Proprioceptive Based Training for stroke recovery. Proposal of new treatment modality for rehabilitation of upper limb in neurological diseases

Abstract

BackgroundThe central nervous system (CNS) has plastic properties allowing its adaptation through development. These properties are still maintained in the adult age and potentially activated in case of brain lesion. In the present study authors hypothesized that a significant recovery of voluntary muscle contraction in post stroke patients experiencing severe upper limb paresis can be obtained, when proprioceptive based stimulations are provided. Proprioceptive based training (PBT) is based on performing concurrent movements with both unaffected and affected arm, with the aim to foster motor recovery through some mutual connections of interhemispheric and transcallosal pathways. The aim of this pre-post pilot study was to evaluate the feasibility of PBT on recovery of voluntary muscle contraction in subacute phase after stroke.MethodsThe treatment lasted 1 h daily, 5 days per week for 3 weeks. The PBT consisted of multidirectional exercises executed synchronously with unaffected limb and verbal feedback. The Medical Research Council scale (MRC), Dynamometer, Fugl-Meyer Upper Extremity scale (F-M UE), Functional Independence Measure scale (FIM) and modified Ashworth scale were administered at the beginning and at the end of training. Statistical significance was set at p < 0.05.ResultsSix patients with severe paresis of the upper limb within 6 months after stroke were enrolled in the study (5 ischemic and 1 hemorrhagic stroke, 3 men and 3 women, mean age 65.7 ± 8.7 years, mean distance from stroke 4.1 ± 1.5 months) and all of them well tolerated the training. The clinical changes of voluntary muscle contraction after PBT were statistically significant at the MRC scale overall (p = 0.028), and dynamometer assessment overall (p = 0.028). Each patient improved muscle contraction of one or more muscles and in 4 out of 6 patients voluntary active movement emerged after therapy. The functional outcomes (i.e. F-M UE and FIM) did not show significant change within group.ConclusionsThe findings of this preliminary research revealed that PBT may be a feasible intervention to improve the motricity of upper limb in stroke survivors.

Does Upper Extremity Proprioceptive Training Have an Impact on Functional Outcomes in Chronic Stroke Patients?

“…Proprioception is the capacity of the CNS to determine the situation of all body parts at any moment (static/dynamic). Proprioceptors located at soft tissues can sense the changes and transfer afferent information to the brain 11 . This sensory information originates from muscle spindles as well as Golgi tendon organs, joints, and cutaneous receptors 10 .…”

Effects of sensory stimulation on upper limb strength, active joint range of motion and function in chronic stroke virtual reality training

“…Recently, several therapeutic techniques have been suggested to promote upper limb recovery in individuals affected by stroke, including robotic therapy [7], virtual reality training (VR) [8], sensory stimulation therapy [9], and imagery training [10]. Out of these therapeutic methods, training interventions for the motor function recuperation utilizing various sensory data, such as visual, tactile, auditory and proprioception, can improve the efficacy of rehabilitation exercises [11].…”

Análise Quantitativa Da Propriocepção Por Meio De Sensores Inerciais Em Espaço Tridimensional – Estudo Piloto

“…Além disto, a avaliação proprioceptiva auxilia no prognóstico e planos de tratamentos de reabilitação para cada indivíduo especificamente [6].…”