A pilot study of sensory feedback by transcutaneous electrical nerve stimulation to improve manipulation deficit caused by severe sensory loss after stroke

Abstract

BackgroundSensory disturbance is common following stroke and can exacerbate functional deficits, even in patients with relatively good motor function. In particular, loss of appropriate sensory feedback in severe sensory loss impairs manipulation capability. We hypothesized that task-oriented training with sensory feedback assistance would improve manipulation capability even without sensory pathway recovery.MethodsWe developed a system that provides sensory feedback by transcutaneous electrical nerve stimulation (SENS) for patients with sensory loss, and investigated the feasibility of the system in a stroke patient with severe sensory impairment and mild motor deficit. The electrical current was modulated by the force exerted by the fingertips so as to allow the patient to identify the intensity. The patient had severe sensory loss due to a right thalamic hemorrhage suffered 27 months prior to participation in the study. The patient first practiced a cylindrical grasp task with SENS for 1 hour daily over 29 days. Pressure information from the affected thumb was fed back to the unaffected shoulder. The same patient practiced a tip pinch task with SENS for 1 hour daily over 4 days. Pressure information from the affected thumb and index finger was fed back to the unaffected and affected shoulders, respectively. We assessed the feasibility of SENS and examined the improvement of manipulation capability after training with SENS.ResultsThe fluctuation in fingertip force during the cylindrical grasp task gradually decreased as the training progressed. The patient was able to maintain a stable grip force after training, even without SENS. Pressure exerted by the tip pinch of the affected hand was unstable before intervention with SENS compared with that of the unaffected hand. However, they were similar to each other immediately after SENS was initiated, suggesting that the somatosensory information improved tip pinch performance. The patient’s manipulation capability assessed by the Box and Block Test score improved through SENS intervention and was partly maintained after SENS was removed, until at least 7 months after the intervention. The sensory test score, however, showed no recovery after intervention.ConclusionsWe conclude that the proposed system would be useful in the rehabilitation of patients with sensory loss.

Effektivität von Neuromobilisation bei Rehabilitation von Störungen der taktilen Diskriminierung der oberen paretischen Extremität bei Patienten in einem späten Zeitpunkt nach Schlaganfall

“…Es geht hier vor allem um die gnostischen Möglichkeiten der Hand (die Erkennung von Form, Größe und Gewicht von verschiedenen Objekten), die eine direkte Übersetzung auf ihre Funktionsfähigkeit haben können. Bisher wurden verschiedene Formen der Therapie ausgearbeitet, die als Ziel die Verbesserung der Bewegungsfunktionen der oberen paretischen Extremität hatten, aber wenige Therapien, die die Sensibilität verbessern sollen ( Kita et al, 2013 ;Schabrun and Hillier 2009 ). Davies verwendete die Neuromobilisierung bei Patienten nach Schlaganfällen.…”

Reliability of the thumb localizing test and its validity against quantitative measures with a robotic device in patients with hemiparetic stroke

“…Proprioception is necessary for the control of limb posture, and the coordination of multijoint movements [1][2][3][4][5][6]. In stroke patients, proprioceptive deficits are quite common [7,8] and known to be partly related to motor recovery [9,10].…”

Accurate Decoding of Material Textures Using a finger Mounted Accelerometer

“…Sensory feedback also modulates the usage of limbs, both in the healthy [2], and especially in stroke patients [3]. Finally, tactile sensory feedback is well known to be crucial for gripping tasks [4,5].For these above reasons, researchers have strived to include sensory feedback modalities in rehabilitation of stroke [5,6] and in the design of prosthesis [4]. One would assume that stimulating sensory nerves directly can provide rich and 'natural' sensory information, but this procedure is invasive and yet to be perfected [7].…”

“…One would assume that stimulating sensory nerves directly can provide rich and 'natural' sensory information, but this procedure is invasive and yet to be perfected [7]. Similarly, external (non-invasive) sensory feedback systems, for example [5,8], that proposed to provide a transcutaneous electrical stimulation modulated by the amount of grip force are to be developed for feedback of texture and material properties [9]. Overall, a sensory feedback system that can provide information about texture as well as force to users with sensory deficits, and amputees is still absent.…”