Proprioceptive Training with Visual Feedback Improves Upper Limb Function in Stroke Patients: A Pilot Study

Abstract

Proprioceptive deficit is one of the common sensory impairments following stroke and has a negative impact on motor performance. However, evidence-based training procedures and cost-efficient training setups for patients with poststroke are still limited. We compared the effects of proprioceptive training versus nonspecific sensory stimulation on upper limb proprioception and motor function rehabilitation. In this multicenter, single-blind, randomized controlled trial, 40 participants with poststroke hemiparesis were enrolled from 3 hospitals in China. Participants were assigned randomly to receive proprioceptive training involving passive and active movements with visual feedback (proprioceptive training group [PG]; n = 20 ) or nonspecific sensory stimulation (control group [CG]; n = 20 ) 20 times in four weeks. Each session lasted 30 minutes. A clinical assessor blinded to group assignment evaluated patients before and after the intervention. The primary outcome was the change in the motor subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-M). Secondary outcomes were changes in box and block test (BBT), thumb localization test (TLT), the sensory subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-S), and Barthel Index (BI). The results showed that the mean change scores of FMA-UE were significantly greater in the PG than in the CG ( p = 0.010 for FMA-UE-M, p = 0.033 for FMA-UE-S). The PG group was improved significantly in TLT ( p = 0.010 ) and BBT ( p = 0.027 ), while there was no significant improvement in TLT ( p = 0.083 ) and BBT ( p = 0.107 ) for the CG group. The results showed that proprioceptive training was effective in improving proprioception and motor function of the upper extremity in patients with poststroke. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2000037808).

Dual‐tDCS combined with sensorimotor training promotes upper limb function in subacute stroke patients: A randomized, double‐blinded, sham‐controlled study

“…The recently advanced studies indicated that skill‐based sensorimotor training and robot‐aided somatosensory training can improve somatosensory and motor function in stroke survivors 14–17 . In addition, our research group found that active sensorimotor training could significantly improve the upper extremity sensorimotor function of patients with subacute stroke compared with conventional rehabilitation training 18,19 …”

“…The hand–brain perception device (Model: SensiTouch2; Shanghai Electric Intelligent Rehabilitation Medical Co., Ltd., Shanghai, China) was used to train the upper limb sensorimotor function for included patients. The device can be used for visual masking, which can more effectively help patients restore the sensorimotor function of the upper limb 18 . This study uses a three‐step method to train patients' sensorimotor functions: the first step is to conduct sensorimotor assessment; the second step is to perform passive sensory stimulation and active sensory training; the third step is to perform task‐oriented motor function training for patients.…”

“…The device can be used for visual masking, which can more effectively help patients restore the sensorimotor function of the upper limb. 18 This study uses a three‐step method to train patients' sensorimotor functions: the first step is to conduct sensorimotor assessment; the second step is to perform passive sensory stimulation and active sensory training; the third step is to perform task‐oriented motor function training for patients. Sensorimotor training was tailored to meet all patients' deficits and lasted a total of 40 min per day (Figure 1A ).…”

“…[14][15][16][17] In addition, our research group found that active sensorimotor training could significantly improve the upper extremity sensorimotor function of patients with subacute stroke compared with conventional rehabilitation training. 18,19 Transcranial direct current stimulation (tDCS) is a non-invasive neuroregulatory technique that uses constant low-intensity direct current (1-2 mA) to modulate neuronal activity in the cerebral cortex. 20,21 The excitability of the affected side decreased and the compensatory excitability of the unaffected side increased after unilateral stroke.…”

“… 14 , 15 , 16 , 17 In addition, our research group found that active sensorimotor training could significantly improve the upper extremity sensorimotor function of patients with subacute stroke compared with conventional rehabilitation training. 18 , 19…”