Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life. Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity, indicating a potential mechanism which may mediate recovery. However, rehabilitation specifically focusing on somatosensory function receives little attention. Objectives: To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke. Methods: Electronic databases and trial registries were searched from inception until November 2018, in addition to hand searching systematic reviews. Study selection included randomized controlled trials for adults of any stroke type with an upper and/or lower limb sensorimotor impairment. Participants all received a sensory-based intervention designed to improve activity levels or impairment, which could be compared with usual care, sham, or another intervention. The primary outcomes were change in activity levels related to sensorimotor function. Secondary outcomes were measures of impairment, participation or quality of life. Results: A total of 38 study trials were included ( n = 1,093 participants); 29 explored passive sensory training (somatosensory; peripheral nerve; afferent; thermal; sensory amplitude electrical stimulation), 6 active (sensory discrimination; perceptual learning; sensory retraining) and 3 hybrid (haptic-based augmented reality; sensory-based feedback devices). Meta-analyses (13 comparisons; 385 participants) demonstrated a moderate effect in favor of passive sensory training on improving a range of upper and lower limb activity measures following stroke. Narrative syntheses were completed for studies unable to be pooled due to heterogeneity of measures or insufficient data, evidence for active sensory training is limited however does show promise in improving sensorimotor function following stroke. Conclusions: Findings from the meta-analyses and single studies highlight some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, evidence for active sensory training continues to be limited. Further high-quality research with rigorous methods (adequately powered with consistent outcome measures) is required to determine the effectiveness of sensory retraining in stroke rehabilitation, particularly for active sensory training.

Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke

“…Somatosensory therapy can improve somatosensory function. Serrada et al (11) reported a moderate positive effect for passive somatosensory therapy such as peripheral stimulation, thermal stimulation and intermittent compression therapy. No evidence was presented for active somatosensory therapy such as somatosensory discrimination training due to heterogeneity in outcome measures.…”

Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic

“…Somatosensory impairment is considered to have a negative prognostic impact on rehabilitation interventions and overall motor function recovery (Bowerman et al, 2012 ; Dietz and Fouad, 2014 ; Zandvliet et al, 2020 ). Although the current literature in this field is limited, a recent systematic review and meta-analysis indicated positive effects in improving somatosensory impairments (Serrada et al, 2019 ). Specifically, sensory discrimination training by repeated practice to distinguish textures and localize tactile stimuli can influence the sensory system and drive recovery (Carey et al, 1993 ; Yekutiel and Guttman, 1993 ; Turville et al, 2019 ).…”

Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study

“…Furthermore, somatosensory deficits significantly impair motor control, impede functional performance 2,[4][5][6][7] and negatively impact quality of life. 8 Though somatosensation has an important role in the functioning of the upper limb 7 and is routinely assessed clinically, 7 interventions that address somatosensory deficits are lacking.…”