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Buckley JG, Frost SS, Hartley S, Rodacki ALF, Barrett BT. Moving from stable standing to single-limb stance or an up-on-the-toes position: The importance of vision to dynamic balance control. PLoS One 2024; 19:e0307365. [PMID: 39042648 PMCID: PMC11265682 DOI: 10.1371/journal.pone.0307365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
Understanding the contribution vision has to dynamic balance control may help in understanding where/why loss of balance occurs during everyday locomotion. The current study determined how body-centre-of-mass (BCoM) dynamics and postural stability when moving to and holding a single-limb-stance (SS) or an up-on-the-toes (UTT) position were affected by visual occlusion. From standing on a force platform, 18 adults (mean (SD) 26.7 (4.8) years; 1.73 (0.08) m; 84.0 (22.9) kg; 7 females) completed repeated trials (x3) with and without vision in which they moved to either a SS or an UTT position (order countered-balanced), and attempted to hold that position for 2 (SS) or 5 (UTT) seconds before returning to standing. UTT trials were also repeated at a fast speed, and SS trials were repeated using both the dominant and non-dominant limb. BCoM dynamics were assessed by analysing the displacement and peak velocity of the centre-of-pressure (CoP) when moving to and from the SS and UTT positions. Balance stability was the variability in the CoP displacement/velocity when holding these positions. Results indicate that under visual occlusion, the peak CoP velocity when moving to the SS or UTT position was reduced (ES, 0.67 and 0.68, respectively), suggesting greater caution. Both the variability in the CoP displacement/velocity when holding these positions and the peak CoP velocity when returning to flat-standing increased (SS: ES, 1.0 and 0.86, respectively; UTT: ES 1.26 and 0.66, respectively), suggesting, respectively, greater instability and poorer control. The poorer control in SS trials, occurred when returning to standing from the SS position held on the non-dominant limb, and correspondingly, the reduction in SS duration when vision was occluded was greater for the non-dominant limb trails (limb-vision interaction; p = 0.042). This suggests that movements initiated/controlled by the non-dominant limb are more reliant on visual feedback than those initiated/controlled by the dominant limb.
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Affiliation(s)
- John G Buckley
- School of Engineering, University of Bradford, Bradford, United Kingdom
| | | | - Shaun Hartley
- School of Engineering, University of Bradford, Bradford, United Kingdom
| | - Andre L F Rodacki
- Department of Physical Education, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Brendan T Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, United Kingdom
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Mostajeran M, Alizadeh S, Rostami HR, Ghaffari A, Adibi I. Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design. Neurol Sci 2024; 45:2737-2746. [PMID: 38158472 DOI: 10.1007/s10072-023-07288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke. DESIGN A pilot, single-subject experimental, A-B-A study. SETTING Stroke unit of an educational hospital and an outpatient occupational therapy clinic. PARTICIPANTS A convenience sample including five people with acute stroke. PROCEDURES Participants received 3 h of an intensive hand and upper limb sensory and motor rehabilitation program, 5 days per week for 3 months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach. OUTCOME MEASURES An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment. RESULTS Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures. CONCLUSIONS The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.
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Affiliation(s)
- Maryam Mostajeran
- Department of Cognitive Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Saeed Alizadeh
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Rostami
- Department of Occupational Therapy, Musculoskeletal Research Center, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amin Ghaffari
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Oh K, Rymer WZ, Choi J. A pilot study: effect of somatosensory loss on motor corrections in response to unknown loads in a reaching task by chronic stroke survivors. Biomed Eng Lett 2024; 14:523-535. [PMID: 38645583 PMCID: PMC11026319 DOI: 10.1007/s13534-024-00348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 04/23/2024] Open
Abstract
Despite recent studies indicating a significant correlation between somatosensory deficits and rehabilitation outcomes, how prevailing somatosensory deficits affect stroke survivors' ability to correct their movements and recover overall remains unclear. To explore how major deficits in somatosensory systems impede stroke survivors' motor correction to various external loads, we conducted a study with 13 chronic stroke survivors who had hemiparesis. An inertial, elastic, or viscous load, which was designed to impose perturbing forces with various force profiles, was introduced unexpectedly during the reaching task using a programmable haptic robot. Participants' proprioception and cutaneous sensation were also assessed using passive movement detection, finger-to-nose, mirror, repositioning, and Weinstein pressure tests. These measures were then analyzed to determine whether the somatosensory measures significantly correlated with the estimated reaching performance parameters, such as initial directional error, positional deviation, velocity deviations, and speed of motor correction were measured. Of 13 participants, 5 had impaired proprioception, as they could not recognize the passive movement of their elbow joint, and they kept showing larger initial directional errors even after the familiarization block. Such continuously found inaccurate initial movement direction might be correlated with the inability to develop the spatial body map especially for calculating the initial joint torques when starting the reaching movement. Regardless of whether proprioception was impaired or not, all participants could show the stabilized, constant reaching movement trajectories. This highlights the role of proprioception especially in the execution of a planned movement at the early stage of reaching movement.
