Effects of Training for Finger Perception on Functional Recovery of Hemiplegic Upper Limbs in Acute Stroke Patients

Abstract

Background Stroke causes severe disability, including motor and sensory impairments. We hypothesized that upper limb functional recovery after stroke may be augmented by combining treatments for motor and sensory functions. In order to examine this hypothesis, we conducted a controlled trial on rehabilitation for sensory function to the plegic hand. Methods The sensory training program consisted of several types of discrimination tasks performed under blind conditions. The sensory training program was performed for 20 min per day, 5 days a week. An experimental group of 31 patients followed this sensory program, while a control group of 25 patients underwent standard rehabilitation. The efficacy of the intervention was evaluated by the tactile-pressure threshold, handgrip strength, and the completion time of manipulating objects. A two-way repeated measures analysis of variance was used to assess interactions between group and time. Moreover, to provide a meaningful analysis for comparisons, effect sizes were calculated using Cohen's d. Results The mean change in the tactile pressure threshold was significantly larger in the experimental group than in the control group (p < 0.05, d = 0.59). Moreover, the completion times to manipulate a middle-sized ball (d = 0.53) and small ball (d = 0.80) and a small metal disc (d = 0.81) in the experimental group were significantly different from those in the control group (p < 0.05). Conclusion The present results suggest that the sensory training program to enhance finger discrimination ability contributes to improvements in not only sensory function but also manual function in stroke patients. The trial is registered with the UMIN Clinical Trials Registry (UMIN000032025).

Upper extremity sensory training after stroke

“…Findings particularly suggest the importance of somatosensory function after stroke for recovery of precision grip force control [12], safety and dexterity in the paretic hand [13] and functional independence in activities of daily living (ADL) [14,15]. Current findings showed that active and passive sensory retraining may be an effective intervention for improving the light touch threshold of the hand, dexterity, upper extremity (UE) motor function [10,16] to improve the activity of daily living in stroke patients with impaired sensory motor abilities [17]. The quality of evidence is low to moderate [18,19] so further research is required to determine the effectiveness of sensory training in stroke rehabilitation.…”

“…Deficits in somatic sensations (body senses such as touch, temperature, pain, and proprioception) after stroke are common with prevalence rates variously reported to be 11-85% [8]. Approximately 50% of stroke patients have hand sensory impairments, especially in tactile and proprioceptive discrimination [9,10]. Sensation is essential for safety even if there is adequate motor recovery [11].…”

Skeletal Muscle Changes in the First Three Months of Stroke Recovery: A Systematic Review

“…Of the 38 included studies, 24 were longitudinal cohort studies in which muscle characteristics were measured at least twice within 3 months post-stroke (31, 33-36, 39, 41, 42, 44, 46, 48, 50, 52-55, 57, 58, 60-62, 64, 65, 67). The remaining eligible studies represent 13 randomized controlled trials (RCTs) (32,37,38,40,43,45,47,49,51,59,63,66,68) and 1 clinical controlled trial (CCT) (56). Participants in the control groups of these interventional trials were considered as longitudinal data as they received conventional physiotherapy…”

“…Skeletal muscle changes in the first 3 months of stroke recovery p. 7 of 19 Statistically significant Studies reporting differences between the paretic and non-paretic side are marked with † (no difference between both sides (p≥0.05)) or ‡ (significant difference between both sides (p < 0.05)). (32,37,38,40,47,49,56,59,63,66,68) or a placebo intervention combined with usual care (32,43,45,51).…”

Study of Compensatory Strategies for Reach-to-Grasp-Pen in Stroke Patients

“…Sensory de cits may also lead to reduced nger control. Umeki et al [28] conducted sensory training to enhance nger discrimination in patients and found that the mean change in tactile pressure threshold was signi cantly greater in the experimental group than in the control group. The reduction in manipulation time required for handling small balls and small metal discs that was observed in the experimental group was signi cantly greater than that observed in the control group.…”