Sensory Function, Measured as Active Discriminative Touch, is Associated With Dexterity after Stroke

The effect of wrist position sense and tactile recognition on manual skills in patients with upper extremity neuropathy

BACKGROUND

Peripheral neuropathy affects fine motor skills in daily life. However, reports on the effects of position sense and tactile recognition on manual dexterity are quite scarce in the literature. The increasing focus on hand rehabilitation has created a need to examine the effects of sensation on manual dexterity.

PURPOSE

The purpose of this study is to compare the effect of tactile recognition and wrist position sense on manual skills in healthy and neuropathy individuals and to investigate the relationship between them.

STUDY DESIGN

Cross-sectional, non-randomized comparative clinical study.

METHODS

Thirty-seven (50 hands) with median and ulnar nerve neuropathy between the ages of 18 and 65 years and 32 (64 hands) healthy individuals of similar age and gender were included in the study. Wrist position sense was assessed using the K-FORCE Sens electrogoniometer as target angle, 30° wrist flexion and extension, and 10° radial and ulnar deviation. Shape-Texture Identification Test (STI), Purdue Pegboard test (PPT), and Michigan Hand Outcome Questionnaire were applied for tactile recognition, manual dexterity, and hand functions, respectively. The independent-sample t test and Mann-Whitney U test were used for K-FORCE Sens, STI, and PPT to compare groups. Correlation coefficient was used to determine the relationship between variables.

RESULTS

The mean age of individuals with neuropathy and healthy individuals was 45.7 ± 10.3 and 44.5 ± 9.2 years, respectively (p > 0.05). Seventy-three percent of individuals had median neuropathy and 27% had ulnar neuropathy. Totally, 33 dominant and 17 non-dominant hands of patients with neuropathy were affected. When healthy and neuropathic hands were compared, the mean error values in the dominant hand, flexion (4.4 ± 1.4; 6.5 ± 2.9), and radial deviation (2.4 ± 1.0; 3.3 ± 1.7) degrees were higher in the neuropathic hands (p < 0.05). Similar results were also found in the non-dominant hands. However, there was no difference between the mean error values in the extension and ulnar deviation degrees (p > 0.05). STI and PPT subtest results were also lower in the neuropathic hands (p < 0.05). There was a relationship between the mean error values of position sense in the flexion and radial deviation directions in the neuropathic dominant hands and all subtests of the PPT (p < 0.05), while there was a relation in the flexion direction in the non-dominant hand (p < 0.05). No relation was found in the Michigan Hand Outcome Questionnaire test (p > 0.05).

CONCLUSIONS

This study has shown that in neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored in determining participation in manual skills. This article can be used as a starting point for further studies and can be considered as one of the sensory focal points in rehabilitation in the development of manual skills.

Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects

BACKGROUND

Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role.

OBJECTIVE

To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects.

METHODS

The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA).

RESULTS

The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side.

CONCLUSION

In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.

Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis

Objective

To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions.

Design

Systematic review and meta-analysis.

Participants

Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems).

Data sources

The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023.

Eligibility criteria

Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT).

Results

Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT.

Conclusion

There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT.

PROSPERO registration number

CRD42022289001.

Efficacy and feasibility of SENSory relearning of the UPPer limb (SENSUPP) in people with chronic stroke: A pilot randomized controlled trial

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.

Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation

INTRODUCTION

Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors.

OBJECTIVE

To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PARTICIPANTS

Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models.

RESULTS

Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value = .032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value = .006, Nagelkerke R Square = 0.207).

CONCLUSION

Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation.

SENSory re-learning of the UPPer limb (SENSUPP) after stroke: development and description of a novel intervention using the TIDieR checklist

Background

Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention “SENSory re-learning of the UPPer limb after stroke (SENSUPP)” that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke.

Methods

The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used.

Results

The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks.

Conclusion

Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training.

Trial registration

ClinicalTrials.govNCT03336749. Registered on 8 November 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05375-6.

Multisensory Integration in Stroke Patients: A Theoretical Approach to Reinterpret Upper-Limb Proprioceptive Deficits and Visual Compensation

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.

Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke-A retrospective cross-sectional study

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.

Anodal Transcranial Direct Current Stimulation Over S1 Differentially Modulates Proprioceptive Accuracy in Young and Old Adults

BACKGROUND

Proprioception is a prerequisite for successful motor control but declines throughout the lifespan. Brain stimulation techniques such as anodal transcranial direct current stimulation (a-tDCS) are capable of enhancing sensorimotor performance across different tasks and age groups. Despite such growing evidence for a restorative potential of tDCS, its impact on proprioceptive accuracy has not been studied in detail yet.

OBJECTIVE

This study investigated online effects of a-tDCS over S1 on proprioceptive accuracy in young (YA) and old healthy adults (OA).

METHODS

The effect of 15 min of a-tDCS vs. sham on proprioceptive accuracy was assessed in a cross-over, double blind experiment in both age groups. Performance changes were tested using an arm position matching task in a robotic environment. Electrical field (EF) strengths in the target area S1 and control areas were assessed based on individualized simulations.

RESULTS

a-tDCS elicited differential changes in proprioceptive accuracy and EF strengths in the two groups: while YA showed a slight improvement, OA exhibited a decrease in performance during a-tDCS. Stronger EF were induced in target S1 and control areas in the YA group. However, no relationship between EF strength and performance change was found.

CONCLUSION

a-tDCS over S1 elicits opposing effects on proprioceptive accuracy as a function of age, a result that is important for future studies investigating the restorative potential of a-tDCS in healthy aging and in the rehabilitation of neurological diseases that occur at advanced age. Modeling approaches could help elucidate the relationship between tDCS protocols, brain structure and performance modulation.