Effect of sensorimotor stimulation on chronic stroke patients' upper extremity function: a preliminary study

Exploring the contribution of case study research to the evidence base for occupational therapy: a scoping review

BACKGROUND

Case study research is generating interest to evaluate complex interventions. However, it is not clear how this is being utilized by occupational therapists or how feasible it is to contribute to the evidence base. This scoping review explores case study research within occupational therapy in terms of how it is defined, the methodological characteristics adopted, such as data collection and analysis, and the range of practice contexts in which it is applied. We consider the viability of case study research for contributing to our evidence base.

METHODS

Opinion, text and empirical studies within an occupational therapy practice context were included. A three-step extensive search following Joanna Briggs Institute methodology was conducted in June 2020 and updated in July 2021 across ten databases, websites, peer-reviewed and grey literature from 2016 onwards. Study selection was completed by two independent reviewers. A data extraction table was developed and piloted and data charted to align with research questions. Data extraction was completed by one reviewer and a 10% sample cross checked by another.

RESULTS

Eighty-eight studies were included in the review consisting of (n = 84) empirical case study and (n = 4) non-empirical papers. Case study research has been conducted globally, with a range of populations across different settings. The majority were conducted in a community setting (n = 48/84; 57%) with populations experiencing neurodevelopmental disorder (n = 32/84; 38%), stroke (n = 14/84;17%) and non-diagnosis specific (n = 13/84; 15%). Methodologies adopted quantitative (n = 42/84; 50%), mixed methods (n = 22/84; 26%) and qualitative designs (n = 20/84; 24%). However, identifying the methodology and 'case' was a challenge due to methodological inconsistencies.

CONCLUSIONS

Case study research is useful when large-scale inquiry is not appropriate; for cases of complexity, early intervention efficacy, theory testing or when small participant numbers are available. It appears a viable methodology to contribute to the evidence base for occupation and health as it has been used to evaluate interventions across a breadth of occupational therapy practice contexts. Viability could be enhanced through consistent conduct and reporting to allow pooling of case data. A conceptual model and description of case study research in occupational therapy is proposed to support this.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework 10.17605/OSF.IO/PCFJ6.

Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

STUDY DESIGN

This is a single-blinded clinical trial study. Clinical Trial Number registry: IRCT201610223551N4.

INTRODUCTION

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

PURPOSE OF THE STUDY

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

METHODS

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

RESULTS

The intervention group made improvement in motor function (P = .0001, Cohen's d = 2.14), activities of daily living of upper limb (P = .0001, Cohen's d = 1.32), and spasticity (P = .002, Cohen's d = -0.94).

DISCUSSION

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

CONCLUSION

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Effect of aerobic exercise on post-stroke cognitive function: a systematic review

Background/Aims

Literature suggests that aerobic exercise improves cognitive impairments post stroke. This systematic review was conducted to analyse evidence on the effectiveness of aerobic exercise in improving post-stroke cognitive impairments.

Methods

Online databases (PubMed, EMBASE and Web of Science) were systematically searched from inception until 13 July 2017 using the keywords stroke/exercise/cognition. Clinical trials that met the inclusion criteria were assessed for methodological quality using the PEDro scale. Extracted data were synthesised for evidence.

Results

A total of seven studies met the inclusion criteria. Participants in most of the studies were aged over 60 years and the majority had ischaemic stroke. The most commonly used measure for assessing cognition was the Mini Mental State Examination. The majority of studies included moderate to high intensity exercise (50–70% of VO2max) for 30–60 minutes three to five times per week. There is moderate evidence that aerobic exercise enhances global cognitive function, attention and working memory. Evidence that aerobic exercise improves memory, levels of brain-derived neurotrophic factor and executive function is conflicting and limited.

Conclusions

Aerobic exercise is moderately effective in improving post-stroke cognitive impairments. More clinical trials are needed in view of the methodological limitations and paucity of existing studies.

Does sensorimotor upper limb therapy post stroke alter behavior and brain connectivity differently compared to motor therapy? Protocol of a phase II randomized controlled trial

Background

The role of somatosensory feedback in motor performance has been warranted in the literature. Although sensorimotor deficits are common after stroke, current rehabilitation approaches primarily focus on restoring upper limb motor ability. Evidence for integrative sensorimotor rehabilitation approaches is scarce, as is knowledge about neural correlates of somatosensory impairments after stroke and the effect of rehabilitation on brain connectivity level. Therefore, we aim to investigate changes in sensorimotor function and brain connectivity following a sensorimotor therapy program compared to an attention-matched motor therapy program for the upper limb after stroke.

Methods

An assessor-blinded randomized controlled trial will be conducted. Sixty inpatient rehabilitation patients up to eight weeks after stroke will be included. Patients will be randomized to either an experimental group receiving sensorimotor therapy or a control group receiving attention-matched motor therapy for the upper limb, with both groups receiving conventional therapy. Thus, all patients will receive extra therapy, a total of 16 1-h sessions over four weeks. Patients will be assessed at baseline, after four weeks of training, and after four weeks of follow-up. Primary outcome measure is the Action Research Arm Test. Secondary outcome measures will consist of somatosensory, motor and cognitive assessments, and a standardized resting-state functional magnetic resonance imaging protocol.

Discussion

The integration of sensory and motor rehabilitation into one therapy model might provide the added value of this therapy to improve sensorimotor performance post stroke. Insight in the behavioral and brain connectivity changes post therapy will lead to a better understanding of working mechanisms of therapy and will provide new knowledge for patient-tailored therapy approaches.

Trial registration

ClinicalTrials.gov, NCT03236376. Registered on 8 August 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2609-4) contains supplementary material, which is available to authorized users.