Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Change in Functional Arm Use Is Associated With Somatosensory Skills After Sensory Retraining Poststroke The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke: a randomized controlled cross-over trial Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke Effects of proprioception training with exercise imagery on balance ability of stroke patients Movement detection at the ankle following stroke is poor. Somatosensory impairment after stroke: frequency of different deficits and their recovery Sensory Loss in Hospital-Admitted People With Stroke: Characteristics, Associated Factors, and Relationship With Function Effect of continuing repeated passive and active exercises on knee's position senses in patients with hemiplegia. Compelled Body Weight Shift Approach in Rehabilitation of Individuals With Chronic Stroke Assisted Movement With Enhanced Sensation (AMES): Coupling Motor and Sensory to Remediate Motor Deficits in Chronic Stroke Patients SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
Objective : To examine the psychometric properties of the sensory scale of the Fugl-Meyer Assessment ( FMA-S ) in stroke patients with a broad range of neurological and functional impairment at times from 14 to 180 days after stroke . Subjects : A total of 176 first stroke patients consecutively admitted to a university based medical centre . Design : This prospect i ve , longitudinal investigation was based on data collected at 14 , 30 , 90 and 180 days after stroke . Main outcome measures : Reliability ( inter-rater reliability and internal consistency ) , validity ( convergent and predictive validity ) and responsiveness of the FMA-S  were examined . Results : The inter-rater agreement of the total score of the FMA-S was excellent , with an intraclass correlation coefficient of 0.93 . The Cronbach 's alphas of the FMA-S at four time points after stroke ranged from 0.94 to 0.98 , indicating excellent internal consistency . However , the FMA-S showed a significant ceiling effect ( more than 44.4 % of the subjects achieving the highest score ) , poor to moderate inter-rater reliability for light touch items ( weighted kappa ranging from 0.30 to 0.55 ) , low to moderate validity ( Spearman 's rho ranging from 0.29 to 0.53 ) , and low to moderate responsiveness ( st and ardized response mean ranging from 0.27 to 0.67 ) at different post-stroke stages of recovery . Conclusions : The psychometric properties of the FMA-S in measuring sensory function do not support its clinical use in stroke patients . Further studies on methods to improve the psychometric properties of the FMA-S are needed Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design OBJECTIVE . We investigated changes in functional arm use after retraining for stroke-related somatosensory loss and identified whether such changes are associated with somatosensory discrimination skills . METHOD . Data were pooled ( N = 80 ) from two r and omized controlled trials of somatosensory retraining . We used the Motor Activity Log to measure perceived amount of arm use in daily activities and the Action Research Arm Test to measure performance capacity . Somatosensory discrimination skills were measured using st and ardized modality-specific measures . RESULTS . Participants ’ arm use improved after somatosensory retraining ( z = −6.80 , p < .01 ) . Change in arm use was weakly associated with somatosensation ( tactile , & bgr ; = 0.31 , p < .01 ; proprioception , & bgr ; = −0.17 , p > .05 ; object recognition , & bgr ; = 0.13 , p < .05 ) . CONCLUSION . Change in daily arm use was related to a small amount of variance in somatosensory outcomes . Stroke survivors  ’ functional arm use can increase after somatosensory retraining , with change varying among survivors Objective : To investigate the feasibility and potential efficacy of ‘ activeTENS ’ ( that is transcutaneous electrical nerve stimulation ( TENS ) during everyday activities ) by assessing the immediate effects on strength , proprioception , balance/falls risk and mobility after stroke . Design : A paired- sample r and omized cross-over trial . Subjects : Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS . Setting : University clinical research facility . Intervention : A single session of ‘ activeTENS ’ delivered via a ‘ sock electrode ’ ( 70–130 Hz , five second cycle ) plus a session of control treatment ( wearing the sock electrode with no stimulation ) , lasting approximately two hours in total . Main Outcomes : Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer , balance and falls risk ( St and ing Forward Reach Test ) and gait speed ( 10-m walk test ) . Results : All participants tolerated ‘ active TENS ’  . Most parameters improved during stimulation with activeTENS ; balance ( p = 0.009 ) , gait speed ( p = 0.002 ) , plantarflexor strength ( p = 0.008 ) and proprioception of plantarflexion ( p = 0.029 ) , except dorsiflexor strength ( p = 0.194 ) and dorsiflexion proprioception ( p = 0.078 ) . Conclusions : The results provide initial evidence of the potential of ‘ active TENS ’ to benefit physical function after stroke which warrants further phase II trials to develop the intervention . Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported Background The study evaluates the effectiveness of Compelled Body Weight Shift ( CBWS ) approach in the rehabilitation of individuals with stroke .  CBWS involves a forced shift of body weight towards a person ’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity . Methods Eleven patients with acute stroke were r and omly assigned to experimental and control groups . The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy .  Weight bearing , Gait velocity , Berg ’s Balance , and Fugl-Meyer ’s Scores were recorded before and after the intervention . Results Weight bearing on the affected side increased in the experimental group and decreased in the control group . The increase in gait velocity with treatment was significant in both the groups ( P < 0.05 ) . However , experimental group ( P = 0.01 ) demonstrated larger improvements in gait velocity compared to the control group ( P = 0.002 ) . Berg Balance and Fugl-Meyer scores increased for both the groups . Conclusion The implementation of a two-week intervention with CBWS result ed in the improvement in weight bearing and gait velocity of individuals with acute stroke . The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke 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 [ Purpose ] The purpose of the present study was to examine and compare the effects of proprioceptive training accompanied by motor imagery training and general proprioceptive training on the balance of stroke patients . [ Subjects and Methods ] Thirty-six stroke patients were r and omly assigned to either an experimental group of 18 patients or a control group of 18 patients . The experimental group was given motor imagery training for 5 minutes and proprioceptive training for 25 minutes , while the control group was given proprioceptive training for 30 minutes . Each session and training program was implemented 5 times a week for 8 weeks . The Korean version of the Berg Balance Scale ( K-BBS ) , Timed Up and Go test ( TUG ) , weight bearing ratio ( AFA-50 , Alfoots , Republic of Korea ) , and joint position sense error ( Dualer IQ Inclinometer , JTECH Medical , USA ) were measured . [ Results ] Both groups showed improvements in K-BBS , TUG , weight bearing ratio , and joint position sense error . The measures of the experimental group showed greater improvement than the control group . [ Conclusion ] Motor imagery training , which is not subject to time restrictions , is not very risky and can be used as an effective treatment method for improving the balance ability of stroke patients This study assessed whether sense of movement is impaired at the ankle in persons post-stroke who are able to walk independently . Eleven chronic post-stroke subjects ( > 4 months post stroke ) who were ambulatory with or without walking aids and living within the community , and 10 healthy age-matched control subjects volunteered to participate .  Proprioceptive acuity at the ankle , measured by sense of movement  , was tested at three velocities , 0.1 , 0.5 , and 2.5 deg/sec , in r and om order . In addition ,  ankle range of motion and the distance that subjects walked in 6 minutes were assessed . Stroke subjects were significantly poorer ( p < 0.001 ) at detecting movement at the affected ankle compared with either the unaffected ankle or with the control group at each of the velocities tested . Six out of 11 stroke subjects demonstrated significant impairment in movement detection compared to controls . The usual primary impairments following stroke are loss of strength and loss of co-ordination . However , reduced proprioceptive acuity at the affected ankle may also contribute to a person 's ability to position and load the foot during walking . This could explain the moderate relationship found between proprioceptive acuity and walking endurance in persons following stroke ( Spearman 's rho = 0.63 to 0.77 ) Objective : To investigate the frequency of somatosensory impairment in stroke patients within different somatosensory modalities and different body areas , and their recovery . Design : Prospect i ve observational study . Setting : Two stroke rehabilitation units . Subjects : Seventy patients with a first stroke ( 36 men , 34 women ; average age , 71 , SD 10.00 years ; average time since stroke onset , 15 days ) were assessed on admission and two , four and six months after stroke . Interventions : Not applicable . Main measure : Nottingham Sensory Assessment . Results : Somatosensory impairment was common after stroke ; 7—53 % had impaired tactile sensations , 31—89 % impaired stereognosis , and 34—64 % impaired proprioception . When comparing somatosensory modalities within body areas the kappa values were low ( kappa values < 0.54 ) . Recovery occurred over time , though not significantly in lower limb tactile sensations . Stroke severity was the main factor influencing initial somatosensory impairment , but accounted for a small amount of the variance ( 21—41 % ) . Initial somatosensory impairment was significantly related to somatosensory ability at six months , accounting for 46—71 % of the variance . Conclusions : Proprioception and stereognosis were more frequently impaired than tactile sensations . The different somatosensory modalities showed only slight agreement between impairment within the same body areas , suggesting that the modalities are independent of each other and all should be assessed . High agreements were found between different body areas for each somatosensory modality . Somatosensory impairment was associated with stroke severity , however low variance indicated other factors were involved Objective : To characterize the nature of sensory impairments after stroke , identify associated factors , and assess the relationships between sensory impairment , disability , and recovery . Methods : Prospect i ve cross-sectional survey of 102 people with hemiparesis following their first stroke .  