Sensorimotor Training and Neural Reorganization After Stroke

Abstract

Background and Purpose Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel two-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization. Case Description Sensorimotor evaluation identified behavioral changes, activity induced neural reorganization was examined using sensory fMRI, diffusion tensor tractography, and brain volume measurement. Participant 1 was a 75-year-old right-handed man one year post right hemisphere stroke with severe sensory impairment across domains in his left hand, he reported limited left hand/arm use. Participant 2 was a 63-year-old right-handed woman who had experienced a left hemisphere stroke 9 months earlier resulting in mild sensory impairment across domains in her right hand, as well as mild motor deficit. Intervention Participants trained 4 hours per day, 5 days per week for two weeks. Training tasks required sensory discrimination of temperature, weights, textures, shapes and objects in the context of active exploration with the involved hand. Random multi-modal feedback was used. Outcomes Both participants had improved scores on the Wolf Motor Function Test after training. Participant 1 had no measureable change in sensory function, while Participant 2 improved in touch perception, proprioception and haptic performance. Sensory fMRI suggested neural reorganization in both participants; Participant 1 had a small increase in brain volume, while superior thalamic radiation white matter connectivity was unchanged in either participant. Discussion/Summary Participating in sensorimotor training focused on sensory discrimination during manual manipulation was feasible for both participants. Future research to determine efficacy and identify optimal measures of sensory function and neural reorganization is recommended. Video Abstract available (see Video, Supplemental Digital Content 1) for more insights from the authors.

Mobilization and Stimulation of Neuromuscular Tissue (MASONT) for Stroke Survivors

“…11 Three trials were the ones that demonstrated the ability of somatosensory interventions to cause functional recovery on stroke survivors by triggering cortical reorganization -a total of 17 out of 23 patients. [12][13][14] This possibly validates the theory that recovery depends on cortical circuits which receive the appropriate sensory input from the periphery and reconnect the partially disconnected circuits in order to 'rescue' the repair of the circuits and not 'collapse' the lesioned circuits which would otherwise be the case. Therefore, the therapist offers guided or assisted recovery through perceptual inputs based on bottom-up targeted stimulation.…”

Comparison of Fine Motor Skills in Patients With Chronic Stroke in Final Stages of Bronestrum and Healthy Adults

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The effects of Mobilization and Stimulation of Neuromuscular Tissue on the hemiplegic upper limb: a case report

“…Previous studies implemented similar interventions of somatosensory stimulation. Sensorimotor training improved the functional recovery of 2 chronic stroke survivors in a 2-week intervention with neural reorganization being induced [45]. Moreover, a program of stretching, range of motion exercises, and soft tissue mobilization techniques offered to 5 chronic stroke patients in a 3-week intervention managed to provide functional improvement along with cortical reorganization [46].…”