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Affiliation(s)
- Keonyoung Oh
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - William Zev Rymer
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL USA
| | - Junho Choi
- Bionics Research Center, Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, 02792 Seoul, Republic of Korea
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Kleeren L, Mailleux L, McLean B, Elliott C, Dequeker G, Van Campenhout A, de Xivry JJO, Verheyden G, Ortibus E, Klingels K, Feys H. Does somatosensory discrimination therapy alter sensorimotor upper limb function differently compared to motor therapy in children and adolescents with unilateral cerebral palsy: study protocol for a randomized controlled trial. Trials 2024; 25:147. [PMID: 38409060 PMCID: PMC10895830 DOI: 10.1186/s13063-024-07967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Besides motor impairments, up to 90% of the children and adolescents with unilateral cerebral palsy (uCP) present with somatosensory impairments in the upper limb. As somatosensory information is of utmost importance for coordinated movements and motor learning, somatosensory impairments can further compromise the effective use of the impaired upper limb in daily life activities. Yet, intervention approaches specifically designated to target these somatosensory impairments are insufficiently investigated in children and adolescents with uCP. Therefore, the aim of this randomized controlled trial (RCT) is to compare the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP, who experience somatosensory impairments in the upper limb. We will further explore potential behavioral and neurological predictors of therapy response. METHODS A parallel group, evaluator-blinded, phase-II, single-center RCT will be conducted for which 50 children and adolescents with uCP, aged 7 to 15 years, will be recruited. Participants will be randomized to receive 3 weekly sessions of 45 minutes of either somatosensory discrimination therapy or upper limb motor therapy for a period of 8 weeks. Stratification will be performed based on age, manual ability, and severity of tactile impairment at baseline. Sensorimotor upper limb function will be evaluated at baseline, immediately after the intervention and after 6 months follow-up. The primary outcome measure will be bimanual performance as measured with the Assisting Hand Assessment. Secondary outcomes include a comprehensive test battery to objectify somatosensory function and measures of bimanual coordination, unimanual motor function, and goal attainment. Brain imaging will be performed at baseline to investigate structural brain lesion characteristics and structural connectivity of the white matter tracts. DISCUSSION This protocol describes the design of an RCT comparing the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP. The results of this study may aid in the selection of the most effective upper limb therapy, specifically for children and adolescents with tactile impairments. TRIAL REGISTRATION ClinicalTrials.gov (NCT06006065). Registered on August 8, 2023.
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Affiliation(s)
- Lize Kleeren
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium.
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium.
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium.
| | - Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
| | - Belinda McLean
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Griet Dequeker
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
| | - Anja Van Campenhout
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Leuven Brain Institute, Leuven, B-3000, Belgium
- KU Leuven, Department of Movement Sciences, Research Group of Motor Control and Neuroplasticity, Leuven, B-3000, Belgium
| | - Geert Verheyden
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
| | - Els Ortibus
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Katrijn Klingels
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
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Carey LM. 2023 Sylvia Docker lecture: Ignite your passion, and connect, to make a difference. Aust Occup Ther J 2024; 71:4-17. [PMID: 38234045 DOI: 10.1111/1440-1630.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
Together, we grow our profession of occupational therapy as we engage in understanding and addressing the issues that challenge the people we work with. In this Sylvia Docker Lecture, I will share the collective journeys of myself and other occupational therapists and health professionals who have undertaken (or are currently undertaking) their PhDs and are actively involved in research, to address these challenges. Together, we will explore three themes: understanding the WHY that ignites one's passion; living the journey-the EXPERIENCE; and making a difference-the IMPACT. Stories will be told through the lived experience of those engaged in research as currently enrolled PhD students, emerging researchers, and experienced researchers. These stories will capture the lived experience across individuals, and at different times in the research journey. Stories are summarised and captured using natural language processing. Topics are identified, concept maps visualised, and outputs interpreted in context of related theoretical models. Key topics identified include: the clinical and personal motivators that have ignited the passion in individuals; the value of connecting with others and growing networks; and how one's research has made a difference. The impact of discoveries and outcomes are highlighted, together with the importance of people and networks. Analysis of connections and synthesis over time revealed frequent and strong connections across themes, concepts and topics; with synthesising concepts of passion, networks, knowledge translation, opportunities, supervision and communication emerging and being shaped over time. These collective journeys provide inspiration and pathways to creative careers that have future potential in the growth of the profession of occupational therapy. It is recommended that each occupational therapist take the time to reflect on the 'why' that ignites your passion, your journey and how you can make a difference!
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Affiliation(s)
- Leeanne M Carey
- Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
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Carranza E, Bertoni T, Mastria G, Boos A, Bassolino M, Serino A, Pirondini E. Feasibility and Validation of a Robotic-Based Multisensory Integration Assessment in Healthy Controls and a Stroke Patient. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941286 DOI: 10.1109/icorr58425.2023.10304735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
After experiencing brain damage, stroke patients commonly suffer from motor and sensory impairments that impact their ability to perform volitional movements. Visuo-proprioceptive integration is a critical component of voluntary movement, allowing for accurate movements and a sense of ownership over one's body. While recent studies have increased our understanding of the balance between visual compensation and proprioceptive deficits in stroke patients, quantitative methods for studying multisensory integration are still lacking. This study aimed to evaluate the feasibility of adapting a 3D visuo-proprioceptive disparity (VPD) task into a 2D setting using an upper-limb robotic platform for moderate to severe chronic stroke patients. To assess the implementation of the 2D task, a cohort of unimpaired healthy participants performed the VPD task in both a 3D and 2D environment. We used a computational Bayesian model to predict errors in visuo-proprioceptive integration and compared the model's predictions to real behavioral data. Our findings indicated that the behavioral trends observed in the 2D and 3D tasks were similar, and the model accurately predicted behavior. We then evaluated the feasibility of our task to assess post-stroke deficits in a patient with severe motor and sensory deficits. Ultimately, this work may help to improve our understanding of the significance of visuo-proprioceptive integration and aid in the development of better rehabilitation therapies for improving sensorimotor outcomes in stroke patients.
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Senadheera I, Larssen BC, Mak-Yuen YYK, Steinfort S, Carey LM, Alahakoon D. Profiling Somatosensory Impairment after Stroke: Characterizing Common "Fingerprints" of Impairment Using Unsupervised Machine Learning-Based Cluster Analysis of Quantitative Measures of the Upper Limb. Brain Sci 2023; 13:1253. [PMID: 37759854 PMCID: PMC10526214 DOI: 10.3390/brainsci13091253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Altered somatosensory function is common among stroke survivors, yet is often poorly characterized. Methods of profiling somatosensation that illustrate the variability in impairment within and across different modalities remain limited. We aimed to characterize post-stroke somatosensation profiles ("fingerprints") of the upper limb using an unsupervised machine learning cluster analysis to capture hidden relationships between measures of touch, proprioception, and haptic object recognition. Raw data were pooled from six studies where multiple quantitative measures of upper limb somatosensation were collected from stroke survivors (n = 207) using the Tactile Discrimination Test (TDT), Wrist Position Sense Test (WPST) and functional Tactile Object Recognition Test (fTORT) on the contralesional and ipsilesional upper limbs. The Growing Self Organizing Map (GSOM) unsupervised machine learning algorithm was used to generate a topology-preserving two-dimensional mapping of the pooled data and then separate it into clusters. Signature profiles of somatosensory impairment across two modalities (TDT and WPST; n = 203) and three modalities (TDT, WPST, and fTORT; n = 141) were characterized for both hands. Distinct impairment subgroups were identified. The influence of background and clinical variables was also modelled. The study provided evidence of the utility of unsupervised cluster analysis that can profile stroke survivor signatures of somatosensory impairment, which may inform improved diagnosis and characterization of impairment patterns.
