Sensory Retraining of the Lower Limb After Acute Stroke: A Randomized Controlled Pilot Trial (original) (raw)
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Evidence for the retraining of sensation after stroke: a systematic review
Clinical Rehabilitation, 2009
Objective: Retraining of sensory function following stroke is frequently overlooked in rehabilitation protocols despite more than 60% of patients presenting with sensory deficits. Methods to train sensory function include both passive and active training protocols. Here we examined the volume and quality of the evidence available for both passive and active sensory training following stroke. In addition, we aimed to quantify the effect of sensory training on impairment and function. Data sources: Databases searched included MEDLINE, AMED, CINAHL, Academic search elite, Scopus and the Cochrane library. Unpublished articles were identified using a search engine. Review methods: Studies utilizing passive or active sensory training paradigms post stroke were identified. Methodological quality was examined using the National Health and Medical Research Council hierarchy of evidence and the McMaster University critical appraisal tool. Results: Fourteen studies met the inclusion criteria; 8 examined passive and 6 active sensory training. Methodological quality scores ranged from 11 to 18.5 (maximum 20). Meta-analysis was performed using three studies examining hand function, demonstrating a moderate effect in favour of passive sensory training. Other studies were unable to be pooled due to heterogeneity of measures or insufficient data. Conclusion: Meta-analyses and single studies offer some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, empirical evidence for active sensory training is limited. Further high-quality studies with greater statistical power and meaningful clinical measures are required in order to accurately determine the effectiveness of sensory retraining following stroke.
Measurement of motor recovery after stroke. Outcome assessment and sample size requirements
Stroke, 1992
The purpose of this study was to analyze recovery of motor function in a cohort of patients presenting with an acute occlusion in the carotid distribution. Analysis of recovery patterns is important for estimating patient care needs, establishing therapeutic plans, and estimating sample sizes for clinical intervention trials. Methods: We prospectively measured the motor deficits of 104 stroke patients over a 6-month period to identify earliest measures that would predict subsequent motor recovery. Motor function was measured with the Fugl-Meyer Assessment. Fifty-four patients were randomly assigned to a training set for model development; SO patients were assigned to a test set for model validation. In a second analysis, patients were stratified on basis of time and stroke severity. The sample size required to detect a 50% improvement in residual motor function was calculated for each level of impairment and at three points in time. Results: At baseline the initial Fugl-Meyer motor scores accounted for only half the variance in 6-month motor function (r 2 =0.53,/><0.001). After 5 days, both the 5-day motor and sensory scores explained 74% of the variance (/><0.001). After 30 days, the 30-day motor score explained 86% of the variance (p<0.001). Application of these best models to the test set confirmed the results obtained with the training set. Sample-size calculations revealed that as severity and time since stroke increased, sample sizes required to detect a 50% improvement in residual motor deficits decreased. Conclusions: Most of the variability in motor recovery can be explained by 30 days after stroke. These findings have important implications for clinical practice and research.
2021
ABSTRACTBackgroundTo implement intervention from research to clinical practice, treatments must be adequately described in randomized clinical trials. Specific reporting guidelines, such as the TIDieR checklist, have been developed to enhance the reporting of intervention in clinical trials.ObjectiveWe aim to evaluate the adherence to the TIDieR checklist in randomized controlled trials evaluating somatic sensory training interventions in individuals following a stroke.Material and MethodsWe will perform a systematic review of the literature, searching PubMed, CENTRAL, and PEDro for randomized controlled trials that evaluate the efficacy of any rehabilitative intervention on somatic sensation in patients with a history of stroke, independently form the comparator.Two authors independently will evaluate the completeness of the reporting of the intervention using the TIDieR checklist.A descriptive analysis of the total score and the individual items of the TIDieR will be produced.Ethi...
Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study
Frontiers in Neurology
Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles.Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT.Methods: Design: randomized, single-blinded, mixed-methods pilot study.Setting: In-patient rehabilitation ward and community.Participants:n = 34, 18+years, 42–112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent.Intervention: Twenty 30-min sessions of task-specific gait training (...
