Following surgical repair of major nerve trunks there is a rapid functional reorganisation in the brain, characterised by a changed cortical mapping of the hand secondary to incorrect reinnervation of peripheral targets. Sensory re-educational programmes are used in the rehabilitation phase to facilitate and positively influence the re-learning process, which is required to make possible an adaptation to the new synaptic organisation and to improve the recovery of functional sensibility - tactile gnosis. However, the outcome is often disappointing, especially in adults. The design of sensory re-education programmes has not changed for several decades. The purpose of this paper is to review evolving concepts in neuroscience and cognitive science, present a rationale for a modified approach to classic sensory re-education, and suggest new strategies for enhanced sensory re-learning following nerve repair.
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