NeuroRehabilitation 42 (2018) 113–119 113

DOI:10.3233/NRE-172220
IOS Press

A comparative study of rehabilitation

therapy in traumatic upper limb peripheral
nerve injuries
Cristian Milicina and Elena Sı̂rbub,∗
a Department of Balneophysiotherapy and Rehabilitation Medicine, University of Medicine and Pharmacy

“Victor Babeş” Timişoara, Timişoara, Romania

b Department of Physical Therapy and Special Motility, West University of Timişoara, Timişoara, Romania

Abstract.
INTRODUCTION: Lower motor neurons are the only neurons of the central nervous system (CNS) with the ability to
regenerate without any intervention after an axotomy.
AIM: This present study was conducted to analyze clinical and electrophysiological parameters in four groups of upper limb
peripheral neuropathies, before and after treatment, comparing the results obtained after three cures of complex rehabilitation
therapy.
MATERIALS AND METHODS: We selected a number of 107 patients (66 women and 41 men) aged between 29 and
77 years (mean age = 49.6). Clinical (muscular strength, sensitivity) and electrophysiological parameters (accommodation
coefficient ␣, nerve conduction velocity) were analyzed. All patients received 3 comprehensive treatment cures, each cure of
14 days and a rest period of 3 months between the cures.
RESULTS: From the total of 107 patients included in the study, 52 were diagnosed with brachial plexus palsy, 27 with
radial nerve palsy, 18 with median nerve palsy and 10 with ulnar nerve palsy. We did not observe a statistically significant
difference between the mean age of males (47.2) and females (51.2) (p = 0.07), but peripheral neuropathies were more
common in young males. At the end of the rehabilitation treatment all patients achieved better outcomes in muscle strength,
sensitivity, adjustment coefficient ␣ and nerve conduction velocity (p < 0.001).
CONCLUSION: The intervention of a physical therapy program in patients with peripheral neuropathies provided signif-
icantly better outcomes in clinical and electrophysiological parameters. Our rehabilitation protocol can be considered an
alternative in order to stimulate and accelerate the nerve regeneration process.

Keywords: Motor neurons, muscle strength, sensitivity, nerve conduction velocity

1. Introduction The lower motor neurons (LMNs) are the only

Lower motor neuron lesions affecting the upper
limb is considered to be a multidisciplinary pathol-
ogy, with severe neurological manifestations, as well
as economic, professional, social and familial impli-
cations.
∗ Address
for correspondence: Elena Sı̂rbu, Department of
Physical Therapy and Special Motility, West University of
Timişoara, V. Parvan, no 5., 300233 Timişoara, Romania. Tel.:
+40 744238960; E-mail: elena sarbu@yahoo.co.uk.
neurons of the central nervous system (CNS) with
the ability to regenerate without any intervention
after an axotomy; this ability results from the
environment surrounding these neurons and from
the intrinsic regrowth property of motor neurons
[22]. Their regenerative ability is impressive and
involves all fibers of the peripheral nervous sys-
tem. The sectioning a peripheral nerve triggers a
series of histological and pathophysiological mecha-
nisms (Wallerian degeneration of the distal segment,

