Myoelectric motor execution and sensory training to treat chronic pain and paralysis in a replanted arm: a case study.

This is one person with no control group, so nothing about the result can be separated from the natural course of recovery, the medications he was already taking, or the effects of simply being assessed and attended to. The patient did not follow the planned schedule. Some weeks had only one session or none, so the 20 sessions were spread over 84 days rather than the intended 10 weeks. The monofilament testing was done exploratorily and not to its usual protocol, because the patient felt referred sensations away from where the probe touched, so the researchers kept increasing probe size in a way the test is not normally performed. There were no qualitative assessments, and the authors themselves flag the limited number of assessments before, during and after the intervention. MME and Sensory Training were given together for part of the treatment, so the contribution of either component on its own cannot be separated.

Funding was from Chalmers University of Technology, a non-commercial funder. The paper reports no other conflicts of interest, but the decoding software used, Neuromotus, is made by Integrum AB, a Swedish company, and the authors state they intend to develop self-administered home versions of the training.

Do not read the disappearance of the highest pain level after session 3 as evidence the treatment relieved pain. The overall pain distribution showed no conclusive decrease, current pain was not lower at the final session, and the authors state plainly that no clinically meaningful improvement in neuropathic pain was observed. Equally, the few degrees of wrist and thumb movement gained came from one person who had already failed conventional therapy, and the authors could not separate the effect of the motor training from the sensory training or from the patient moving his unaffected arm alongside the affected one.