Hand & Orthopedic Physical Therapy Associates, P.C., Levittown, Pennsylvania 19056, USA.
J Hand Ther. 2012 Apr-Jun;25(2):202-18; quiz 219. doi: 10.1016/j.jht.2011.12.004.
Treatment of peripheral nervous system (PNS) pathology presents intervention challenges to every therapist. Many of the current and future interventions will be directed at restoring the normal anatomy, function, and biomechanical properties of the PNS, restoring normal neural physiology and ultimately patient function and quality of life. Present interventions use mechanical (movement) or electrical procedures to affect various properties of the peripheral nerve. The purpose of this article was to apply basic science to clinical practice. The pathology and accompanying structural and biomechanical changes in the PNS will be presented in three specific areas commonly encountered in the clinic: nerve injury and laceration; compression neuropathies; and neuropathic pain and neural tension dysfunction. The intent is to address possible interventions exploring the clinical reasoning process that combines basic science and evidence-based best practice. The current lack of literature to support any one intervention requires a strong foundation and understanding of the PNSs' structure and function to refine current and develop new intervention strategies. Current evidence will be presented and linked with future considerations for intervention and research. During this interlude of development and refinement, best practice will rely on sound clinical reasoning skills that incorporate basic science to achieve a successful outcome when treating these challenging patients.
治疗周围神经系统 (PNS) 病理对每位治疗师来说都是干预的挑战。目前和未来的许多干预措施将旨在恢复 PNS 的正常解剖结构、功能和生物力学特性,恢复正常的神经生理学,最终恢复患者的功能和生活质量。目前的干预措施使用机械(运动)或电程序来影响周围神经的各种特性。本文的目的是将基础科学应用于临床实践。将在临床中常见的三个特定领域中呈现 PNS 的病理学及其伴随的结构和生物力学变化:神经损伤和裂伤;压迫性神经病;以及神经病理性疼痛和神经张力功能障碍。目的是探讨可能的干预措施,探索将基础科学和基于证据的最佳实践相结合的临床推理过程。目前缺乏支持任何一种干预措施的文献,这需要对 PNS 的结构和功能有坚实的基础和理解,以完善现有干预策略并开发新策略。将提出当前的证据,并将其与干预和研究的未来考虑因素联系起来。在这个发展和完善的过程中,最佳实践将依赖于良好的临床推理技能,将基础科学融入其中,以在治疗这些具有挑战性的患者时取得成功的结果。