Why the fuck are you even asking the question? You, your mentors and senior researchers incompetently don't know about the Margaret Yekutiel book about this from 2001, 'Sensory Re-Education of the Hand After Stroke'? We can look forward to 18 more years of incompetency from you?
Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis
Ines Serrada
Brenton Hordacre
Susan L. Hillier- 1School of Health Sciences, University of South Australia, Adelaide, SA, Australia
- 2Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
Background: Reduced sensation is
experienced by one in two individuals following stroke, impacting both
the ability to function independently and overall quality of life.
Repetitive activation of sensory input using active and passive
sensory-based interventions have been shown to enhance adaptive motor
cortical plasticity, indicating a potential mechanism which may mediate
recovery. However, rehabilitation specifically focusing on somatosensory
function receives little attention.
Objectives: To investigate
sensory-based interventions reported in the literature and determine the
effectiveness to improve sensation and sensorimotor function of
individuals following stroke.
Methods: Electronic databases and trial
registries were searched from inception until November 2018, in
addition to hand searching systematic reviews. Study selection included
randomized controlled trials for adults of any stroke type with an upper
and/or lower limb sensorimotor impairment. Participants all received a
sensory-based intervention designed to improve activity levels or
impairment, which could be compared with usual care, sham, or another
intervention. The primary outcomes were change in activity levels
related to sensorimotor function. Secondary outcomes were measures of
impairment, participation or quality of life.
Results: A total of 38 study trials were included (n
= 1,093 participants); 29 explored passive sensory training
(somatosensory; peripheral nerve; afferent; thermal; sensory amplitude
electrical stimulation), 6 active (sensory discrimination; perceptual
learning; sensory retraining) and 3 hybrid (haptic-based augmented
reality; sensory-based feedback devices). Meta-analyses (13 comparisons;
385 participants) demonstrated a moderate effect in favor of passive
sensory training on improving a range of upper and lower limb activity
measures following stroke. Narrative syntheses were completed for
studies unable to be pooled due to heterogeneity of measures or
insufficient data, evidence for active sensory training is limited
however does show promise in improving sensorimotor function following
stroke.
Conclusions: Findings from the
meta-analyses and single studies highlight some support for the
effectiveness of passive sensory training in relation to sensory
impairment and motor function. However, evidence for active sensory
training continues to be limited. Further high-quality research with
rigorous methods (adequately powered with consistent outcome measures)
is required to determine the effectiveness of sensory retraining in
stroke rehabilitation, particularly for active sensory training.
Introduction
Rationale
Sensation is the means by which we process and interact with the world and our environment (Connell, 2007; Carey et al., 2016).
It allows us to detect and discriminate objects and textures, know
where our body is in space (proprioception) and accurately perceive and
discriminate sensations of pain, temperature, pressure and vibration (Carey, 1995; Schabrun and Hillier, 2009; Doyle et al., 2010; Carey et al., 2011, 2018). As a result, sensation is critical for normal human function and is fundamental for motor behaviors (Doyle et al., 2010).
For example, somatosensory input is required for accurate and adaptable
motor control and the acquisition of motor skills, suggesting intact
sensation may be a critical component to facilitate motor rehabilitation
(Carey et al., 1993; Yekutiel and Guttman, 1993; Wu et al., 2006; Celnik et al., 2007).
Reduced sensation is experienced by one in two individuals following stroke (Carey et al., 2018), impacting both the ability to function independently and overall quality of life (Carey et al., 1993, 2018; Yekutiel and Guttman, 1993).
Most significantly these deficits contribute to confidence and movement
difficulties with an enduring impact on simple everyday activities such
as reaching, grasping and manipulating objects or knowing where a foot
is positioned during gait without the need to visually observe its
position. As expected, reduced sensation following stroke is associated
with slower recovery, reduced motor function (in terms of quality of
movement control) and lesser rehabilitation outcomes (Wu et al., 2006; Doyle et al., 2010; de Diego et al., 2013; Carey, 2014).
These deficits continue to persist for years with many individuals
often learning not to use their sensory affected limb (learned non-use)
due to uncertainty, lack of confidence of whether to use it and/or
vulnerability and fear of safety (Doyle et al., 2010; Turville et al., 2017). This continued disuse leads to a further reduction and deterioration (Carey et al., 1993, 2018; Yekutiel and Guttman, 1993; Doyle et al., 2010).
In addition, these sensory deficits have widespread effects not only in
predicting poor functional outcomes but increasing length of
hospitalization, reduced numbers of discharges to home and increased
mortality rates (Yekutiel and Guttman, 1993; Carey, 1995; Doyle et al., 2010; Carey et al., 2011).
Repetitive activation of sensory input (sensory-based
interventions) has been shown to enhance adaptive motor cortical
plasticity, indicating a potential mechanism which may mediate recovery (Carrico et al., 2016b). As such, sensory input may be integral to facilitate the recovery of function following stroke (Schabrun and Hillier, 2009).
Yet despite these findings suggesting an association between sensory
and motor function in recovery following stroke, rehabilitation
specifically focusing on somatosensory function receives little
attention (Carey, 1995; Schabrun and Hillier, 2009; de Diego et al., 2013; Carey et al., 2016).
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