To stimulate or not to stimulate? A rapid systematic review of repetitive sensory stimulation for the upper-limb following stroke

Abstract

Background Repetitive sensory stimulation (RSS) is a therapeutic approach which involves repeated electrical stimulation of the skin’s surface to improve function. This rapid systematic review aimed to describe the current evidence for repetitive sensory stimulation (RSS) in rehabilitation of the upper-limb for people who have had a stroke. Main text Methods: Relevant studies were identified in a systematic search of electronic databases and hand-searching in February 2020. The findings of included studies were synthesized to describe: the safety of RSS, in whom and when after stroke it has been used, the doses used and its effectiveness. Results Eight studies were included. No serious adverse events were reported. The majority of studies used RSS in participants with mild or moderate impairments and in the chronic stage after stroke. Four studies used RSS in a single treatment session, reporting significant improvements in strength and hand function. Findings from longitudinal studies showed few significant differences between control and experimental groups. Meta-analysis was not possible due to the heterogeneity of included studies. Conclusions This review suggests that there is insufficient evidence to support the use of RSS for the upper-limb after stroke in clinical practice. However, this review highlights several clear research priorities including establishing the mechanism and in whom RSS may work, its safety and optimal treatment parameters to improve function of the upper-limb after stroke.

Tactile Sensation Improves Following Motor Rehabilitation for Chronic Stroke: The VIGoROUS Randomized Controlled Trial

“…6,37 However, evidence regarding the effects of motor rehabilitation on somatosensory recovery in people with chronic stroke is limited. 7,8,38 To our knowledge, this is the first large RCT of upper limb motor rehabilitation to report improvements in tactile sense. Notably, tactile sense improved for one-third of the participants, and improvements were sustained for at least 6 months.…”

National Clinical Guideline for Stroke for the United Kingdom and Ireland: Part I – An overview of the updated recommendations

“…In relation to motor recovery, the primary rehab approach recommended by the guideline is repetitive task practice (RTP) (da Silva et al, 2020; French et al, 2016; Grattan et al, 2016; Pollock et al, 2014; Veerbeek et al, 2014a; Wattchow et al, 2018) over all other approaches including Bobath (Dorsch et al, 2023). Further, the guidelines recommend, functional electrical stimulation for wrist and finger extension (Kristensen et al, 2022; Loh et al, 2022; Tang et al, 2021; Yang et al, 2019) to enable engagement with RTP, constraint-induced movement therapy (Barzel et al, 2015; Corbetta et al, 2015; Kwakkel et al, 2015; Liu et al, 2016; Yadav et al, 2016) in those with mild-moderate weakness (see guidelines for specific parameters), and both mirror therapy (Thieme et al, 2018; Yang et al, 2018; Zeng et al, 2018; Zhang et al, 2022) and mental practice (Di Rienzo et al, 2014; Barclay et al, 2020; Page and Peters, 2014; Poveda-Garcia et al, 2021; Stockley et al, 2020) as adjuncts to support RTP. Transcutaneous vagal nerve stimulation (Ahmed et al, 2022; Xie et al, 2021; Zhao et al, 2022) has been recommended for the first time as an addition to usual therapy to enhance the effect of RTP.…”

Maximizing Strength: The Stimuli and Mediators of Strength Gains and Their Application to Training and Rehabilitation

“…Alternatively, manipulation of sensory input (e.g., via brief, local vibration or sensory nerve electrical stimulation) represents another neural-based strategy that may have potential to maximize strength gains. These approaches augment sensory feedback to modulate (or prime) neural excitability and can, in some instances, immediately improve performance on clinical tests of motor function in selected populations (3,46,76,81,87). However, clinical populations and those with neurological disorders are more likely to positively respond to approaches that manipulate sensory input than healthy, high-performing individuals (because of a ceiling effect in the latter population).…”

“…Supplemental activities (used in conjunction with RE) might help to rehabilitate strength. For example, in addition to potentially maximizing strength in healthy populations, biofeedback (57) and external stimulation (8,74,87,93) might also help to rehabilitate strength capabilities in some clinical contexts. That stated, the associated nuance and necessary clinical judgement prevents detailed recommendations.…”