Input-increase and input-decrease types of cortical reorganization after upper extremity amputation in humans Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial Increase in hand muscle strength of stroke patients after somatosensory stimulation Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial.
Abstract A plastic remodeling of regions in somatosensory cortex has previously been observed to occur in separate experimental paradigms in response to loss of somatosensory input and to increase in input . In this study , both types of cortical reorganization have been observed to occur concurrently in the same adult human nervous system as a result of a single intervention . Following upper extremity amputation , magnetic source imaging revealed that tactile stimulation of the lip evoked responses not only in the area of the somatosensory cortex corresponding to the face , but also within the cortical region that would normally correspond to the now absent h and . This “ invasion ” of the cortical amputation zone was accompanied by a significant increase in the size of the representation of the digits of the intact h and , presumably as a result of an increased importance of sensory stimulation consequent to increased dependence on that h and imposed by the loss of the contralateral extremity Objective : To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke . Subjects and setting : Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation . Thirty-two received active treatment in the paretic h and and eight received no-current placebo treatment in the paretic h and . Nineteen patients received active stimulation of the paretic foot . None received stimulation in both upper and lower limbs . Intervention : Cutaneous stimulation was delivered twice daily via a special glove/sock electrode . Main outcome measures : Modified Motor Assessment Scale , 10-metre walking test , paretic limb function , limb skin sensation and somatosensory evoked potentials ( SEP ) were performed before and after the treatment . Results : Modified Motor Assessment Scale ( p < 0.001 ) , 10-metre walking test ( p < 0.05 ) , paretic h and function ( p < 0.01 ) , upper limb skin sensation ( p < 0.01 ) and SEP normality classification of paretic upper limb ( p < 0.01 ) and paretic lower limb ( p < 0.5 ) improved significantly in the treatment group ( n = 51 ) after three weeks of stimulation . When active h and treatment and placebo h and treatment were compared , a significant improvement in the sensory and motor function was observed only in the actively treated group . Conclusions : Cutaneous stimulation had positive effects in the motor performance , limb sensation and the configuration of SEP of the paretic limb in chronic stroke patients Normalization of upper limb movement remains a difficult problem for a significant sub population of hemiplegic stroke patients . Clinical observations prompted investigation of a novel approach using simultaneous identical bilateral movements performed independently . We briefly report 12 controlled single-case experiments using multiple-baseline design s across three separate grasp/reach activities . Unilateral performance tests with the hemiplegic arm using the bilaterally trained actions demonstrated clinical ly and statistically significant improvements in movement patterns . These improvements were specific to the trained movement and well maintained . Using recent literature we develop a theoretical model proposing that bilateral simultaneous movement promotes interhemispheric disinhibition likely to allow reorganization by sharing of normal movement comm and s from the undamaged hemisphere . Disinhibition may also encourage recruitment of undamaged neurones to construct new task-relevant neural networks . The potential contribution of spared ipsilateral pathways in the damaged hemisphere , indirect corticospinal pathways and ipsilateral pathways from the undamaged hemisphere is discussed OBJECTIVE To test the hypothesis that somatosensory stimulation would enhance the effects of training functional h and tasks immediately after practice and 1 day later in chronic subcortical stroke patients . DESIGN Single-blinded and r and omized , crossover study . SETTING Human research laboratory . PARTICIPANTS Nine chronic subcortical stroke patients . INTERVENTIONS Three separate sessions of motor training preceded by ( 1 ) synchronous peripheral nerve stimulation ( PNS ) , ( 2 ) no stimulation , or ( 3 ) asynchronous PNS . MAIN OUTCOME MEASURES Time to complete the Jebsen-Taylor H and Function Test ( JTHFT time ) and corticomotor excitability tested with transcranial magnetic stimulation . RESULTS After familiarization practice , during which all patients reached a performance plateau , training under the effects of PNS reduced JTHFT time by 10 % beyond the post-familiarization plateau . This behavioral gain was accompanied by a specific reduction in GABAergically mediated intracortical inhibition in the motor cortex . These findings were not observed after similar practice under the influence of no stimulation or asynchronous PNS sessions . CONCLUSIONS Somatosensory stimulation may enhance the training of