Tactile and proprioceptive sensation  in the affected arm and leg were measured using the Rivermead Assessment of Somatosensory Perception 2 - 4 weeks post-stroke . Demographics , stroke pathology , weakness , neglect , disability , and recovery were documented . Results : Tactile impairment was more common than proprioceptive ( P < .000 ) , impairment of discrimination was more common than detection ( P < .000 ) , and tactile sensation was more severely impaired in the leg than the arm ( P < .000 ) . No difference in proprioception between the arm and leg ( P = .703 ) or between proximal and distal joints ( P = .589 , P = .705 ) was found . The degree of weakness and the degree of stroke severity were significantly associated with sensory impairment ; demographics , stroke side and type , and neglect were not associated . All the sensory modalities were significantly related to independence , mobility , and recovery ( r = 0.287 [ P < .011 ] to r = 0.533 [ P < .000 ] ) . Conclusion : Sensory impairments of all modalities are common after stroke , although tactile impairment is more frequent than proprioceptive loss , especially in the leg . They are associated with the degree of weakness and the degree of stroke severity but not demographics , stroke pathology , or neglect , and they are related to mobility , independence in activities of daily living , and recovery OBJECTIVE To determine the repeated passive movement ( RPM ) and repeated active movement ( RAM ) exercise on position sense of the knee joint in patients with hemiplegia . METHODS 45 hemiplegia patients were r and omly allocated to either the control group(no exercise ) , RPM group , or RAM group , with 15 subjects in each group . The exercise was repeated 60 times on the angle 10 to 100 degrees of the knee joint with an angle speed of 120 ° /s , with three sets for 15 minutes . Evaluation was performed using Passive Angle Repositioning ( PAR ) and Active Angle Repositioning ( AAR ) . RESULTS Error of positioning sense showed a decrease in PAR and AAR in the RPM group ( p < 0.01 ) and an increase in AAR was observed in the RAM group ( p < 0.05 ) . In comparison of knee joint position sense error value and rate of change among the three groups , the RPM group is decreased mostly in PAR and AAR ( p < 0.01 ) , and Error value ( p < 0.05 ) and rate of change ( p < 0.01 ) of the RAM group showed a greater increase in AAR than the control group . CONCLUSION RAM exercise can support an increase in proprioception on the knee joint of hemiplegia ; however , RAM exercise that causes fatigue can decrease proprioception Abstract Purpose : This study was design ed to evaluate the effectiveness of the compelled body weight shift ( CBWS ) therapy approach in the rehabilitation of individuals with chronic stroke . CBWS involves a forced shift of body weight toward a person ’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity . Method : Eighteen individuals with chronic , unilateral stroke ( mean age 57.7 ± 11.9 years , with a range of 35 - 75 years ; mean time since stroke 6.7 ± 3.9 years , with a range of 1.1 - 14.1 years ) who showed asymmetrical stance were r and omly divided into 2 groups : the experimental group received 6 weeks of physical therapy combined with CBWS therapy , and the control group received only physical therapy . Both groups underwent a battery of identical tests ( Fugl-Meyer Assessment , Berg Balance Scale , weight bearing , and gait velocity ) before the start of the rehabilitation intervention , following its completion , and 3 months after the end of therapy . Results : After the intervention , weight bearing on the affected side ( measured with the Balance Master ) increased in the experimental group to a larger degree compared to the control group ( 9.7 % vs 6.4 % ) . Similarly , gait velocity increased 10.5 % in the experimental group compared to the control group . Improvements in weight bearing and gait velocity were maintained in the experimental group after the 3-month retention period . Conclusion : The study outcome revealed that a 6-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke Background . Conventional methods of rehabilitation in patients with chronic , severe motor impairments after stroke usually do not lessen paresis . Objective . A novel therapeutic approach ( assisted movement with enhanced sensation [ AMES ] ) was employed in a medical device phase I clinical trial to reduce paresis and spasticity and , thereby , to improve motor function . Methods . Twenty subjects more than 1 year poststroke with severe motor disability of the upper or lower extremity were studied .  