Effects of Mobilization and Tactile Stimulation on Chronic Upper-Limb Sensorimotor Dysfunction After Stroke

Winter, Jacqueline; Crome, Peter; Sim, Julius; Hunter, Susan M.

doi:10.1016/j.apmr.2012.11.028

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…Hence, the integration of a clinical somatosensory component into motor therapy may not be of added value for motor recovery in the early rehabilitation phase. Similar, in the review of Gopaul et al improvements after sensorimotor therapy were found in a trial with stroke patients in the chronic phase but not in other studies with subacute stroke patients (14,43,44). Further research, implementing and evaluating the effect of a revised sensorimotor therapy approach, is needed to provide better insight in effective sensorimotor therapy models, the long-term effects of sensorimotor therapy and the optimal rehabilitation phase.…”

Section: Discussionmentioning

confidence: 81%

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

et al. 2020

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Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery.Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy?Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke.Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center.Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy.Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up.Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003].Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03236376.

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Section: Discussionmentioning

confidence: 81%

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

et al. 2020

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“…Therapist-led hands-on guidance and feedback assisted practice of functional tasks, sometimes with increasing resistance or mass of an object and changes in speed of movement to increase the challenge of the activity, but this was not progressed systematically. Replicated single system studies of one module of MPT, known as mobilisation and tactile stimulation delivered daily for up to 60 min/day, 5 days/week for 6 weeks to the paretic upper limb of people in the subacute ( 54 ) and chronic phases after stroke ( 45 ) produced improvements in upper limb muscle strength and activity capacity.…”

Section: Methodsmentioning

confidence: 99%

“…The two well-characterised physical therapies providing the context for investigation are used in conventional physical therapy (CPT): functional strength training (FST) focussed on improving the ability to perform everyday tasks ( 32 – 41 ); and movement performance therapy (MPT) focussed on improving the quality of movement during performance of everyday tasks ( 32 , 39 – 43 ), referred to as extra CPT in early phase studies ( 32 , 39 – 41 ). A recent systematic review concluded that such conceptually different physical therapies are probably no less or more effective than each other ( 4 ) although early phase trials indicate variation between people in their response to FST and MPT ( 32 , 41 , 44 , 45 ).…”

Section: Introductionmentioning

confidence: 99%

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

et al. 2018

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BackgroundVariation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.ObjectivesTo determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.DesignExplanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.ParticipantsWith some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.InterventionsConventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.OutcomesThe primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.AnalysisCovariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.ConclusionsThere was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registrationCurrent Controlled Trials: ISRCT 19090862,

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“…No discrimination tasks were established in the CG although mobilizations and different surfaces were proposed28, 29 ) . Hence, CG participants received the same type of information (propioceptive and tactile) but they were not asked to resolve any problem nor to be aware of their body sensations.…”

Section: Methodsmentioning

confidence: 99%

A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study

et al. 2017

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[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol’s feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

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Effects of Mobilization and Tactile Stimulation on Chronic Upper-Limb Sensorimotor Dysfunction After Stroke

Cited by 14 publications

References 23 publications

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

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study

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