functional h and tasks in patients with chronic stroke , possibly through modulation of intracortical GABAergic pathways Somatosensory stimulation enhances aspects of motor function in patients with chronic , predominantly subcortical infa rcts . We investigated the effects of somatosensory stimulation on motor function in stroke patients with predominantly cortical involvement in the middle cerebral artery territory in a double-blind , pseudor and omized crossover trial . Motor performance was evaluated with the Jebsen-Taylor test before , after 2-hour somatosensory stimulation , and after subsequent motor training ( n = 11 ) . In one experimental session , patients were su bmi tted to median nerve stimulation ( MNS ) and in the other session , to control stimulation ( CS ) . The order of the sessions was counterbalanced across patients . Improvement in performance in the Jebsen-Taylor test after somatosensory stimulation and after motor training was significantly greater in the MNS session than in the CS session . Additionally , patients who received MNS in the second session maintained the beneficial effects of training 30 days later . A single MNS session improves h and motor function in patients with chronic cortico-subcortical strokes and appears to favor consolidation of training effects .  Somatosensory stimulation may be an adjuvant tool for stroke rehabilitation in patients with cortical lesions OBJECTIVE To evaluate the effects of sensory-amplitude electric stimulation ( SES ) of the paretic leg on motor recovery and gait kinematics of patients with stroke . DESIGN R and omized , controlled , double-blind study . SETTING Rehabilitation ward and gait laboratory of a university hospital . PARTICIPANTS A total of 30 consecutive in patients with stroke ( mean age , 63.2 y ) , all within 6 months poststroke and without volitional ankle dorsiflexion were studied . INTERVENTION Both the SES group ( n=15 ) and the placebo group ( n=15 ) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks . The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks . MAIN OUTCOME MEASURES Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait . RESULTS Brunnstrom stages improved significantly in both groups ( P<.05 ) . In total , 58 % of the SES group and 56 % of the placebo group gained voluntary ankle dorsiflexion . The between-group difference of percentage change was not significant ( P>.05 ) . Gait kinematics was improved in both groups , but the between-group difference was not significant . CONCLUSIONS In our patients with stroke , SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics Objective : To examine the effects of a home-based arm exercise programme of sensory and motor amplitude electrical stimulation . Design : Non-concurrent , multiple-baseline , single-subject design . Subjects : Ten adults with chronic arm hemiparesis following stroke . Subjects ranged in age from 38 to 74 years and were 2 - 16 years post stroke . Three subjects had right-sided involvement ; seven had left . Intervention : Subjects completed an eight-week , individualized , home programme of neuromuscular and sensory amplitude electrical stimulation . All subjects engaged in stimulation-assisted task-specific exercises for 15 minutes 2 -3 times daily . Participants with sensory deficits received an additional 15 minutes of sensory amplitude stimulation twice daily . The Action Research Arm Test was used to examine arm function ; the Stroke Rehabilitation Assessment of Movement was used to examine movement quality ; and the Modified Ashworth Assessment of Spasticity was used to examine muscle tone . Results : A statistically significant improvement was demonstrated by six of the 10 subjects on the Action Research Arm Test , and five subjects on the Stroke Rehabilitation Assessment of Movement . Four subjects had ≥ 10 % improvement on the Modified Ashworth Assessment of Spasticity . Two subjects demonstrated significant improvement on all three outcome measures ; six subjects improved on two or more measures ; and seven subjects improved on one or more measure . Subjects who improved on two or more measures tended to have had more recent onset of stroke , were older and had higher baseline motor and functional capacity . Conclusion : Subjects with chronic stroke can experience impairment and functional improvements following a home-based programme of motor and sensory amplitude electrical stimulation OBJECTIVE To test the influence of electric somatosensory stimulation on performance of the Jebsen-Taylor H and Function Test ( JTHFT ) , a widely used assessment of functional h and motor skills , by the paretic arm in patients with chronic stroke . DESIGN Initially , patients trained for several sessions until reaching plateau performance on the JTHFT . Subsequently , they entered a crossover r and omized study , design ed to evaluate the influence of somatosensory stimulation on JTHFT performance . SETTING A research laboratory . PARTICIPANTS Nine patients with chronic stroke ( > /=1.5 y ) who acutely had marked weakness ( paralysis of the upper extremity is evaluated as equal or below Medical Research Council [ MRC ] grade 2 ) followed by improvement