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Ofek H1, Alperin M2, Knoll T2, Livne D2, Laufer Y1
1University of Haifa, Haifa, Israel, 2Clalit Health Services, Haifa and Western Galilee, Israel
Background: Sensory impairment is demonstrated in 50%-85% of individuals post-stroke and leads to poorer motor and functional recovery. To date, within sensorimotor learning approaches, no customized treatment has been assigned to the lower extremity of this population. Explicit (i.e. sensory discrimination training) and implicit (i.e. repeated exposure) perceptual learning sensory training approaches are in clinical use to enhance balance and mobility, but no study has established their effectiveness in individuals with sensory impairment.
Purpose: To study the effectiveness of explicit sensory discrimination training to the lower extremity post stroke, and to compare it with an implicit perceptual learning approach.
Methods: An RCT was conducted comparing the two sensory learning approaches in 64 (explicit-34, implicit-30) subjects with chronic hemiparesis (>6 months post stroke) and lower extremity sensory impairment. Participants were assessed twice pre-intervention (a week apart) and twice post-intervention (immediately after treatment and at 3 months followup) by a physical therapist blind to treatment allocation. Activity and participation outcome measures included Activities-specific Balance Confidence questionnaire (ABC), mini Balance Evaluation Systems Test (miniBEST), Timed Up and Go (TUG) with orthosis and shoes, TUG barefoot, two minute walk and Stroke Impact Scale (SIS)-Activities of Daily Living/ SIS-participation sections. Treatment included 10 sessions of 45 minutes, conducted once or twice a week at an outpatient physiotherapy clinic, with home assignments. ANOVA and post hoc tests were used to determine treatment effects over time. Significance was set at p≤0.05.
Results: A stable baseline was assured between the two pre-treatment sessions. Significant post treatment improvements were demonstrated for all variables (p 0.0001) for both groups with no timeXgroup effect, with gains stable at 3 months followup. Improvements were greater than measures of clinical relevance standards (MDC/MCID). For example: miniBEST improved by 18-21%; Barefoot TUG improved by 30-33%.
Conclusion(s): When sensory loss is present post-stroke, sensory focused rehabilitation treatment by either explicit or implicit sensory learning can make clinically significant improvements in balance, mobility and participation.
Implications: The results of this study suggest that focusing on sensory components within sensorimotor treatment is important and should be implemented, when treating subjects with post stroke sensory impairment, which otherwise are said to have a ceiling effect of improvement and a poorer prognosis. Since both explicit and implicit perceptual training are beneficial to the recovery of lower extremity related performance in this population, both are suggested for clinical use.
Keywords: Stroke, Sensory impairment, Randomized Controlled Trial
Funding acknowledgements: Non
Purpose: To study the effectiveness of explicit sensory discrimination training to the lower extremity post stroke, and to compare it with an implicit perceptual learning approach.
Methods: An RCT was conducted comparing the two sensory learning approaches in 64 (explicit-34, implicit-30) subjects with chronic hemiparesis (>6 months post stroke) and lower extremity sensory impairment. Participants were assessed twice pre-intervention (a week apart) and twice post-intervention (immediately after treatment and at 3 months followup) by a physical therapist blind to treatment allocation. Activity and participation outcome measures included Activities-specific Balance Confidence questionnaire (ABC), mini Balance Evaluation Systems Test (miniBEST), Timed Up and Go (TUG) with orthosis and shoes, TUG barefoot, two minute walk and Stroke Impact Scale (SIS)-Activities of Daily Living/ SIS-participation sections. Treatment included 10 sessions of 45 minutes, conducted once or twice a week at an outpatient physiotherapy clinic, with home assignments. ANOVA and post hoc tests were used to determine treatment effects over time. Significance was set at p≤0.05.
Results: A stable baseline was assured between the two pre-treatment sessions. Significant post treatment improvements were demonstrated for all variables (p 0.0001) for both groups with no timeXgroup effect, with gains stable at 3 months followup. Improvements were greater than measures of clinical relevance standards (MDC/MCID). For example: miniBEST improved by 18-21%; Barefoot TUG improved by 30-33%.
Conclusion(s): When sensory loss is present post-stroke, sensory focused rehabilitation treatment by either explicit or implicit sensory learning can make clinically significant improvements in balance, mobility and participation.
Implications: The results of this study suggest that focusing on sensory components within sensorimotor treatment is important and should be implemented, when treating subjects with post stroke sensory impairment, which otherwise are said to have a ceiling effect of improvement and a poorer prognosis. Since both explicit and implicit perceptual training are beneficial to the recovery of lower extremity related performance in this population, both are suggested for clinical use.
Keywords: Stroke, Sensory impairment, Randomized Controlled Trial
Funding acknowledgements: Non
Topic: Neurology: stroke; Neurology
Ethics approval required: Yes
Institution: Clalit health services
Ethics committee: Community Helsinki ethical committee
Ethics number: 0034-13-COM
All authors, affiliations and abstracts have been published as submitted.