Trials, 2018
Many stroke survivors suffer from sensory impairments of their affected upper limb (UL). Although such impairments can affect the ability to use the UL in everyday activities, very little attention is paid to sensory impairments in stroke rehabilitation. The purpose of this trial is to investigate if sensory re-learning in combination with task-specific training may prove to be more effective than task-specific training alone to improve sensory function of the hand, dexterity, the ability to use the hand in daily activities, perceived participation, and life satisfaction. This study is a single-blinded pilot randomized controlled trial (RCT) with two treatment arms. The participants will be randomly assigned either to sensory re-learning in combination with task-specific training (sensory group) or to task-specific training only (control group). The training will consist of 2.5 h of group training per session, 2 times per week for 5 weeks. The primary outcome measures to assess sens...
Neurorehabilitation and neural repair, 2018
Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance. To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke. We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed. There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% CI, 0.09-1.24; I = 65%). Only 1 study included subjects in the subacute phase after stroke. Subgroup anal...
Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data
Topics in Stroke Rehabilitation, 2013
To obtain more generalizable information on the frequency and factors infl uencing sensory impairment after stroke and their relationship to mobility and function. Method: A pooled analysis of individual data of stroke survivors (N = 459); mean (SD) age = 67.2 (14.8) years, 54% male, mean (SD) time since stroke = 22.33 (63.1) days, 50% left-sided weakness. Where different measurement tools were used, data were recoded. Descriptive statistics described frequency of sensory impairments, kappa coeffi cients investigated relationships between sensory modalities, binary logistic regression explored the factors infl uencing sensory impairments, and linear regression assessed the impact of sensory impairments on activity limitations. Results: Most patients' sensation was intact (55%), and individual sensory modalities were highly associated (κ = 0.60, P < .001). Weakness and neglect infl uenced sensory impairment (P < .001), but demographics, stroke pathology, and spasticity did not. Sensation infl uenced independence in activities of daily living, mobility, and balance but less strongly than weakness. Conclusions: Pooled individual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated; interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.
Clinical rehabilitation, 2016
Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studi...
Topics in Stroke Rehabilitation, 2014
I would like to acknowledge the members of my dissertation committee who provided invaluable support and guidance throughout this project. I would especially like to thank Dr. Thomas Fisher for his support and counsel as my dissertation committee chair. He has truly been a mentor and role model for not only my dissertation, but also for my academic career development. I am grateful for his persistence during challenging times as my committee chair. His dedication to the profession of occupational therapy and academia continue to inspire me. Dr. Jeffrey Crabtree provided thoughtful suggestions and continually broadened my theoretical perspective particularly in regards to rehabilitation and healthcare. His attention to detail and broad perspective are both appreciated for this project. He is dedicated to post professional education and serving society's occupational needs. Dr. Arlene Schmid helped me to become a better stroke rehabilitation researcher. Her expertise and experience in stroke rehabilitation helped guide me through this project particularly with the results and discussion. Dr. Stephen Page inspired me to pursue stroke rehabilitation and afforded me many opportunities. His expertise in stroke rehabilitation research, particularly motor control, helped develop my dissertation focus and has served as a support throughout this project. His dedication and commitment to excellence in stroke rehabilitation research is inspirational. Ms. Elaine Fess first exposed me to research and inspired me to pursue touch sensation in the stroke population. Her counsel and support with the study design and methodology contributed to the success of this project. It is because of her faith in the project that I was able to persevere through the challenging times during my dissertation. Dr. Linda Levin helped me with the statistical analyses for my dissertation. Her passion for statistics and determination was greatly appreciated throughout the results section. I would like to thank Dr. Kari Dunning and Mr. Johnny Wilkerson for supporting me through this project and serving as counsel with the institutional review board and study management. v I would like to acknowledge the students who helped collect data and make this project a reality.