Abstract
Background An important reason for the difficulty in recovering sensorimotor dysfunction of the upper extremity in chronic stroke survivors, is the lack of sensory function, such as tactile and proprioception feedback. In clinical practice, single sensory training is only for the restoration of sensory function. Increasing evidence suggests that use of task-oriented training (TOT) is a useful approach to hand motor rehabilitation. However, neither approach is optimal since both methods are trained only for specific functional recovery. Our hypothesis is that multi-sensory feedback therapy (MSFT) combined with TOT has the potential to provide stimulating tasks to restore both sensory and motor functions. The objective of the trial is to investigate whether novel MSFT is more effective in improving arm sensorimotor function in chronic stroke phase than single TOT.
Methods/Design: The study will be conducted as a multicenter, randomized, double blind controlled trial. Participants (n = 90) will be randomised into three groups to compare the effect of the multi-sensory feedback therapy group against task-oriented training group and conventional group. Participants will receive treatment at the same intensity (60 min, 5 days a week, 4 weeks, 20 hours total). Primary outcome measures for assessment of sensory function are the Semmes Weinstein monofilaments examination (SWME),two-point discrimination test (2PD) test. Secondary measures are the Action Research Arm Test (ARAT)༌Nine-Hole Peg Test (NHPT), Wolf Motor Function Test (WMFT), Box and Blocks Test (BBT), Modified Barthel Index (MBI), Instrumental activities of daily living (IADL) and Generalized Anxiety Disorder 7-Item Scale (GAD-7). Outcome mearsures will be evaluated at baseline, post treatment, and two months follow-up. All assessments will be conducted by trained assessors blinded to treatment allocation.
Discussion This study will determine the acceptability and efficacy of the intervention on the hemiparetic upper limb, it may be promising tools for sensorimotor functional recovery after stroke.
Figure 2. The multi-sensory feedback therapy system used in the present study. Step 1：Patients will undergo multi-sensory training under a visual feedback device, including (A) Tactile training for patients with different materials, textures, objects; (B) Proprioceptive control of hand gestures; (C) 2-point discrimination with tools. Step 2：All sensory stimuli will be visually blocked and visually exposed in all patients. Step 3：The multi-sensory feedback therapy combined with task-oriented training will increase motivation for sensorimotor tasks.
Background
Stroke is a major cause of serious long-term disability in chronic stroke [1, 2]. In China alone, the age-standardized prevalence, incidence, and mortality rates were approximately 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively [3]. More than two thirds of all patients experience impaired function in the upper extremity [4, 5], and many of chronic stroke patients require continued rehabilitation for hand disability from hospitals. Sensory impairments of all modalities are thought to be common during the chronic stage of stroke [6].
Although tactile loss is more frequent than proprioceptive dysfunction, especially in the hand. Approximately 80% of chronic stroke patients experience tactile loss, over 69% without proprioceptive discriminations [7]. Somatosensory deficits are associated with the degree of weakness and stroke severity, and they are also related to mobility, mental health, independence in activities of daily living, and recovery [8]. Sensory function is an important composition of widely used physiotherapy approaches such as Bobath (known as Neurodevelopment Therapy in the United States) and Brunnstrom, and it is considered a precursor to the recovery of movement and functional activities of daily living in patients with stroke [9]. Poor motor function is associated with reduced sensory experience and processing after stroke [10, 11]. Joint position sensation of the upper extremity is closely related to motor ability due to stroke-related reduced discrimination in proprioception [9], it causes disturbances in the arm movement trajectory. The relation between sensory and motor dysfunction is unsurprising since biomechanics and motor control of human movement require bidirectional interaction between cortex and periphery [12].
Sensory disorders include light touch, temperature, joint position, two-point discrimination, object discrimination, spatial orientation [5]. Different types of sensory disorders have different inefficiencies to perform daily activities and social participation [12]. Thermohypesthesia is the reason leading to scalding and freezing injury [6]. Scalding injuries often occur as the result of spilled food or beverages. They are also unable to feel pain, which means that they can’t retract arms and hands actively. In addition, bleeding often happens after touching acupuncture or sharp objects. Stroke is also a major global mental health problem. The sensory impairment has negative implications to explore environment, and lower the effect of rehabilitation outcomes. Anxiety, depressive symptoms, general psychological distress and social isolation are prevalent if chronic patients have sensory disorders [13]. Psychosocial difficulties may impact significantly on long-term functioning and quality of life [14, 15], and it reduces the effects of rehabilitation services and bring about higher mortality rates [16].
TBI Rehabilitation 