1053-8135/18/$35.00 © 2018 – IOS Press and the authors. All rights reserved
114 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries
changes in the proximal segment, regeneration of
nerve fibers) [7].
After a peripheral nerve lesion, from the proxi-
mal end budding fragments of new neurofilaments
start to grow. The growth process takes place in
the empty axonal cylinders from the distal tube.
Therefore, axonal growth determines an activation
of the Schwann cells, which play an important role
in axonal regeneration [6]. Schwann cells prolifer-
ation is followed by the appearance of “Bungner
bands” formed through the multiplication and dis-
position in parallel columns, bands that will create
the needed network for the migration of nutrient and
for growth. They cover the axons with a pluristrati-
fied layer that will eventually transform into a myelin
sheath [5, 10].
Numerous studies have analyzed the mechanisms
that determine the budding process. Many of these
studies agree with the theory of sympathetic fibers
sprouting after peripheral nerve lesions and with
the intervention of neurotropic factors in the axonal
regeneration process [1, 8].
Neurotrophic factors (neurotrophins) are specific
proteins that induce neuronal survival, neuronal
growth, synaptic plasticity and neurotransmission.
The neurotrophins refer to the following factors:
nervegrowth factor (NGF), the brain derived neu-
rotropic factor (BDNF), the neurotrophin-3 (NT-3),
and the neurotrophin-4/5 (NT-4/5). Many studies
suggested that these neurotrophic factors have roles
in specific axonal guidance during the growth and
regeneration process of peripheral nerves [18].
In order to increase functional recovery following
peripheral nerve injuries, a comprehensive planned
program of medical and rehabilitation therapy must
be initiated. As regards physical rehabilitation, a vari-
ety of methods are used in the treatment of upper limb
peripheral neuropathies.
The present study was conducted to analyze clin-
ical and electrophysiological parameters in four
groups of upper limb peripheral neuropathies, before
and after treatment, comparing the results obtained
after three cures of complex rehabilitation therapy.
Hence, we designed a rehabilitation protocol in
order to demonstrate that a comprehensive rehabil-
itation has an effect on the nerve recovery.
2. Materials and methods
This study took place between January
2011 and April 2016 at the Department of
Balneophysiotherapy and Rehabilitation Medicine
from the Emergency County Hospital in Timisoara.
The patients selected for the study need to fulfill the
following criteria: (1) traumatic upper limb periph-
eral nerve lesions; (2) time until surgery less than
2 months (in patients that underwent surgical treat-
ment); (3) no other associated diseases (metabolic,
peripheral nervous system, chronic intoxications). A
number of 107 patients (66 women and 41 men)
with traumatic upper limb peripheral nerve injuries
were selected. All patients gave their informed
consent regarding their participation, agreeing to
both evaluation and treatment. Clinical (muscular
strength, superficial and profound sensitivity) and
electrophysiological parameters (accommodation
coefficient ␣, motor nerve conduction velocity) were
analyzed.
Manual muscle testing (MMT) was used to deter-
minate the muscular strength on a scale known as
“0–5 scale” (by the National Foundation for Infant
Paralysis). Moreover, we used the electro-diagnosis
for the affected muscles and we determined the
adjustment coefficient ␣. This coefficient reflects the
degree of denervated muscle that will undergo elec-
trostimulation. The ␣ accommodation coefficient is
defined as the ratio between the intensity of the tri-
angular current with a duration of 1000 ms and the
intensity of the rectangular current with the same
duration, for values that produce a minimal contrac-
tion [9, 13]. In order to determine this coefficient we
used the Siemens Universal – Neuroton 826, and as a
work technique – the bipolar determination technique
of the I/t curve (normal values of the ␣ accom-
modation coefficient: normal innervation ␣ = 2,5 –
6; partially denervated ␣ = 1-2,5; completely dener-
vated ␣ < 1).
The nerve conduction velocity was performed with
the aid of Keypoint – EMG/EP SySTEM manufac-
tured by Alpine Biomed Corp. USA. The normal
value for the nervous motor conduction velocity for
the upper limb is 75 m/s.
All patients received 3 complex treatment cures,
each cure of 14 days and a rest period of 3 months
between the cures. Each patient received assessments
before and at the end of each cure of rehabilitation
treatment.