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Affiliation(s)
- Isuru Senadheera
- Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia;
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
| | - Beverley C. Larssen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Yvonne Y. K. Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
- Department of Occupational Therapy, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Sarah Steinfort
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
| | - Damminda Alahakoon
- Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia;
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Ramanathan S, Lynch E, Bernhardt J, Nilsson M, Cadilhac DA, Carey L, Middleton S, Chamberlain J, Walker FR, Reeves P, Searles A. Impact assessment of the Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery. Health Res Policy Syst 2023; 21:30. [PMID: 37127659 PMCID: PMC10152619 DOI: 10.1186/s12961-023-00974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/08/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Research impact is an emerging measure of research achievement alongside traditional academic outputs such as publications. We present the results of applying the Framework to Assess the Impact from Translational health research (FAIT) to the Centre for Research Excellence (CRE) in Stroke Rehabilitation and Brain Recovery (CRE-Stroke, 2014-2019) and report on the feasibility and lessons from the application of FAIT to a CRE rather than a discrete research project. METHODS Data were gathered via online surveys, in-depth interviews, document analysis and review of relevant websites/databases to report on the three major FAIT methods: the modified Payback Framework, an assessment of costs against monetized consequences, and a narrative account of the impact generated from CRE-Stroke activities. FAIT was applied during the last 4 years of CRE-Stroke operation. RESULTS With an economic investment of AU$ 3.9 million over 5 years, CRE-Stroke delivered a return on investment that included AU$ 18.8 million in leveraged grants, fellowships and consultancies. Collectively, CRE-Stroke members produced 354 publications that were accessed 470,000 times and cited over 7220 times. CRE-Stroke supported 26 PhDs, 39 postdocs and seven novice clinician researchers. There were 59 capacity-building events benefiting 744 individuals including policy-makers and consumers. CRE-Stroke created research infrastructure (including a research register of stroke survivors and a brain biobank), and its global leadership produced international consensus recommendations to influence the stroke research landscape worldwide. Members contributed to the Australian Living Stroke Guidelines: four researchers' outputs were directly referenced. Based only on the consequences that could be monetized, CRE-Stroke returned AU$ 4.82 for every dollar invested in the CRE. CONCLUSION This case example in the developing field of impact assessment illustrates how researchers can use evidence to demonstrate and report the impact of and returns on research investment. The prospective application of FAIT by a dedicated research impact team demonstrated impact in broad categories of knowledge-gain, capacity-building, new infrastructure, input to policy and economic benefits. The methods can be used by other research teams to provide comprehensive evidence to governments and other research funders about what has been generated from their research investment but requires dedicated resources to complete.
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Affiliation(s)
- Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, Locked Bag 100, New Lambton Heights, NSW, 2305, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.
| | - Elizabeth Lynch
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Parkville, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Parkville, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Health Research Economics, Hunter Medical Research Institute, Locked Bag 100, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Parkville, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Leeanne Carey
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Parkville, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- Occupational Therapy, School of Allied Health, Human Services and Sport, LaTrobe University, Bundoora, VIC, Australia
| | - Sandy Middleton
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Darlinghurst, Sydney, Australia
| | - Jan Chamberlain
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Parkville, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Frederick Rohan Walker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, Locked Bag 100, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Health Research Economics, Hunter Medical Research Institute, Locked Bag 100, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Mak-Yuen YYK, Matyas TA, Carey LM. Characterizing Touch Discrimination Impairment from Pooled Stroke Samples Using the Tactile Discrimination Test: Updated Criteria for Interpretation and Brief Test Version for Use in Clinical Practice Settings. Brain Sci 2023; 13:533. [PMID: 37190498 PMCID: PMC10137035 DOI: 10.3390/brainsci13040533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
Somatosensory loss post-stroke is common, with touch sensation characteristically impaired. Yet, quantitative, standardized measures of touch discrimination available for clinical use are currently limited. We aimed to characterize touch impairment and re-establish the criterion of abnormality of the Tactile Discrimination Test (TDT) using pooled data and to determine the sensitivity and specificity of briefer test versions. Baseline data from stroke survivors (n = 207) and older neurologically healthy controls (n = 100) assessed on the TDT was extracted. Scores were re-analyzed to determine an updated criterion of impairment and the ability of brief test versions to detect impairment. Updated scoring using an area score was used to calculate the TDT percent maximum area (PMA) score. Touch impairment was common for the contralesional hand (83%) but also present in the ipsilesional hand (42%). The criterion of abnormality was established as 73.1 PMA across older adults and genders. High sensitivity and specificity were found for briefer versions of the TDT (25 vs. 50 trials; 12 or 15 vs. 25 trials), with sensitivity ranging between 91.8 and 96.4% and specificity between 72.5 and 95.0%. Conclusion: Updated criterion of abnormality and the high sensitivity and specificity of brief test versions support the use of the TDT in clinical practice settings.
