Lower Extremity Position Test: A new clinical quantitative assessment tool of proprioception post stroke

The investigation of cognition, proprioception, sensory and physical function in stroke patients with urinary incontinence

PURPOSE

This study aimed to investigate cognition, proprioception, and sensory/physical function in stroke patients with urinary incontinence (UI).

METHODS

A prospective cross-sectional study was conducted on 53 individuals with stroke (23 had UI and 21 matched controls). The Incontinence Impact Questionnaire Short Form (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to assess the patients' UI symptoms. Participants were also evaluated with Mini-Mental State Examination (MMSE), Barthel Index (BI), Fugl-Meyer Sensory Assessment (FMA-S), Five Times Sit to Stand Test (FTSST), Functional Reach Test (FRT) and Proprioception Test.

RESULTS

FTSST, FRT and FMA-S were better in stroke subjects without UI (p < 0.05). There was a moderate correlation between IIQ-7 with FMA-S, FTSST and proprioception (left extremity) (r₁: - 0.415, r₂: 0.440, r₃: 0.430, p < 0.05) and a low correlation with BI (r: - 0.356, p < 0.05).

CONCLUSION

Individuals with UI had worse sensory/motor function and static balance. Stroke patients with UI were more dependent, had less sensory function, and had worse lower extremity muscle strength and proprioception as the level of urinary incontinence increased. To reduce urinary incontinence, emphasis on motor/sensory function, balance, and proprioception should be considered.

Evaluation of the Effect of SPIDER System Therapy on Weight Shifting Symmetry in Chronic Stroke Patients-A Randomized Controlled Trial

(1) Background: The Strengthening Program for Intensive Developmental Exercises and Activities for Reaching Health Capability (SPIDER) system is dedicated to patients with motor deficits resulting from damage to the peripheral or central nervous system (including post-stroke patients). It enables the conduct of forced-weight-bearing therapy to the lower limb affected by the paresis. In this study, the TYMO^® measuring platform was used to quantify the impact of therapy using the SPIDER system and therapy that did not use this system. The TYMO^® device is a portable posturography platform that monitors the tilting of the body's center of mass and reports the results of the rehabilitation process. (2) Objective: To evaluate the effect of therapy based on neurophysiological methods (proprioceptive neuromuscular facilitation (PNF), neurodevelopmental treatment according to the Bobath concept (NDT-Bobath)) and the SPIDER system on body weight transfer shifting, in post-stroke patients in the chronic phase, compared to therapy based on neurophysiological methods (PNF, NDT-Bobath), without the use of the SPIDER system. (3) Methods: This is a randomized controlled trial in which patients (n = 120; adults, post-ischemic stroke-first stroke episode, in chronic phase-up to 5 years after the stroke incident) were assigned to one of two groups: study, n = 60 (with therapy using PNF, NDT-Bobath methods and the SPIDER system); and control, n = 60 (with therapy using PNF and NDT-Bobath methods, without the SPIDER system). In patients in both groups, before and after the training (2 weeks of therapy), body weight distribution was measured on the TYMO^® platform. (4) Results and Conclusions: The results of the statistical analysis demonstrated a greater reduction in the tilt of the body's center of mass in therapy using the SPIDER system, compared to therapy in which the system was not used.

Where Are We on Proprioception Assessment Tests Among Poststroke Individuals? A Systematic Review of Psychometric Properties

BACKGROUND AND PURPOSE

Proprioception is often impaired in poststroke individuals. This is a significant issue since altered proprioception is associated with poorer physical function outcomes poststroke. However, there is limited consensus on the best tools for assessing proprioception and support for their widespread use by clinicians. The objective is to appraise the psychometric properties of each test used to assess proprioception in poststroke individuals.

METHODS

A systematic search was performed according to PRISMA guidelines using the databases MEDLINE, Cochrane Library, PEDro, DiTa, and BioMedicalCentral for articles published up to January 2021.

RESULTS

Sixteen studies of low methodological quality were included. Sixteen different proprioception assessment tests were extracted. The proprioception portion of the Fugl-Meyer Assessment Scale was found to be the most valid and reliable tool for screening patients in clinical settings. Although no real gold standard exists, the technological devices demonstrated better responsiveness and measurement accuracy than clinical tests. Technological devices might be more appropriate for assessing proprioception recovery or better suited for research purposes.

DISCUSSION AND CONCLUSIONS

This review revealed low-quality articles and a paucity of tests with good psychometric properties available to clinicians to properly screen and assess all subcomponents of proprioception. In perspective, technological devices, such as robotic orthoses or muscle vibration, may provide the best potential for assessing the different subcomponents of proprioception. Further studies should be conducted to develop and investigate such approaches.Video, Supplemental Digital Content 1, available at:http://links.lww.com/JNPT/A388.

Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial

PURPOSE

Sensory impairment post-stroke limits rehabilitation of balance and gait. This study aims to compare the effect of explicit sensory retraining (ESR) versus implicit repeated exposure (IRE) to stimuli of the lower extremity, assessing their effects on sensation, balance, and gait in individuals with chronic post-stroke sensory impairment.

MATERIALS AND METHODS

A two-arm parallel double-blind multicenter randomized controlled trial was conducted in physical therapy outpatient clinics. Volunteers with chronic sensory impairment post-stroke participated in 10 sessions of 45 min ESR or IRE, according to a detailed protocol. Outcome measures assessed sensation, balance, mobility, and participation.

RESULTS

A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30). The intention-to-treat pre-post analysis demonstrated clinically meaningful changes for both interventions (10-31% improvement for the various measures), with no between-group difference or time × group interaction. The effect size for the time effect varied, with the largest being 0.63 for the miniBEST.

CONCLUSIONS

Sensory rehabilitation treatment by either ESR or IRE led to similar clinically significant changes in the performance of the lower extremity and participation in subjects with sensory loss post-stroke. Both treatment protocols are easy to implement in an outpatient clinic.  .

CLINICALTRIALS.GOV REGISTRATION

NCT01988220. Implications for rehabilitationStandardized, structured, sensory-focused training can improve balance and gait in subjects with chronic post-stroke sensory impairment.Both explicit and implicit learning-based sensory protocols focused on the lower extremity effectively improved balance, mobility, and gait abilities, resulting in enhanced participation of individuals in the chronic post-stroke phase.A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.