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

Håkan Carlsson, Birgitta Rosén, Anders Björkman, Hélène Pessah-Rasmussen, Christina Brogårdh, Håkan Carlsson, Birgitta Rosén, Anders Björkman, Hélène Pessah-Rasmussen, Christina Brogårdh

Abstract

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.gov NCT03336749 . Registered on 8 November 2017.

Keywords: Sensory training; Stroke; Task-specific training; Upper limb.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A description of the components in the SENSUPP study
Fig. 2
Fig. 2
A Various surfaces and fabrics for touch discrimination. B Items for touch discrimination of different (a) size; (b) shape; (c) weight and (d) temperature. C Objects for tactile object recognition. D Materials for the task- specific training
Fig. 3
Fig. 3
Illustration of sensory re-learning, i.e., examination with the affected hand without the aid of vision

References

    1. World Health Organization. Stroke/cerebrovascular accident. . Accessed 28 Aug 2020.
    1. Carey LM, Matyas TA. Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting. J Rehabil Med. 2011;43(3):257–263. doi: 10.2340/16501977-0662.
    1. Kessner SS, Schlemm E, Cheng B, Bingel U, Fiehler J, Gerloff C, Thomalla G. Somatosensory Deficits after ischemic stroke. Stroke. 2019;50(5):1116–1123. doi: 10.1161/STROKEAHA.118.023750.
    1. Scalha TB, Miyasaki E, Lima NM, Borges G. Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke. Arq Neuropsiquiatr. 2011;69(4):624–629. doi: 10.1590/S0004-282X2011000500010.
    1. Meyer S, De Bruyn N, Lafosse C, Van Dijk M, Michielsen M, Thijs L, et al. Somatosensory impairments in the upper limb poststroke: distribution and association with motor function and visuospatial neglect. Neurorehabil Neural Repair. 2016;30(8):731–742. doi: 10.1177/1545968315624779.
    1. Kessner SS, Bingel U, Thomalla G. Somatosensory deficits after stroke: a scoping review. Top Stroke Rehabil. 2016;23(2):136–146. doi: 10.1080/10749357.2015.1116822.
    1. Hill VA, Fisher T, Schmid AA, Crabtree J, Page SJ. Relationship between touch sensation of the affected hand and performance of valued activities in individuals with chronic stroke. Top Stroke Rehabil. 2014;21(4):339–346. doi: 10.1310/tsr2104-339.
    1. Doyle SD, Bennett S, Dudgeon B. Upper limb post-stroke sensory impairments: the survivor’s experience. Disabil Rehabil. 2014;36(12):993–1000. doi: 10.3109/09638288.2013.825649.
    1. Sullivan JE, Hedman LD. Sensory dysfunction following stroke: incidence, significance, examination, and intervention. Top Stroke Rehabil. 2008;15(3):200–217. doi: 10.1310/tsr1503-200.
    1. Doyle SBS, Dudgeon BJ. Sensory impairment after stroke: exploring therapists clinical decision making. Can J OccupatTher. 2014;81:215–225.
    1. Carlsson H, Gard G, Brogardh C. Upper-limb sensory impairments after stroke: self-reported experiences of daily life and rehabilitation. J Rehabilitation Med. 2018;50(1):45–51. doi: 10.2340/16501977-2282.
    1. Schabrun SM, Hillier S. Evidence for the retraining of sensation after stroke: a systematic review. Clin Rehabil. 2009;23(1):27–39. doi: 10.1177/0269215508098897.
    1. Doyle S, Bennett S, Fasoli SE, McKenna KT. Interventions for sensory impairment in the upper limb after stroke. Cochrane Database Syst Rev. 2010;6:Cd006331.
    1. Kattenstroth JC, Kalisch T, Sczesny-Kaiser M, Greulich W, Tegenthoff M, Dinse HR. Daily repetitive sensory stimulation of the paretic hand for the treatment of sensorimotor deficits in patients with subacute stroke: RESET, a randomized, sham-controlled trial. BMC Neurol. 2018;18(1):2. doi: 10.1186/s12883-017-1006-z.
    1. Chen JC, Liang CC, Shaw FZ. Facilitation of sensory and motor recovery by thermal intervention for the hemiplegic upper limb in acute stroke patients: a single-blind randomized clinical trial. Stroke. 2005;36(12):2665–2669. doi: 10.1161/01.STR.0000189992.06654.ab.
    1. 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. doi: 10.3389/fnins.2019.00402.
    1. Carey L, Macdonell R, Matyas TA. SENSe: study of the effectiveness of neurorehabilitation on sensation: a randomized controlled trial. Neurorehabil Neural Repair. 2011;25(4):304–313. doi: 10.1177/1545968310397705.
    1. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8(8):741–754. doi: 10.1016/S1474-4422(09)70150-4.
    1. Hubbard IJ, Parsons MW, Neilson C, Carey LM. Task-specific training: evidence for and translation to clinical practice. Occup Ther Int. 2009;16(3-4):175–189. doi: 10.1002/oti.275.