The patients underwent a complex treatment
scheme, administered daily, at the same time and
in the same order for the procedures: ultrasound
treatment, thermotherapy (fango), electrostimulation
of the partially or totally denervated muscles, kine-
totherapy and massage. In the present study we chose
 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries
to use our own protocol that includes the following
procedures:
– Direct-coupled ultrasound therapy, in partly
mobile field, with an intensity of 0,5 W/cm2 for
5 minutes, on the affected nerve. In this man-
ner the profound micro-massage function of the
ultrasound included the nervous fibers of the
affected peripheral nerve;
– Thermotherapy (fango) in the areas innervated
by the affected nervous roots, with a temperature
of 40–42◦ C, for 15 minutes/session daily, with
a stimulatory, excitatory and revulsive purpose;
– Electrostimulation, with exponential momen-
tum, of the muscles that were partially or totally
denervated, preceded by electrodiagnosis for the
determination of the ␣ adjustment coefficient;
– Electrostimulation of the muscles innervated by
the affected peripheral nerve was performed
daily, for 8 minutes/session, and the duration of
the therapy was increased with 1 minute/session;
– Daily kinetotherapy sessions were adapted to the
diagnosis of each patient. Intially, the patients
underwent only 1 session/day, after that, they
received 2 sessions/day;
– Manual stimulatory massage of the whole
affected limb and especially massage of the
cervical plexus emergence (antalgic and stim-
ulation effect of the affected muscles). The
sessions of manual massage took place daily, for
15 minutes, at the end of the daily therapeutic
routine.
For all the patients included in the study we
collected demographical data (age, sex, diagnosis,
localization of the lesion), as well as specific param-
eters measured at the beginning and the end of each
phase.
Descriptive statistics was used to describe the basic
features of the data in this study. As descriptive
statistics methods we used the average, the standard
deviation, the median and the interquartilar distance
(quartile 1 and 3) for numerical values, respectively
Patient distribution depending on age and diagnosis (average values, median values, and quartiles Q1–Q3)
Gender (p = 0.07)
Male Female
Average (SD) 47.2 (10.37) 51.2 (11.74)
Median (Min–Max) 48 (29–67) 51 (29–77)
Q1–Q3 39–55 43.3–60
Values are described as mean ± standard deviation, median and interquartilar distance (quartile 1 and 3); ∗ p ≤ 0.05.
115
proportions for qualitative variables. Student’s t test
for paired or unpaired data was used to compare dif-
ferent data; ANOVA and Wilcoxon tests were used
for numerical values, as well as the chi2 and Fischer
tests. All tests were bilateral and the statistical sig-
nificance p value was 0.05. For data visualization we
used histograms and box plots.
3. Results
From a total of 107 patients included in the study,
52 were diagnosed with brachial plexus palsy, 27 with
radial nerve palsy, 18 with median nerve palsy and 10
with ulnar nerve palsy. The mean age of the group was
49.6, varying between 29 and 77 years.
After centralizing the demographical data, we
did not observe a statistically significant difference
between the mean age of males (47.2) and females
(51.2) (p = 0.07). However, men presented peripheral
neuropathies at a younger age than women (Table 1).
On the other hand we can state that there is a statis-
tically significant difference between the four groups
of upper limb peripheral neuropathies, as follows
(Table 1):
• Patients with radial nerve palsy (average: 44.5
years of age) were younger than the rest of the
patients in the study group (p = 0.01);
• Patients with median nerve palsy (average: 59.5
years of age) were older than the rest of the
patients in the study group (p = 0.01);
• Patients with brachial plexus palsy and ulnar
nerve palsy had similar ages (average: 50.2 and
50.0 years of age) (p = 0.01).
In all patients significant difference in muscular
strength was observed at the end of the three treatment
phases (p < 0.001) (Table 2).
We noticed that muscle strength generally
improved with one stage during all three treatment
phases (p < 0.001). Individual increase in muscle
strength during each treatment phase was between
Table 1
Palsy diagnosis (p = 0.01)* Total
Median Radial Ulnar Brahial n = 107
nerve Nerve nerve Plexus
55.8 (11.43) 44.5 (8.50) 50.2 (10.18) 50.0 (11.89) 49.6 (11.35)
59.5 (38–74) 48.0 (30–56) 50.5 (35–65) 50.5 (35–65) 49 (29–77)
46–64.3 38–52 42.8–57.3 41.8–59.3 41–59
116 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries

Table 2
Comparative analysis of muscle strength at the beginning and at the end of the three treatment phases (p < 0.001)
Initial Final
Muscle strength PHASE 1 PHASE 2 PHASE 3 PHASE 1 PHASE 2 PHASE 3
(n = 107) (n = 107) (n = 107) (n = 107) (n = 107) (n = 107)
Average (SD) 1.16 (0.70) 2.1 (0.83) 3.2 (0.64) 0.86 (0.62) 1.13 (0.58) 0.766 (0.506)
Median (Min–Max) 1 (0–3) 2 (0–4) 3 (2–4) 1 (0–2) 1 (0–2) 1 (0–2)
Q1–Q3 1–2 1.5–3 3–4 0–1 1–1 0–1
Values are described as mean ± standard deviation, median and interquartilar distance (quartile 1 and 3); ∗ p ≤ 0.05.

Fig. 1. Comparative analysis of muscle strength at the beginning Fig. 2. Sensitivity evaluation for the affected upper limb – initial
and at the end of the three treatment phases (p < 0.001). and final (p < 0.001).

0 and 2 points, and global improvement for the three
phases was between 2 and 3 points. Although the
final effects of each phase are minor, the combined
effect corresponds with a 3 point or higher improve-
ment for more than half of the patients included in
the study.
The maximal effect for one phase was obtained
for phase 2, the difference between this and the other
two treatment phases being statistically significant
(p < 0.005, block-ANOVA test) (Fig. 1).
Moreover, we found that all patients presented sen-
sory symptoms in the affected upper limb. However,
at the end of the whole treatment we observed a signif-
icant improvement in sensitivity in the affected upper
limb (p < 0.001). The best results were noted at the
end of phase 3 (Table 3) (Fig. 2).
The ␣ adjustment coefficient quantitatively
assesses the degree of denervated muscle after a
peripheral nerve injury. After the treatment, most
patients presented a 0.5–0.7 increase in the adjust-
ment coefficient values. During phase 1, the increase
was 0.05–0.2, during phase 2 it was 0.1–0.3, and
0.2–0.3 during phase 3. This improvement was sta-
tistically significant (p < 0.001) (Table 4) (Fig. 3).
Motor nerve conduction velocity (MNCV) for the
affected peripheral nerves varied during the first
phase between 23 and 50 m/s. This parameter was
higher at the beginning of phase 2 and phase 3.
At the end of the 3 treatment cures most of the
patients presented a significant increase in nerve
conduction velocity. Overall, during all treatment
phases, nerve conduction velocity increased between
12–19 m/s. This improvement was statistically
significant (p < 0.001) (Table 5) (Fig. 4).
4. Discussion
The reactions of nervous tissues to trauma com-
prise of a sequential activation of degeneration and
regeneration processes at the axon level.

Table 3
Sensitivity evaluation for the affected upper limb – initial and final (p < 0.001)
Initial Final
Sensitivity PHASE 1 PHASE 2 PHASE 3 PHASE 1 PHASE 2 PHASE 3
(n = 107) (n = 107) (n = 107) (n = 107) (n = 107) (n = 107)
Average (SD) 9.16 (2.76) 10.36 (3.21) 13.98 (3.37) 1.084 (1.13) 3.617 (1.49) 2.88 (1.34)
Median (Min–Max) 8 (4–16) 10 (5–19) 14.0 (6–21) 1 (0–5) 3 (0–7) 3 (0–7)
Q1–Q3 7–11 7.5–13 11–16 0–2 3–5 2–4
Values are described as mean ± standard deviation, median and interquartilar distance (quartile 1 and 3); ∗ p ≤ 0.05.
 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries 117

Table 4
Evaluation of the adjustment coefficient – initial and final
Adjustment PHASE 1 PHASE 2 PHASE 3 PHASE 1 PHASE 2 PHASE 3
coefficient ␣ (n = 107) (n = 107) (n = 107) (n = 107) (n = 107) (n = 107)
Average (SD) 1.24 (0.26) 1.36 (0.27) 1.565 (0.25) 0.116 (0.085) 0.196 (0.095) 0.269 (0.118)
Median (Min–Max) 1.3 (0.8–1.8) 1.4 (0.8–2) 1.6 (1.0–2.1) 0.1 (0–0.4) 0.2 (0–0.4) 0.3 (0–0.7)
Q1–Q3 1.1–1.4 1.2–1.6 1.4–1.75 0.05–0.2 0.1–0.3 0.2–0.4
Values are described as mean ± standard deviation, median and interquartilar distance (quartile 1 and 3); ∗ p ≤ 0.05.

Fig. 3. Evaluation of the adjustment coefficient – initial and final Fig. 4. Progression of motor nerve conduction velocity – initial
(p < 0.001). and final (p < 0.001).

Nerve growth factors (NGF) play an important
role in the regeneration process by directly stimu-
lating axonal regeneration. Understanding the way
in which neurotrophic factors contribute to neuro-
protection and regeneration after peripheral nerve
injuries is challenging and represents the beginning
of a new non-pharmacological therapeutic approach
in neuropathies [1, 8, 18, 21].
It is notable that the regeneration rate is vari-
able, depending on the nerve injury. The median
nerve regenerates at a rate of 2–4.5 m/day, the cubital
nerve at a rate of 1.5 mm, and the radial at a rate
of 4-5 mm/day. On the other hand, the regeneration
rate varies depending on the type of peripheral nerve
lesion, being higher in the axonotmesis than in neu-
rotmesis imjuries [15, 21].
The ability to manage the peripheral nerve regen-
erative processes at a cellular or genetic level is a
future challenge for rehabilitation medicine. There-
fore, the clinical and electrophysiological evaluation
of peripheral motor neuron lesions of the upper limb
is mandatory in order to set the localization and
degree of nerve damage, as well as the proper thera-
peutic strategy.
This paper presents a rehabilitation protocol in
which four groups of upper limb peripheral nerve
injury patients participated. Taking into account the
type of nervous lesion and the not so long time
from the traumatic event (2 months), the aim of
this protocol is to stimulate and accelerate the nerve
regeneration process.
In order to achieve our goal we selected a number
of 107 patients (66 female, 41 male), aged between
29 and 77 years (mean age = 49.6). From the total
number of patients included in the study, 52 were
diagnosed with brachial plexus palsy, 27 with radial
nerve palsy, 18 with median nerve palsy and 10 with
ulnar nerve palsy.
This study did not find a statistically significant
difference between the mean age of males (47.2) and
females (51.2) (p = 0.07), but peripheral neuropathies
were more common in young males. Thus, our results
coincide to other previous studies which showed that
peripheral neuropathies are more frequent in young