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Affiliation(s)
- Yvonne Y. K. Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia; (Y.Y.K.M.-Y.); (T.A.M.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
- Department of Occupational Therapy, St Vincent’s Hospital Melbourne, Melbourne 3065, Australia
| | - Thomas A. Matyas
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia; (Y.Y.K.M.-Y.); (T.A.M.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia; (Y.Y.K.M.-Y.); (T.A.M.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
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Carlsson H, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. Efficacy and feasibility of SENSory relearning of the UPPer limb (SENSUPP) in people with chronic stroke: A pilot randomized controlled trial. PM R 2022; 14:1461-1473. [PMID: 35049134 PMCID: PMC10078719 DOI: 10.1002/pmrj.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sensorimotor impairments of the upper limb (UL) are common after stroke, but there is a lack of evidence-based interventions to improve functioning of UL. OBJECTIVE To evaluate (1) the efficacy of sensory relearning and task-specific training compared to task-specific training only, and (2) the feasibility of the training in chronic stroke. DESIGN A pilot randomized controlled trial. SETTING University hospital outpatient clinic. PARTICIPANTS Twenty-seven participants (median age; 62 years, 20 men) were randomized to an intervention group (IG; n = 15) or to a control group (CG; n = 12). INTERVENTION Both groups received training twice weekly in 2.5-hour sessions for 5 weeks. The training in the IG consisted of sensory relearning, task-specific training, and home training. The training in the CG consisted of task-specific training. MAIN OUTCOME MEASURES Primary outcome was sensory function (touch thresholds, touch discrimination, light touch, and proprioception). Secondary outcomes were dexterity, ability to use the hand in daily activities, and perceived participation. A blinded assessor conducted the assessments at baseline (T1), post intervention (T2), and at 3-month follow-up (T3). Nonparametric analyses and effect-size calculations (r) were performed. Feasibility was evaluated by a questionnaire. RESULTS After the training, only touch thresholds improved significantly from T1 to T2 (p = .007, r = 0.61) in the IG compared to the CG. Within the IG, significant improvements were found from T1 to T2 regarding use of the hand in daily activities (p = .001, r = 0.96) and movement quality (p = .004, r = 0.85) and from T1 to T3 regarding satisfaction with performance in meaningful activities (p = .004, r = 0.94). The CG significantly improved the performance of using the hand in meaningful activities from T1 to T2 (p = .017, r = 0.86). The training was well tolerated by the participants and performed without any adverse events. CONCLUSIONS Combined sensory relearning and task-specific training may be a promising and feasible intervention to improve UL sensorimotor function after stroke.
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Affiliation(s)
- Håkan Carlsson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Machine learning predicts clinically significant health related quality of life improvement after sensorimotor rehabilitation interventions in chronic stroke. Sci Rep 2022; 12:11235. [PMID: 35787657 PMCID: PMC9253044 DOI: 10.1038/s41598-022-14986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Health related quality of life (HRQOL) reflects individuals perceived of wellness in health domains and is often deteriorated after stroke. Precise prediction of HRQOL changes after rehabilitation interventions is critical for optimizing stroke rehabilitation efficiency and efficacy. Machine learning (ML) has become a promising outcome prediction approach because of its high accuracy and easiness to use. Incorporating ML models into rehabilitation practice may facilitate efficient and accurate clinical decision making. Therefore, this study aimed to determine if ML algorithms could accurately predict clinically significant HRQOL improvements after stroke sensorimotor rehabilitation interventions and identify important predictors. Five ML algorithms including the random forest (RF), k-nearest neighbors (KNN), artificial neural network, support vector machine and logistic regression were used. Datasets from 132 people with chronic stroke were included. The Stroke Impact Scale was used for assessing multi-dimensional and global self-perceived HRQOL. Potential predictors included personal characteristics and baseline cognitive/motor/sensory/functional/HRQOL attributes. Data were divided into training and test sets. Tenfold cross-validation procedure with the training data set was used for developing models. The test set was used for determining model performance. Results revealed that RF was effective at predicting multidimensional HRQOL (accuracy: 85%; area under the receiver operating characteristic curve, AUC-ROC: 0.86) and global perceived recovery (accuracy: 80%; AUC-ROC: 0.75), and KNN was effective at predicting global perceived recovery (accuracy: 82.5%; AUC-ROC: 0.76). Age/gender, baseline HRQOL, wrist/hand muscle function, arm movement efficiency and sensory function were identified as crucial predictors. Our study indicated that RF and KNN outperformed the other three models on predicting HRQOL recovery after sensorimotor rehabilitation in stroke patients and could be considered for future clinical application.
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12
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Essers B, Van Gils A, Lafosse C, Michielsen M, Beyens H, Schillebeeckx F, Veerbeek JM, Luft AR, Kos D, Verheyden G. Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study. BMC Neurol 2021; 21:488. [PMID: 34906100 PMCID: PMC8672498 DOI: 10.1186/s12883-021-02493-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previously shown 'mismatch' group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. METHODS Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. RESULTS We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. CONCLUSIONS We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
| | - Annick Van Gils
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Christophe Lafosse
- Department of Allied Health and Department of Research, Rehabilitation Hospital RevArte, Antwerp, Belgium
| | - Marc Michielsen
- Rehabilitation Campus Sint Ursula, Jessa Hospital, Hasselt, Belgium
| | - Hilde Beyens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | | | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
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Decraene L, Feys H, Klingels K, Basu A, Ortibus E, Simon-Martinez C, Mailleux L. Tyneside Pegboard Test for unimanual and bimanual dexterity in unilateral cerebral palsy: association with sensorimotor impairment. Dev Med Child Neurol 2021; 63:874-882. [PMID: 33720409 DOI: 10.1111/dmcn.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
AIM We explored the psychometric properties of the recently developed Tyneside Pegboard Test (TPT) for unimanual and bimanual dexterity in children with unilateral cerebral palsy (CP) and investigated the impact of sensorimotor impairments on manual dexterity. METHOD In this cross-sectional study, the TPT was assessed in 49 children with unilateral CP (mean age 9y 8mo, SD 1y 11mo, range 6-15y; 30 males, 19 females; 23 with right unilateral CP). All participants additionally underwent a standardized upper limb evaluation at body function and activity level. We investigated: (1) known-group, concurrent, and construct validity and (2) impact of sensorimotor impairments including spasticity, grip force, stereognosis, and mirror movements using analysis of covariance, Spearman's rank correlation (r), and multiple linear regression (R2 ) respectively. RESULTS TPT outcomes significantly differed according to the Manual Ability Classification System (p<0.001, known-group validity). Relationships were found between the unimanual TPT tasks and the Jebsen-Taylor Hand Function Test (r=0.86-0.88, concurrent validity). Bimanual TPT tasks were negatively correlated with the Assisting Hand Assessment, ABILHAND-Kids, and Children's Hand-use Experience Questionnaire (r=-0.38 to -0.78, construct validity). Stereognosis was the main determinant influencing all tasks (p<0.001, R2 =37-50%). Unimanual dexterity was additionally determined by grip strength (p<0.05, R2 =8-9%) and mirror movements in the more impaired hand (p<0.05, R2 =4-8%). Bimanual dexterity was also explained by mirror movements in the more impaired hand (p<0.01, R2 =10-16%) and spasticity (p=0.04, R2 =5%). INTERPRETATION The TPT is a valid test to measure unimanual and bimanual dexterity in unilateral CP. The results further emphasize the importance of somatosensory impairments in children with unilateral CP. What this paper adds The Tyneside Pegboard Test is valid for measuring unimanual and bimanual dexterity in unilateral cerebral palsy. Children with poorer manual ability show worse unimanual and bimanual dexterity. Stereognosis is the main predictor of both unimanual and bimanual dexterity. Stronger mirror movements in the more impaired hand result in worse bimanual dexterity.
