Nothing useful here. A sensory protocol should have been written 16 years ago after the publication of the book, 'Sensory Re-Education of the Hand After Stroke' in
2001 by Margaret
Yekutiel. Better sensation leads to better motor recovery. What the hell
will it take to write a simple fucking protocol on sensation and motor
recovery? Is everyone in stroke that goddamned lazy AND incompetent?
- Martijn P. Vlaar†Email author,
- Teodoro Solis-Escalante†,
- Julius P. A. Dewald,
- Erwin E. H. van Wegen,
- Alfred C. Schouten,
- Gert Kwakkel,
- Frans C. T. van der Helm and
- on behalf of the 4D-EEG consortium
†Contributed equally
Journal of NeuroEngineering and Rehabilitation201714:30
DOI: 10.1186/s12984-017-0240-3
© The Author(s). 2017
Received: 17 November 2016
Accepted: 30 March 2017
Published: 17 April 2017
Abstract
Background
Cortical damage after stroke
can drastically impair sensory and motor function of the upper limb,
affecting the execution of activities of daily living and quality of
life. Motor impairment after stroke has been thoroughly studied, however
sensory impairment and its relation to movement control has received
less attention. Integrity of the somatosensory system is essential for
feedback control of human movement, and compromised integrity due to
stroke has been linked to sensory impairment.
Methods
The goal of this study is to
assess the integrity of the somatosensory system in individuals with
chronic hemiparetic stroke with different levels of sensory impairment,
through a combination of robotic joint manipulation and high-density
electroencephalogram (EEG). A robotic wrist manipulator applied
continuous periodic disturbances to the affected limb, providing
somatosensory (proprioceptive and tactile) stimulation while challenging
task execution. The integrity of the somatosensory system was evaluated
during passive and active tasks, defined as ‘relaxed wrist’ and
‘maintaining 20% maximum wrist flexion’, respectively. The evoked
cortical responses in the EEG were quantified using the power in the
averaged responses and their signal-to-noise ratio.
Results
Thirty individuals with
chronic hemiparetic stroke and ten unimpaired individuals without stroke
participated in this study. Participants with stroke were classified as
having severe, mild, or no sensory impairment, based on the Erasmus
modification of the Nottingham Sensory Assessment. Under passive
conditions, wrist manipulation resulted in contralateral cortical
responses in unimpaired and chronic stroke participants with mild and no
sensory impairment. In participants with severe sensory impairment the
cortical responses were strongly reduced in amplitude, which related to
anatomical damage. Under active conditions, participants with mild
sensory impairment showed reduced responses compared to the passive
condition, whereas unimpaired and chronic stroke participants without
sensory impairment did not show this reduction.
Conclusions
Robotic continuous joint
manipulation allows studying somatosensory cortical evoked responses
during the execution of meaningful upper limb control tasks. Using such
an approach it is possible to quantitatively assess the integrity of
sensory pathways; in the context of movement control this provides
additional information required to develop more effective
neurorehabilitation therapies.
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