A robotic device cycled the ankle or the wrist and fingers at 5 ° /s through ±17.5 ° in flexion and extension while the subject assisted this motion . Feedback of the subject 's active torque was displayed on a monitor . Simultaneously , 2 vibrators applied a 60 pps stimulus to the tendons of the lengthening muscles , alternating from flexors to extensors as the joint rotation reversed from extension to flexion , respectively . Subjects treated themselves at home for 30 min/day for 6 months . Every other day prior to treatment , the therapy device performed automated tests of strength and joint positioning . Functional testing was performed prior to enrollment , immediately after completing the protocol , and 6 months later . Functional tests included gait and weight distribution ( lower extremity subjects only ) and the Stroke Impact Scale . Results . Most subjects improved on most tests , and gains were sustained for 6 months in most subjects . No safety problems arose . Conclusion . The AMES strategy appears safe and possibly effective in patients with severe chronic impairments . The mechanism underlying these gains is likely to be multifactorial Background . Sensory loss is common after stroke , with negative impact on exploration of the immediate environment , h and function , and return to daily activities . Objective . To compare the effectiveness of a perceptual-learning based sensory discrimination program versus non-specific exposure to sensory stimuli via passive movements and grasping of common objects . Methods . The authors conducted a r and omized parallel-group controlled trial , with blinding of subjects , clinical assessors , and data analysts . Fifty subjects with impaired texture discrimination , limb position sense , and /or tactile object recognition ( > 6 weeks , median 48 weeks poststroke ) were r and omized  to receive somatosensory discrimination training ( n = 25 ) or repeated exposure to sensory stimuli ( n = 25 ) in 60-minute sessions for a total of 10 hours . The primary outcome was change in a composite st and ardized somatosensory deficit ( SSD ) index following intervention . Follow-up was at 6 weeks and 6 months posttraining . Results . Between-group comparisons revealed a significantly greater improvement in sensory capacity following sensory discrimination training , t(47 ) = 2.75 , P = .004 , 1-tailed ; mean between-group change = 11.1 SSD ; confidence interval 3.0 to 19.2 . Improvements were maintained at 6 weeks and 6 months . Conclusion . Sensory discrimination training can achieve significant improvements in functional sensory discrimination capacity after stroke . The clinical ly oriented training achieved transfer of training effects to novel stimuli . Our findings provide support for introducing SENSe discrimination training in rehabilitation of sensory deficits after stroke Abstract Background : The Nintendo ® Wii is a simple and affordable virtual therapy alternative . It may be used at home , and it is a motivating recreational activity that provides continuous feedback . However , studies comparing the use of the Nintendo ® Wii to conventional physical therapy are needed . Objective : To compare the effect of a rehabilitation treatment using the Nintendo ® Wii ( NW ) with conventional physical therapy ( CPT ) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients . Methods : The present study applied a r and omized , blind , and controlled clinical trial . In total , 30 patients with post-stroke hemiparesis were evaluated . A total of 15 patients were r and omly assigned to each group . The SF-36 quality of life and Fugl – Meyer scales were used to evaluate the patients . Results : After treatment , the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy . A significant difference was observed between both groups before and after treatment in terms of the following Fugl – Meyer scale items : passive movement and pain , motor function of the upper limbs ( ULs ) , and balance . The CPT group also showed a significant difference with regard to their UL and lower limb ( LL ) coordination . The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains : physical functioning , role limitation due to physical aspects , vitality , and role limitation due to emotional aspects . The NW group also exhibited a significant difference in the mental health domain . The results indicate that both approaches improved the patients ' performance in a similar manner . Conclusion : Virtual rehabilitation using the Nintendo Wii ® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores , motor function of the upper limb , balance , physical functioning , vitality , and the physical and emotional aspects of role functioning 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 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 The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials
Objective : This systematic review aim ed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment , and secondary outcomes of balance and gait , after stroke .