to an MRC grade of 4.24+/-0.43 ( range , 3.5 - 4.9 ) and Fugl-Meyer Assessment ( FMA ) score of 86.43%+/-2.02 % at the time of testing . INTERVENTIONS Two hours of electric somatosensory stimulation was applied to the ( 1 ) paretic h and , ( 2 ) paretic leg , or ( 3 ) no stimulation in different sessions , in a r and omized order . MAIN OUTCOME MEASURE The time required to complete the JTHFT was analyzed by using repeated- measures analysis of variance ( ANOVA ) with factors time ( pre- , postintervention ) and intervention ( paretic h and , paretic leg , no stimulation ) followed by post hoc testing . RESULTS Significant effects of intervention and intervention by time interaction ( P<.01 ) on JTHFT time was revealed by repeated- measures ANOVA . Post hoc testing documented improvements in JTHFT time with paretic h and stimulation alone ( P<.005 ) , an effect that appeared more prominent in subjects with lower FMA scores . CONCLUSIONS Somatosensory stimulation applied to a paretic limb can benefit performance of a functional test in patients with chronic stroke . This result supports the proposal that electric sensory stimulation in combination with training protocol s may enhance the benefit of customary neurorehabilitative treatments and possibly motor learning Objective : To investigate the effect of perceptual learning exercises for hardness discrimination by the soles on st and ing balance in stroke patients with hemiplegia . Subjects : Twenty-eight subjects were r and omly assigned to an experimental or a control group and participated in a rehabilitation programme . Intervention : The experimental group received perceptual learning exercises on hardness discrimination using three different levels of hardness of a rubber sponge for 10 days . Main measures : Length , enveloped area and rectangular area of the parameter of postural sway were measured by a stabilometer on entry into the study and after 10 days . Results : Twenty-six subjects completed the study . Data indicate that more parameters indicating postural sway were significantly decreased in the experimental group than in the control group . Also , there was a significant difference between the groups in change scores ( pre-exercise minus postexercise ) of length and enveloped area . Conclusion : The plantar perception exercise used as a method in this study is considered to be effective as a supplemental exercise for st and ing balance . The possibility of clinical application using the hardness discrimination task with rubber as a balance exercise is therefore suggested It has been proposed that somatosensory input in the form of peripheral nerve stimulation can influence functional measures of motor performance . We studied the effects of median nerve stimulation on pinch muscle strength ( a function mediated predominantly by median nerve innervated muscles ) in the affected h and of chronic stroke patients . A 2‐hour period of median nerve stimulation elicited an increase in pinch strength that outlasted the stimulation period . The improvement in muscle strength correlated with stimulus intensity and was identified in the absence of motor training . These results suggest that somatosensory stimulation may be a promising adjuvant to rehabilitation of the motor deficits in stroke patients OBJECTIVE To determine the effects of a sensory retraining protocol on sensation , postural control , and gait in acute stroke subjects . DESIGN R and omized controlled pilot trial . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Twenty-one subjects with sensory deficits in the feet , undergoing rehabilitation for stroke . INTERVENTION Sensory retraining of the more affected lower limb versus relaxation ( sham intervention ) . MAIN OUTCOME MEASURES Light touch at the sole of the foot ( Semmes-Weinstein monofilaments ) , proprioception ( Distal Proprioception Test ) , postural control ( Berg Balance Scale ) , and gait ( timed , Iowa Level of Assistance Scale ) . RESULTS Significant improvements ( P<.05 ) over time were found in light touch at 3 points of the feet and in postural control , timed gait , and walking aid . No significant time effects were observed in proprioception or amount of assistance required to walk . No significant differences were detected between groups in any of the outcome variables , apart from light touch at the first metatarsal . The study had poor power ( 13 % ) to detect group effects due to the small sample size . CONCLUSIONS Results of this pilot study are unable to support or refute the routine use of sensory retraining of the lower limb for people during inpatient rehabilitation after stroke . Further research with a larger sample size is required
Objective : Retraining of sensory function following stroke is frequently overlooked in rehabilitation protocol s despite more than 60 % of patients presenting with sensory deficits .
Methods to train sensory function include both passive and active training protocol s. Here we examined the volume and quality of the evidence available for both passive and active sensory training following stroke .
In addition , we aim ed to quantify the effect of sensory training on impairment and function .