140 CHAPTER 7 multidisciplinary rehabilitation to that after 17 weeks of usual care in a group of 47 NA patients. We expected that clinical improvement would be greater after specific rehabilitation than after usual care. We found that 17 weeks of specific rehabilitation was more effective for improving the functional capability of the upper extremity, the RCT’s primary outcome measure, than usual care and that these effects were retained 4 months post-treatment. The proportion of patients who had attained a clinically relevant improvement in functional capability was larger for the rehabilitation (59%) than for usual care group (33%), resulting in a number needed to treat of 4. We did not find significant differences between usual care and specific rehabilitation on other ICF domains. We did observe a trend in favour of specific rehabilitation on almost all domains, including less pain and fatigue, higher self-management and more optimal participation in daily activities. Chapter 5 concluded that specific, multidisciplinary outpatient rehabilitation, which targets the central motor system, is an effective treatment to improve functional capability of the upper extremity in NA patients. To gain insight into how underlying cerebral processes changed with rehabilitation and recovery, we conducted a task-based fMRI study in a sub-sample (n=27) of NA patients that participated in the RCT, described in chapter 6. Patients performed the same motor imagery task they performed at baseline (described in chapter 4) a second time after 17 weeks of treatment. We expected that specific rehabilitation, but not usual care, could modify altered cerebral sensorimotor representations of the affected upper extremity. In this sub-sample, specific rehabilitation elicited significantly greater improvement in functional capability of the upper extremity (in line with the findings in chapter 5), as well as a significant reduction in persistent pain as compared to usual care. Despite this clinical group effect, we did not find significant differences in cerebral changes between patients that received specific rehabilitation and those that received usual care. Patients in both groups did show a significant improvement in task performance, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. Interestingly, increases occurred in the same visuomotor regions where they had previously shown decreased activity compared to healthy volunteers (as described in chapter 4). Despite the fact that we found significant changes in brain activity, task performance and clinical outcome, and the direction of those changes aligned, there were no significant longitudinal correlations between them. The findings in chapter 6 indicated that altered cerebral sensorimotor representations in NA can recover towards normality alongside clinical recovery. Concluding part two, we showed that specific rehabilitation can aid clinical recovery after NA and that cerebral processes can recover. Our findings additionally underlined the importance of a multidisciplinary approach for rehabilitation after peripheral nerve damage in NA, and identified visuomotor processes as a potential target to further improve rehabilitation. Taking the two parts of this thesis together, we confirmed the clinical intuition that maladaptive cerebral neuroplasticity is involved in NA, that maladaptations can recover towards normality, and that specific rehabilitation can aid clinical recovery. We did however not find evidence that specific rehabilitation is more effective than usual care in modulating cerebral changes in NA.