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Affiliation(s)
- Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
| | - Anna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Paediatric Neurology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland.,Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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14
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Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors. J Neuroeng Rehabil 2021; 18:77. [PMID: 33971912 PMCID: PMC8112068 DOI: 10.1186/s12984-021-00871-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. Methods Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). Results Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. Conclusions This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.
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15
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Bernard-Espina J, Beraneck M, Maier MA, Tagliabue M. Multisensory Integration in Stroke Patients: A Theoretical Approach to Reinterpret Upper-Limb Proprioceptive Deficits and Visual Compensation. Front Neurosci 2021; 15:646698. [PMID: 33897359 PMCID: PMC8058201 DOI: 10.3389/fnins.2021.646698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/04/2021] [Indexed: 11/29/2022] Open
Abstract
For reaching and grasping, as well as for manipulating objects, optimal hand motor control arises from the integration of multiple sources of sensory information, such as proprioception and vision. For this reason, proprioceptive deficits often observed in stroke patients have a significant impact on the integrity of motor functions. The present targeted review attempts to reanalyze previous findings about proprioceptive upper-limb deficits in stroke patients, as well as their ability to compensate for these deficits using vision. Our theoretical approach is based on two concepts: first, the description of multi-sensory integration using statistical optimization models; second, on the insight that sensory information is not only encoded in the reference frame of origin (e.g., retinal and joint space for vision and proprioception, respectively), but also in higher-order sensory spaces. Combining these two concepts within a single framework appears to account for the heterogeneity of experimental findings reported in the literature. The present analysis suggests that functional upper limb post-stroke deficits could not only be due to an impairment of the proprioceptive system per se, but also due to deficiencies of cross-references processing; that is of the ability to encode proprioceptive information in a non-joint space. The distinction between purely proprioceptive or cross-reference-related deficits can account for two experimental observations: first, one and the same patient can perform differently depending on specific proprioceptive assessments; and a given behavioral assessment results in large variability across patients. The distinction between sensory and cross-reference deficits is also supported by a targeted literature review on the relation between cerebral structure and proprioceptive function. This theoretical framework has the potential to lead to a new stratification of patients with proprioceptive deficits, and may offer a novel approach to post-stroke rehabilitation.
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Affiliation(s)
| | | | - Marc A Maier
- Université de Paris, INCC UMR 8002, CNRS, Paris, France
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16
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Tashiro S, Kuroki M, Okuyama K, Oshima O, Ogura M, Hijikata N, Nakamura T, Oka A, Kawakami M, Tsuji T, Liu M. Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke-A retrospective cross-sectional study. PLoS One 2021; 16:e0247998. [PMID: 33690690 PMCID: PMC7942978 DOI: 10.1371/journal.pone.0247998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/17/2021] [Indexed: 12/05/2022] Open
Abstract
AIMS The present study aimed to determine factors associated with the frequency of paralyzed upper extremity (UE) use in chronic stroke patients with severe UE functional deficiency. METHODS We retrospectively reviewed the medical records of 138 consecutive patients, and 117 was analyzed (median age, 55 [range, 18-85] years; median stroke duration, 24.5 [range, 7-302] months) with chronic hemiparetic stroke who were admitted to our hospital for intensive upper extremity rehabilitation. The mean Fugl-Meyer Assessment (FMA) UE score was 28.6. All of them are independent in their activity of daily living (ADL) and without remarkable cognitive deficits. Amount-of-use score of Motor Activity Log-14 (MAL-AOU) was applied as the index of daily use of affected UE. The following parameters were examined as the explanatory variables: demographics, proximal and distal sub-scores of FMA UE, Modified Ashworth Scale (MAS), and sensory function scores in the Stroke Impairment Assessment Set (SIAS). RESULTS The median MAL-AOU score was 0.57 [range, 0.28-0.80]. Ordinal regression analysis revealed that FMA proximal, FMA distal, and SIAS sensory function (touch) were associated with AOU score of MAL-14 (Pseudo R-square = 0.460). CONCLUSION Not only motor but also sensory function, especially tactile sensation, play a crucial role in the daily use of affected UE in chronic stroke patients with severe UE hemiparesis.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Miho Kuroki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Osamu Oshima
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Miho Ogura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Asako Oka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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17
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Suda M, Kawakami M, Okuyama K, Ishii R, Oshima O, Hijikata N, Nakamura T, Oka A, Kondo K, Liu M. Validity and Reliability of the Semmes-Weinstein Monofilament Test and the Thumb Localizing Test in Patients With Stroke. Front Neurol 2021; 11:625917. [PMID: 33584520 PMCID: PMC7873561 DOI: 10.3389/fneur.2020.625917] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself. Objective: We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis. Methods: Fifty patients with chronic stroke (median time after onset of stroke, 848 [474–1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated. Results: Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83–0.95)/ 0.75 (0.60–0.91) and 0.80 (index finger, 0.67–0.93)/0.79 (0.66–0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71–0.95)/ 0.83 (0.73–0.92), 0.90 (navel level distal space, 0.85–0.96)/ 0.80 (0.69–0.90), 0.80 (shoulder level proximal space, 0.68–0.92)/ 0.77 (0.65–0.89), and 0.87 (shoulder level distal space, 0.80–0.93)/ 0.80 (0.68–0.92) (P < 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94–2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item (r = 0.65, p < 0.001), as did the TLT with the SIAS position sense item (r = −0.70–0.62, p < 0.001 each space). Conclusions: The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.
