SENSORY AND BALANCE FUNCTIONS AND THEIR EFFECT ON PARTICIPATION IN INDIVIDUALS WITH CHRONIC SENSORY LOSS POST-STROKE

H. Ofek^1,2, T. Knoll³, D. Livne³, M. Alperin³, Y. Laufer²

¹Zefat Academic College, Physical Therapy, Zefat, Israel, ²University of Haifa, Physical Therapy, Haifa, Israel, ³Clalit Health Services, Haifa and Western Galilee, Haifa, Israel

Background: Up to 80% of individuals post-stroke present impaired contralesional somatosensation, and the majority will remain with chronic sensory impairment. Sensory loss to the lower extremity has been associated with reduced balance, impaired gait and reduced participation.
Study rationale: The impact of the sensory impairment on balance and gait and the impact of both body functions and activity limitations on participation in this specific clinical population is of interest, in order to focus personalized treatment to improve participation as the highest aim of the rehabilitation process.

Purpose: To observe the impact of sensory function of different modalities in lower extremity of individuals with post-stroke sensory impairment and their correlations and relationships to relevant balance and mobility activities and on participation.

Methods: Individuals with chronic sensory impairment post-stroke were assessed for: tactile threshold using Semmes Weinstein Monofilments, proprioception using Lower Extremity Position Test, texture discrimination, TENS detection threshold, miniBEST, Activities-specific Balance Confidence Scale (ABC), Timed Up & Go (TUG), Two-minute walk and Stroke Impact Scale (SIS). Correlations analysis and linear regression was conducted.

Results: Fourty-eight volunteers, aged 66±10, 46±58 months since stroke onset, displayed impaired sensory function of the contralesional lower limb: tactile threshold 4.92±0.76; LEPT 3.91±2.31 cm. Their participation score on SIS was 0.5±0.2; ABC was 0.44±0.22; Barefoot TUG was 46.54±38.48 seconds; miniBEST was 0.29±0.26. Correlations and regression relationships were found. Correlations between tactile detection and activities were moderate (the highest being between tactile threshold and miniBEST r=-0.50, p<0.001). However, correlation between sensory function and participation was weak (tactile detection and participation r=-0.13, p,0.001). Linear regression was found significant with ABC predicting 18% of participation rate (r=0.39, p=0.005). Barefoot TUG and miniBEST added together 9% of prediction (r square = 0.346, 0.429 respectively).

Conclusions: a. Sensory function is correlated to balance b. the subjective appraisal of the individual post-stroke of their balance and functional ability using a patient-reported outcome measure (ABC) has the strongest relationship to their participation rate. b. The ability to walk barefoot and miniBEST balance score have an additional impact on the participation rate.

Implications: The results of this study suggest that in order to increase participation in individuals with sensory loss post-stroke, treatment should aim at improving both balance activities as well as improvement of sensory capacity and function.

Funding acknowledgements: We have no funding to declare

Keywords:
Stroke
Sensory impairment
Participation

Topics:
Neurology: stroke
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Clalit Health Services

Committee: Clalit Health Services - Community Helsinki commitee

Ethics number: 00-34-13-COM