference was not statistically significant.

Effects of motor imagery on hand function during immobilization after flexor tendon repair.

Abstract

OBJECTIVE:
To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function.

DESIGN:
Randomized controlled trial.

SETTING:
Tertiary referral hospital.

PARTICIPANTS:
Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group.

INTERVENTION:
Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period.

MAIN OUTCOME MEASURES:
The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength.

RESULTS:
After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period.

http://www.ncbi.nlm.nih.gov/pubmed/19345768

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