Effectiveness of somatosensory interventions on somatosensory, motor and functional outcomes in the upper limb post-stroke: A systematic review and meta-analysis

Abstract

BACKGROUND: Research mainly focuses on motor recovery of the upper limb after stroke. Less attention has been paid to somatosensory recovery. OBJECTIVE: To review and summarize the effect of upper limb somatosensory interventions on somatosensory impairment, motor impairment, functional activity and participation after stroke. METHODS: Biomedical databases Ovid Medline, EMBASE, Web of Science, PEDro, and OTseeker were searched with an update in May 2018. Randomized controlled trials investigating the effect of somatosensory-specific interventions focusing on exteroceptive, proprioceptive or higher cortical somatosensory dysfunction, or any combination were eligible for inclusion. Quality of included studies were assessed using Physiotherapy Evidence Database (PEDro) scale. Standardized Mean Differences and Mean Differences and 95% confidence intervals were calculated and combined in meta-analyses. RESULTS: Active somatosensory interventions did not show a significant effect on somatosensation and activity, but demonstrated a significant improvement in motor impairment (SMD = 0.73, 95% CI = 0.14 to 1.32). No study evaluating active somatosensory intervention included participation. Passive somatosensory interventions significantly improved light touch sensation (SMD = 1.13, 95% CI = 0.20 to 2.05). Passive somatosensory interventions did not show significant effects on proprioception and higher cortical somatosensation, motor impairment, activity and participation. CONCLUSIONS: To date, there is low quality evidence suggesting active somatosensory interventions having a beneficial effect on upper limb impairment and very low quality evidence suggesting passive somatosensory interventions improving upper limb light touch sensation. There is a need for further well-designed trials of somatosensory rehabilitation post stroke.

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

“…They found moderate evidence that somatosensory stimulation does not improve motor performance. Yilmazer et al (13) on the other hand, showed limited evidence for passive somatosensory therapy and some evidence for the effect of active somatosensory therapy on motor function. Nevertheless, when aiming at improving motor function, a pure somatosensory approach may not be sufficient as it is known that task-specific motor training is effective in improving motor outcome.…”

Why we should systematically assess, control and report somatosensory impairments in BCI-based motor rehabilitation after stroke studies

“…Second, the use of a constant sensory stimulation (mechanical vibration on the wrist) during motor rehabilitation has proven efficient in enhancing the motor function both at short and long terms and in increasing motor related brain activity ( Fleming et al, 2015 ). Also, exteroceptive and proprioceptive stimulations seem to have a beneficial influence on motor function, even though further high quality studies are required ( Yilmazer et al, 2019 ).…”

Diskriminationstraining

“…Ebenfalls verbesserte sich ihre Zwei-Punkt-Diskriminierung: Die Schwellenwerte waren am Ende des Trainings signifikant besser als zu Beginn [11]. Diskriminationstraining wird häufig bei chronischen Schmerzen eingesetzt [12], und es gibt mehr Studien zum Diskriminationstraining bei Schmerzen als zur Verbesserung von Körperfunktion [3].…”

“…Eine aktuelle Übersichtsarbeit aus dem letzten Jahr beschrieb den aktuellen Stand zum sensorischen Beüben der oberen Extremität [3]. Die Arbeitsgruppe um Yilmazer und Verheyden aus Leuven, Belgien, zeigte, dass die Effekte somatosensorischer Interventionen auf die Motorik und Funktion der oberen Extremität nach Schlaganfall lediglich gering sind.…”

“…Interventionen zeigten kaum einen Effekt auf die Oberflächensensibilität oder Aktivitäten, hatten jedoch einen Effekt auf motorische Einschränkungen. Passive somatosensorische Interventionen verbesserten immerhin leicht die Oberflächenberührungsempfindlichkeit, hatten jedoch keinen Effekt auf höhere kortikale somatosensorische und motorischer Einschränkungen sowie auf Aktivitäten und Partizipation [3].…”