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Affiliation(s)
- Mabu Suda
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Osamu Oshima
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Asako Oka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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18
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Carey LM, Mak-Yuen YYK, Matyas TA. The Functional Tactile Object Recognition Test: A Unidimensional Measure With Excellent Internal Consistency for Haptic Sensing of Real Objects After Stroke. Front Neurosci 2020; 14:542590. [PMID: 33071730 PMCID: PMC7538651 DOI: 10.3389/fnins.2020.542590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction Our hands, with their exquisite sensors, work in concert with our sensing brain to extract sensory attributes of objects as we engage in daily activities. One in two people with stroke experience impaired body sensation, with negative impact on hand use and return to previous valued activities. Valid, quantitative tools are critical to measure somatosensory impairment after stroke. The functional Tactile Object Recognition Test (fTORT) is a quantitative measure of tactile (haptic) object recognition designed to test one’s ability to recognize everyday objects across seven sensory attributes using 14 object sets. However, to date, knowledge of the nature of object recognition errors is limited, and the internal consistency of performance across item scores and dimensionality of the measure have not been established. Objectives To describe the original development and construction of the test, characterize the distribution and nature of performance errors after stroke, and to evaluate the internal consistency of item scores and dimensionality of the fTORT. Method Data from existing cohorts of stroke survivors (n = 115) who were assessed on the fTORT quantitative measure of sensory performance were extracted and pooled. Item and scale analyses were conducted on the raw item data. The distribution and type of errors were characterized. Results The 14 item sets of the fTORT form a well-behaved unidimensional scale and demonstrate excellent internal consistency (Cronbach alpha of 0.93). Deletion of any item failed to improve the Cronbach score. Most items displayed a bimodal score distribution, with function and attribute errors (score 0) or correct response (score 3) being most common. A smaller proportion of one- or two-attribute errors occurred. The total score range differentiated performance over a wide range of object recognition impairment. Conclusion Unidimensional scale and similar factor loadings across all items support simple addition of the 14 item scores on the fTORT. Therapists can use the fTORT to quantify impaired tactile object recognition in people with stroke based on the current set of items. New insights on the nature of haptic object recognition impairment after stroke are revealed.
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Affiliation(s)
- Leeanne M Carey
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Yvonne Y K Mak-Yuen
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Thomas A Matyas
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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Pillette L, Lotte F, N'Kaoua B, Joseph PA, Jeunet C, Glize B. Why we should systematically assess, control and report somatosensory impairments in BCI-based motor rehabilitation after stroke studies. Neuroimage Clin 2020; 28:102417. [PMID: 33039972 PMCID: PMC7551360 DOI: 10.1016/j.nicl.2020.102417] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
The neuronal loss resulting from stroke forces 80% of the patients to undergo motor rehabilitation, for which Brain-Computer Interfaces (BCIs) and NeuroFeedback (NF) can be used. During the rehabilitation, when patients attempt or imagine performing a movement, BCIs/NF provide them with a synchronized sensory (e.g., tactile) feedback based on their sensorimotor-related brain activity that aims at fostering brain plasticity and motor recovery. The co-activation of ascending (i.e., somatosensory) and descending (i.e., motor) networks indeed enables significant functional motor improvement, together with significant sensorimotor-related neurophysiological changes. Somatosensory abilities are essential for patients to perceive the feedback provided by the BCI system. Thus, somatosensory impairments may significantly alter the efficiency of BCI-based motor rehabilitation. In order to precisely understand and assess the impact of somatosensory impairments, we first review the literature on post-stroke BCI-based motor rehabilitation (14 randomized clinical trials). We show that despite the central role that somatosensory abilities play on BCI-based motor rehabilitation post-stroke, the latter are rarely reported and used as inclusion/exclusion criteria in the literature on the matter. We then argue that somatosensory abilities have repeatedly been shown to influence the motor rehabilitation outcome, in general. This stresses the importance of also considering them and reporting them in the literature in BCI-based rehabilitation after stroke, especially since half of post-stroke patients suffer from somatosensory impairments. We argue that somatosensory abilities should systematically be assessed, controlled and reported if we want to precisely assess the influence they have on BCI efficiency. Not doing so could result in the misinterpretation of reported results, while doing so could improve (1) our understanding of the mechanisms underlying motor recovery (2) our ability to adapt the therapy to the patients' impairments and (3) our comprehension of the between-subject and between-study variability of therapeutic outcomes mentioned in the literature.
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Affiliation(s)
- Léa Pillette
- Inria, 200 av.de la Vieille Tour, 33400 Talence, France; LaBRI (Univ.Bordeaux, CNRS, Bordeaux-INP), 351, cours de la Libération, 33405 Talence, France.
| | - Fabien Lotte
- Inria, 200 av.de la Vieille Tour, 33400 Talence, France; LaBRI (Univ.Bordeaux, CNRS, Bordeaux-INP), 351, cours de la Libération, 33405 Talence, France.
| | - Bernard N'Kaoua
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France.
| | - Pierre-Alain Joseph
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France; Service MPR Pôle de Neurosciences Cliniques CHU, University of Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux cedex, France.
| | - Camille Jeunet
- CLLE (CNRS, Univ.Toulouse Jean Jaurès), 5 Allées Antonio Machado, 31058 Toulouse cedex 9, France.
| | - Bertrand Glize
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France; Service MPR Pôle de Neurosciences Cliniques CHU, University of Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux cedex, France.