Table 5
Progression of motor nerve conduction velocity – initial and final (p < 0.001)
Motor NCV PHASE 1 PHASE 2 PHASE 3 PHASE 1 PHASE 2 PHASE 3
(n = 107) (n = 107) (n = 107) (n = 107) (n = 107) (n = 107)
Average (SD) 32.67 (6.27) 35.47 (6.88) 39.35 (7.39) 2.682 (1.697) 3.879 (1.961) 9.252 (3.948)
Median (Min–Max) 31 (23–50) 33 (25–55) 37.0 (27–60) 2 (0–9) 3 (0–12) 9 (2–19)
Q1–Q3 29–35 30.5–40 34–45 2–4 3–5 7–12
Values are described as mean ± standard deviation, median and interquartilar distance (quartile 1 and 3); ∗ p ≤ 0.05.
118 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries
males [2, 20]. The difference between the genders
can be explained by the fact that men get more often
involved in physical work and are more exposed to
accidents.
At the end of the rehabilitation treatment, both clin-
ical and electrophysiological parameters improved.
Although the effects of each treatment individually
did not show spectacular results, the global effect
led to the improvement of all parameters. There-
fore, after analyzing the results we observed that the
aforementioned parameters registered a statistically
significant improvement during phase 3, regardless
of the diagnosis.
In recent years, many studies evaluated the efficacy
of rehabilitation techniques on clinical and electro-
physiological parameters in upper limb peripheral
neuropathies. Physical therapy modalities include
pain modulators like hot and cold packs, ultrasound,
low-power laser, TENS, transcutaneous electrostim-
ulation and mobilization techniques. These have
proven to be efficient in reducing pain, increas-
ing muscle strength, sensitivity and peripheral nerve
conduction velocity [4, 12, 14, 19].
In our study we proposed a protocol with the
following procedures: ultrasound treatment, ther-
motherapy, electrostimulation of the partially or
totally denervated muscles, kinetotherapy and mas-
sage. The results recorded at the end of the
rehabilitation program confirm previous reports,
above mentioned. All patients achieved better out-
comes in muscle strength, sensitivity, adjustment
coefficient ␣ and nerve conduction velocity in the
affected limb (p < 0.001) [4, 12, 14, 19].
Another finding of this study is that rehabilitation
technique should be initiated as soon as possible
after the trauma in order to avoid eventual pathologic
regeneration (Wallerian degeneration) and the estab-
lishment of muscular hypotrophies or atrophies that
would hinder rehabilitation of the limb. Thus, several
authors demonstrated the importance of early reha-
bilitation therapy for good outcomes [3, 11, 16, 17].
The favorable results obtained allow us to state that
our protocol could be proposed as an alternative in the
rehabilitation therapy of upper limb peripheral nerve
injuries.
5. Conclusions
The clinical and electrophysiological assessment
[10]
of traumatic peripheral motor neuron lesions is
mandatory to establish the location and the level
of nervous damage, as well as a proper therapeutic
strategy.
This protocol could have two effects in patients
with peripheral nerve injuries:
a) Nerve stimulation by producing supramaximal
impulses leading to a motor response;
b) Regeneration stimulation of the limb by pro-
moting the tissue regrowth processes, by
activating the metabolism and timulating cyto-
genesis.
The intervention of an early physical therapy
program in patients with peripheral neuropathies
provided significantly better outcomes in muscle
strength, sensitivity, adjustment coefficient ␣ and
nerve conduction velocity of the affected limb.
Conflict of interest
All authors declare that they have no conflict of
interest.
References
[1] Boyd, J. G., & Gordon, T. (2003). Neurotrophic factors
and their receptors in axonal regeneration and functional
