Purpose
Sensory
impairment post-stroke limits rehabilitation of balance and gait. This
study aims to compare the effect of explicit sensory retraining (ESR)
versus implicit repeated exposure (IRE) to stimuli of the lower
extremity, assessing their effects on sensation, balance, and gait in
individuals with chronic post-stroke sensory impairment.
Materials and methods
A
two-arm parallel double-blind multicenter randomized controlled trial
was conducted in physical therapy outpatient clinics. Volunteers with
chronic sensory impairment post-stroke participated in 10 sessions of
45 min ESR or IRE, according to a detailed protocol. Outcome measures
assessed sensation, balance, mobility, and participation.
Results
A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30).
The intention-to-treat pre-post analysis demonstrated clinically
meaningful changes for both interventions (10–31% improvement for the
various measures), with no between-group difference or time × group
interaction. The effect size for the time effect varied, with the
largest being 0.63 for the miniBEST.
Conclusions
Sensory
rehabilitation treatment by either ESR or IRE led to similar clinically
significant changes in the performance of the lower extremity and
participation in subjects with sensory loss post-stroke. Both treatment
protocols are easy to implement in an outpatient clinic.
ClinicalTrials.gov registration:
NCT01988220.
Implications for rehabilitation
Standardized,
structured, sensory-focused training can improve balance and gait in
subjects with chronic post-stroke sensory impairment.
Both
explicit and implicit learning-based sensory protocols focused on the
lower extremity effectively improved balance, mobility, and gait
abilities, resulting in enhanced participation of individuals in the
chronic post-stroke phase.
A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.
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