Treating sensory impairments in the post-stroke upper limb with intermittent pneumatic compression. Results of a preliminary trial Somatosensory impairment after stroke: frequency of different deficits and their recovery SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial
Objective : To evaluate the efficacy of intermittent pneumatic compression ( IPC ) in treating  sensory impairments in the hemiplegic upper limb in stroke patients . Design : Twenty-three stroke patients were enrolled in a r and omized , controlled preliminary trial that compared the application of intermittent pneumatic compression with a passive treatment strategy . Setting : Four Belgian day centers for treatment of neurological disabilities . Four acute and rehabilitation care wards specialized in neurological treatment . Subjects : Twenty-three stroke patients . Interventions : The experimental group ( n = 11 ) received st and ard physiotherapy combined with intermittent pneumatic compression treatment ( 10 cycles of 3 minutes with a peak of 40 mmHg ) for their hemiplegic upper limb . The control group ( n = 12 ) received supplementary to their conventional physiotherapy a placebo treatment , namely sham short-wave therapy on the hemiplegic shoulder for 30 minutes . Main outcome measures : Sensory impairments were clinical ly assessed at three occasions over a period of four weeks using the Nottingham Sensory Assessment scale . Results : Both groups improved in somatosensation over time , but the experimental group improved more than the control group ( p = 0.036 ) or 81.1 % improvement versus 30.9 % . Conclusions : The use of intermittent pneumatic compression in the rehabilitation of stroke patients may be of clinical importance for the restoration of sensory function 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 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 Based on the principles of neuroplasticity , the purpose of this crossover study was to determine if improvement in upper extremity ( UE ) function and independence could be achieved in patients 6 months to 7 years poststroke following an outpatient rehabilitation program ( supervised 1.5 hours per week for 8 weeks reinforced with home gloving unaffected side and attended , grade d , repetitive sensory and motor training activities ) . Twenty-one subjects ( right or left hemiparesis ; able to walk 100 feet with or without a cane ; partially opened and closed the h and ; partially elevated the shoulder and elbow against gravity ) were r and omly assigned to Group A ( sensory training 4 weeks , motor training 4 weeks ) or Group B ( motor training 4 weeks , sensory training 4 weeks ) . Greater than 20 % ( P < 0.01 ) improvement was measured in functional independence and UE function ( fine motor , sensory discrimination , and musculoskeletal performance ) . Gains were hemispheric and training specific and maintained over 3 months . This study provides evidence documenting significant improvement in function in the late poststroke recovery period following 12 hours of supervised learning based sensory motor training Question : Are Butler ’s neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone ? Design : Pretest — posttest three-group r and omized clinical experimental design . Participants : A total of 96 late-stage stroke subjects were r and omly assigned to three groups . Intervention : The therapeutic programme in the control group was based on traditional post-stroke methods . The second group ( experimental 1 ) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method . The third group ( experimental 2 ) received a combination : traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity . All groups received 18 training sessions lasting about 45 minutes each . Outcome measures : Assessment of the two-point discriminatory sense ( distance between the tips of the compass when the subject indicated two-point sensation ) , stereognosia ( identification up to 10 objects by touch ) and thermaesthesia ( using hot and cold cylinders on dermatomes C6—C8 ) were performed . Results : Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups ( P<0.001 ) . Similar results were registered for thermaesthesia ( experimental 2 versus experimental 1 P<0.01 ; experimental 2 versus control P<0.001 ) . For stereognosia the only significant difference was found between experimental group 2 and the control group ( P<0.05 ) . Conclusion : In our subjects , application of Butler ’s neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone
Objective : The aim of this study was to evaluate if somatosensory retraining programmes assist people to improve somatosensory discrimination skills and arm functioning after stroke .