recovery after peripheral nerve injury. Mol Neurobiol, 27,
277-324.
[2] Ciaramitaro, P., Mondelli, M., Logullo, F., et al. (2010).
Traumatic peripheral nerve injuries: Epidemiological find-
ings, neuropathic pain and quality of life in 158 patients.
J Peripher Nerv Syst, 15(2), 120-127.
[3] Dahlin, L. B. (2013). The role of timing in nerve reconstruc-
tion. International Review of Neurobiology, 109, 151-164.
[4] Ellis, R. F., & Hing, W. A. (2008). Neural mobilization:
A systematic review of randomized controlled trials with
an analysis of therapeutic efficacy. Journal of Manual and
Manipulative Therapy,16, 8-22.
[5] Gaudet, A. D., Popovich, P. G., & Ramer, M. S. (2011). Wal-
lerian degeneration: Gaining perspective on inflammatory
events after peripheral nerve injury, J Neuroinflamm, 8.
[6] Geuna, S., Raimondo, S., Ronchi, G., et al. (2009). Chapter
3: Histology of the peripheral nerve and changes occurring
during nerve regeneration. Int Rev Neurobiol, 87, 27-46.
[7] Hanz, S., & Fainzilber, M. (2006). Retrograde signaling
in injured nerve—The axon reaction revisited. Journal of
Neurochem, 99, 13–19.
[8] Kemp, S. W., Walsh, S. K., & Midha, R. (2008). Growth
factor and stem cell enhanced conduits in peripheral nerve
regeneration and repair. Neurol Res, 30, 1030-1038.
[9] Kimura, D. J. (2000). Electrodiagnosis in diseases of nerve
and muscle: Principles and Practice. (3rd ed.). Oxford Uni-
versity Press.
Klein, D., & Martini, R. (2015). Myelin and macrophages
in the PNS: An intimate relationship in trauma and disease.
Brain Research, 1641, 130–138.
 C. Milicin and E. Sı̂rbu / A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries
[11] Matsuo, H., Uchida, K., Nakajima, H., Guerrero, A. R., et
al. (2014). Early transcutaneous electrical nerve stimulation
reduces hyperalgesia and decreases activation of spinal glial
cells in mice with neuropathic pain. Pain, 155(9), 1888-
1901.
[12] Michlovitz, S. L. (2004). Conservative Interventions for
Carpal Tunnel Syndrome. Journal of Orthopaedic & Sports
Physical Therapy, 34(10), 589-600.
[13] Milicin, C., & Drăgoi, M. (2008). Ghid practic şi legislativ
de electroterapie. LITO UMFT, 25-29.
[14] Misook, H. A., Youngmin, Son, & Dongwook, Han (2012).
Effect of Median Nerve Mobilization and Median Nerve
Self-Mobilization on Median Motor Nerve Conduction
Velocity. Journal of Physical Therapy Science, 24(9), 801-
804.
[15] Pederson, W. C. (2014). Median nerve injury and repair. J
Hand Surg Am, 39(6), 1216-1222.
[16] Robinson, M. D., & Shannon, S. (2002). Rehabilitation of
peripheral nerve injuries. Physical Medicine and Rehabili-
tation Clinics of North America, 13(1), 109-135.
[17] Rosén, B., & Lundborg, G. (2003). Early use of artificial
sensibility to improve sensory recovery after repair of the
119
median and ulnar nerve. Scandinavian Journal of Plas-
tic and Reconstructive Surgery and Hand Surgery, 37(1),
54-57.
[18] Roux, P. P., & Barker, P. A. (2002). Neurotrophin signaling
through the p75 neurotrophin receptor. Prog Neurobiol, 67,
203-233.
[19] Santos, F. M, Silva, J. T., Giardini, A. C., Rocha, P. A.,
Achermann, A. P., Alves, A. S., Britto, L. R., & Chacur, M.
(2012). Neural mobilization reverses behavioral and cellular
changes that characterize neuropathic pain in rats. Molecu-
lar Pain, 10(1), 57.
[20] Szyłejko, A., Bielecki, M., & Terlikowski, R. (2015).
Epidemiology of upper limb peripheral nerve injuries in
the material collected in the Department of Orthopedics
and Traumatology Medical University of Bialystok. Prog
Health Sci, 5(1), 130-137.
[21] Thomas, M. B. (2011). Nerve repair, Oxford University
Press, 297-298.
[22] Witzel, C., Rohde, C., & Brushart, T. M. (2005). Pathway
sampling by regenerating peripheral axons. The Journal of
Comparative Neurology, 485(3), 183-190.