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Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke. J Neuroeng Rehabil 2020; 17:115. [PMID: 32831097 PMCID: PMC7444058 DOI: 10.1186/s12984-020-00746-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hand function is often impaired after stroke, strongly affecting the ability to perform daily activities. Upper limb robotic devices have been developed to complement rehabilitation therapy offered to persons who suffered a stroke, but they rarely focus on the training of hand sensorimotor function. The primary goal of this study was to evaluate whether robot-assisted therapy of hand function following a neurocognitive approach (i.e., combining motor training with somatosensory and cognitive tasks) produces an equivalent decrease in upper limb motor impairment compared to dose-matched conventional neurocognitive therapy, when embedded in the rehabilitation program of inpatients in the subacute stage after stroke. Methods A parallel-group, randomized controlled trial was conducted on subjects with subacute stroke receiving either conventional or robot-assisted neurocognitive hand therapy using a haptic device. Therapy was provided for 15, 45-min sessions over four weeks, nested within the standard therapy program. Primary outcome was the change from baseline in the upper extremity part of the Fugl-Meyer Assessment (FMA-UE) after the intervention, which was compared between groups using equivalence testing. Secondary outcome measures included upper limb motor, sensory and cognitive assessments, delivered therapy dose, as well as questionnaires on user technology acceptance. Results Thirty-three participants with stroke were enrolled. 14 subjects in the robot-assisted and 13 subjects in the conventional therapy group completed the study. At the end of intervention, week 8 and week 32, the robot-assisted/conventional therapy group improved by 7.14/6.85, 7.79/7.31, and 8.64/8.08 points on the FMA-UE, respectively, establishing that motor recovery in the robot-assisted group is non-inferior to that in the control group. Conclusions Neurocognitive robot-assisted therapy of hand function allows for a non-inferior motor recovery compared to conventional dose-matched neurocognitive therapy when performed during inpatient rehabilitation in the subacute stage. This allows the early familiarization of subjects with stroke to the use of such technologies, as a first step towards minimal therapist supervision in the clinic, or directly at home after hospital discharge, to help increase the dose of hand therapy for persons with stroke. Trial registration EUDAMED database (CIV-13-02-009921), clinicaltrials.gov (NCT02096445). Registered 26 March 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02096445
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Elangovan N, Yeh IL, Holst-Wolf J, Konczak J. A robot-assisted sensorimotor training program can improve proprioception and motor function in stroke survivors. IEEE Int Conf Rehabil Robot 2020; 2019:660-664. [PMID: 31374706 DOI: 10.1109/icorr.2019.8779409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proprioceptive deficits are common among stroke survivors and are associated with slower motor recovery, poorer upper limb motor function, and decreased self-care ability. Somatosensory feedback augmenting proprioception should enhance motor control after stroke, but available evidence is inconclusive. This study evaluated the effects of a robot-aided, somatosensory-focused training on proprioceptive acuity and motor performance in individuals with sub-acute and chronic stroke. Twelve stroke survivors completed two training sessions on two consecutive days. During training, participants used a haptic robotic wrist exoskeleton and made continuous, goal-directed wrist ab/adduction movements to a visual target while receiving vibro-tactile feedback. Proprioceptive acuity and active movement errors were assessed before, immediately after, and two days after intervention. Results showed significantly improved proprioceptive acuity at posttest and retention. Motor accuracy measures showed improvements, however these were not statistically significant. This study demonstrates the feasibility of robot-aided somatosensory rehabilitation training in stroke survivors.
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Chia FSF, Kuys S, Low Choy N. Sensory retraining of the leg after stroke: systematic review and meta-analysis. Clin Rehabil 2019; 33:964-979. [PMID: 30897960 PMCID: PMC6557007 DOI: 10.1177/0269215519836461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke. DATA SOURCES Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched. REVIEW METHODS All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets. RESULTS The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I2 = 59.05%). Gait SES, mainly of gait velocity, was not significant. CONCLUSION This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.
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Affiliation(s)
- Fenny SF Chia
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
- Community Rehabilitation Unit, Tasmanian Health Service, Hobart, TAS, Australia
| | - Suzanne Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Nancy Low Choy
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
- Queensland Health Service, Brisbane, QLD, Australia
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Serrada I, Hordacre B, Hillier SL. Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:402. [PMID: 31114472 PMCID: PMC6503047 DOI: 10.3389/fnins.2019.00402] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life. Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity, indicating a potential mechanism which may mediate recovery. However, rehabilitation specifically focusing on somatosensory function receives little attention. Objectives: To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke. Methods: Electronic databases and trial registries were searched from inception until November 2018, in addition to hand searching systematic reviews. Study selection included randomized controlled trials for adults of any stroke type with an upper and/or lower limb sensorimotor impairment. Participants all received a sensory-based intervention designed to improve activity levels or impairment, which could be compared with usual care, sham, or another intervention. The primary outcomes were change in activity levels related to sensorimotor function. Secondary outcomes were measures of impairment, participation or quality of life. Results: A total of 38 study trials were included (n = 1,093 participants); 29 explored passive sensory training (somatosensory; peripheral nerve; afferent; thermal; sensory amplitude electrical stimulation), 6 active (sensory discrimination; perceptual learning; sensory retraining) and 3 hybrid (haptic-based augmented reality; sensory-based feedback devices). Meta-analyses (13 comparisons; 385 participants) demonstrated a moderate effect in favor of passive sensory training on improving a range of upper and lower limb activity measures following stroke. Narrative syntheses were completed for studies unable to be pooled due to heterogeneity of measures or insufficient data, evidence for active sensory training is limited however does show promise in improving sensorimotor function following stroke. Conclusions: Findings from the meta-analyses and single studies highlight some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, evidence for active sensory training continues to be limited. Further high-quality research with rigorous methods (adequately powered with consistent outcome measures) is required to determine the effectiveness of sensory retraining in stroke rehabilitation, particularly for active sensory training.
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Affiliation(s)
- Ines Serrada
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Susan L Hillier
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Gopaul U, Carey L, Callister R, Nilsson M, van Vliet P. Combined somatosensory and motor training to improve upper limb function following stroke: a systematic scoping review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2018.1553668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Urvashy Gopaul
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Leeanne Carey
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Robin Callister
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Michael Nilsson
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Paulette van Vliet
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Humanities and Social Sciences, University of Newcastle, Newcastle, NSW, Australia
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Lamp G, Goodin P, Palmer S, Low E, Barutchu A, Carey LM. Activation of Bilateral Secondary Somatosensory Cortex With Right Hand Touch Stimulation: A Meta-Analysis of Functional Neuroimaging Studies. Front Neurol 2019; 9:1129. [PMID: 30687211 PMCID: PMC6335946 DOI: 10.3389/fneur.2018.01129] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/10/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Brain regions involved in processing somatosensory information have been well documented through lesion, post-mortem, animal, and more recently, structural and functional neuroimaging studies. Functional neuroimaging studies characterize brain activation related to somatosensory processing; yet a meta-analysis synthesis of these findings is currently lacking and in-depth knowledge of the regions involved in somatosensory-related tasks may also be confounded by motor influences. Objectives: Our Activation Likelihood Estimate (ALE) meta-analysis sought to quantify brain regions that are involved in the tactile processing of the right (RH) and left hands (LH) separately, with the exclusion of motor related activity. Methods: The majority of studies (n = 41) measured activation associated with RH tactile stimulation. RH activation studies were grouped into those which conducted whole-brain analyses (n = 29) and those which examined specific regions of interest (ROI; n = 12). Few studies examined LH activation, though all were whole-brain studies (N = 7). Results: Meta-analysis of brain activation associated with RH tactile stimulation (whole-brain studies) revealed large clusters of activation in the left primary somatosensory cortex (S1) and bilaterally in the secondary somatosensory cortex (S2; including parietal operculum) and supramarginal gyrus (SMG), as well as the left anterior cingulate. Comparison between findings from RH whole-brain and ROI studies revealed activation as expected, but restricted primarily to S1 and S2 regions. Further, preliminary analyses of LH stimulation studies only, revealed two small clusters within the right S1 and S2 regions, likely limited due to the small number of studies. Contrast analyses revealed the one area of overlap for RH and LH, was right secondary somatosensory region. Conclusions: Findings from the whole-brain meta-analysis of right hand tactile stimulation emphasize the importance of taking into consideration bilateral activation, particularly in secondary somatosensory cortex. Further, the right parietal operculum/S2 region was commonly activated for right and left hand tactile stimulation, suggesting a lateralized pattern of somatosensory activation in right secondary somatosensory region. Implications for further research and for possible differences in right and left hemispheric stroke lesions are discussed.
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Affiliation(s)
- Gemma Lamp
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
- Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, VIC, Australia
| | - Peter Goodin
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Susan Palmer
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Essie Low
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
- Department of Neurology, Sunshine Hospital, Western Health, Melbourne, VIC, Australia
- Department of Psychology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ayla Barutchu
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
- Balliol College, University of Oxford, Oxford, United Kingdom
| | - Leeanne M. Carey
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
- Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, VIC, Australia
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Villepinte C, Catella E, Martin M, Hidalgo S, Téchené S, Lebely C, Castel-Lacanal E, de Boissezon X, Chih H, Gasq D. Validation of French upper limb Erasmus modified Nottingham Sensory Assessment in stroke. Ann Phys Rehabil Med 2019; 62:35-42. [DOI: 10.1016/j.rehab.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 11/15/2022]
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Stefanello JL, Mendes GC, Moser ADDL, Nohama P. Ludic-activities-based therapeutic suitcase for rehabilitation of people with stroke. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The rehabilitation of people who suffered a stroke depends on patient commitment, rehabilitation strategies and technologies employed. Objective: To develop a suitcase with rehabilitation activities using devices that provide functional exercises in a fun and motivating way. Method: The main motor and sensory functions lost due to the stroke were identified and a set of three boards was modeled, providing activities with adequate structure and strategies to conduct rehabilitation exercises. A pilot experiment was performed with a subject with poststroke sequelae. Results: The suitcase has three boards containing devices for exercises of proprioception, motor coordination, grasping and reeducation to decrease agnosia, to increase muscle strength and for cognitive training. Conclusion: The suitcase fulfilled its functional reeducation purpose via a playful method; it provides improvements in the ability to fit parts, differentiate colors, recognize shapes and textures, and increase the strength.
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Affiliation(s)
| | | | | | - Percy Nohama
- Pontifícia Universidade Católica do Paraná, Brazil; Universidade Tecnológica Federal do Paraná, Brazil
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Gopaul U, van Vliet P, Callister R, Nilsson M, Carey L. COMbined Physical and somatoSEnsory training after stroke: Development and description of a novel intervention to improve upper limb function. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1748. [PMID: 30230136 DOI: 10.1002/pri.1748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE After stroke, reach-to-grasp goal-directed movements are disrupted as a result of both residual motor and somatosensory impairments. This report describes the rationale and development of a new upper limb stroke rehabilitation intervention known as COMPoSE: "COMbined Physical and somatoSEnsory training," designed to improve somatosensory and motor deficits in the upper limb after stroke. A standardized training matrix has been developed to facilitate intervention delivery. METHODS The COMPoSE intervention was developed through the following stages: (a) Definition and operationalization of somatosensory and motor variables used in training sensation and movement after stroke; (b) development of methods to give feedback to enhance skill acquisition; and (c) Combination of somatosensory and motor variables, and feedback, into a standardized training matrix. The reporting of the COMPoSE intervention adheres to the recommendations of the Template for Intervention Description and Replication checklist to facilitate replication of the intervention in the future. RESULTS The essential features of COMPoSE include combined somatosensory-motor training variables (grasp pressure, distance, object size, crushability, surface texture, and friction), feedback, and calibration using a haptic device providing measures of grasp pressure, use of anticipation trials, and high-dose repetitive task practice. Ten treatment sessions are delivered over 3 weeks, using a standardized matrix for treatment delivery. CONCLUSION COMPoSE is a new intervention that combines somatosensory and movement training, delivered synchronously, within the same intervention, and within the same task.
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Affiliation(s)
- Urvashy Gopaul
- School of Physiotherapy, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Paulette van Vliet
- School of Humanities and Social Sciences, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Michael Nilsson
- Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Leeanne Carey
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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