    1. Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003;84(11):1692–1702. doi: 10.1053/S0003-9993(03)00277-6.
    1. Byl N, Roderick J, Mohamed O, Hanny M, Kotler J, Smith A, Tang M, Abrams G. Effectiveness of sensory and motor rehabilitation of the upper limb following the principles of neuroplasticity: patients stable poststroke. Neurorehabil Neural Repair. 2003;17(3):176–191. doi: 10.1177/0888439003257137.
    1. Carlsson H, Rosen B, Pessah-Rasmussen H, Bjorkman A, Brogardh C. SENSory re-learning of the UPPer limb after stroke (SENSUPP): study protocol for a pilot randomized controlled trial. Trials. 2018;19(1):229. doi: 10.1186/s13063-018-2628-1.
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj. 2014;348(mar07 3):g1687. doi: 10.1136/bmj.g1687.
    1. Alvarez G, Cerritelli F, Urrutia G. Using the template for intervention description and replication (TIDieR) as a tool for improving the design and reporting of manual therapy interventions. Man Ther. 2016;24:85–89. doi: 10.1016/j.math.2016.03.004.
    1. Hoffmann TC, Erueti C, Glasziou PP. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. Bmj. 2013;347(sep10 1):f3755. doi: 10.1136/bmj.f3755.
    1. Cotterill S, Knowles S, Martindale AM, Elvey R, Howard S, Coupe N, Wilson P, Spence M. Getting messier with TIDieR: embracing context and complexity in intervention reporting. BMC Med Res Methodol. 2018;18(1):12. doi: 10.1186/s12874-017-0461-y.
    1. Carey LM. Stroke rehabilitation insights from neuroscience and imaging. New York: Oxford University Press; 2012.
    1. Hunter SM. Hand function and stroke. Rev Clin Gerontol. 2002;12(1):68–81. doi: 10.1017/S0959259802012194.
    1. Blennerhassett JM, Matyas TA, Carey LM. Impaired discrimination of surface friction contributes to pinch grip deficit after stroke. Neurorehabil Neural Repair. 2007;21(3):263–272. doi: 10.1177/1545968306295560.
    1. Carlsson H, Ekstrand E, Brogårdh C. Sensory function, measured as active discriminative touch, is associated with dexterity after stroke. PM R. 2019;11(8):821–827. doi: 10.1002/pmrj.12044.
    1. Johansson RS. Dynamic use of tactile afferent signals in control of dexterous manipulation. Adv Exp Med Biol. 2002;508:397–410. doi: 10.1007/978-1-4615-0713-0_45.
    1. Hermsdorfer J, Hagl E, Nowak DA, Marquardt C. Grip force control during object manipulation in cerebral stroke. Clin Neurophysiol. 2003;114(5):915–929. doi: 10.1016/S1388-2457(03)00042-7.
    1. Nowak DA, Hermsdorfer J, Topka H. Deficits of predictive grip force control during object manipulation in acute stroke. J Neurol. 2003;250(7):850–860. doi: 10.1007/s00415-003-1095-z.
    1. Nudo RJ, Friel KM, Delia SW. Role of sensory deficits in motor impairments after injury to primary motor cortex. Neuropharmacology. 2000;39(5):733–742. doi: 10.1016/S0028-3908(99)00254-3.
    1. Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. Handb Clin Neurol. 2013;110:93–103. doi: 10.1016/B978-0-444-52901-5.00008-3.
    1. Mulder T, Hochstenbach J. Adaptability and flexibility of the human motor system: implications for neurological rehabilitation. Neural Plast. 2001;8(1-2):131–140. doi: 10.1155/NP.2001.131.
    1. Yekutiel M, Guttman E. A controlled trial of the retraining of the sensory function of the hand in stroke patients. J Neurol Neurosurg Psychiatry. 1993;56(3):241–244. doi: 10.1136/jnnp.56.3.241.
    1. Shumway-Cook A, Woollacott M. Motor control: translating research into clinical practice. Fourth edition ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
    1. Chapman CE, Tremblay F, Ageranioti-Belanger SA. Role of primary somatosensory cortex in active and passive touch. In: Wing AM, editor. Hand and brain: Amsterdam: Academic; 1996. p. 513.
    1. Borstad AL, Nichols-Larsen DS. Assessing and treating higher level somatosensory impairments post stroke. Top Stroke Rehabil. 2014;21(4):290–295. doi: 10.1310/tsr2104-290.
    1. Yekutiel M. Sensory re-education of the hand after stroke: London: Whurr Publishers; 2000.
    1. Rosén B, Björkman A, Lundborg G. Sensory re-learning and the plastic brain. In: Skirven O, Osterman A, Fedorczyk J, Amadio P, Feldscher SH, editors. Rehabilitation of the hand and upper extremity. 7th ed. Philadelphia: Elsevier Mosby; 2020. p. 597–608.
    1. Cunningham P, Turton AJ, Van Wijck F, Van Vliet P. Task-specific reach-to-grasp training after stroke: development and description of a home-based intervention. Clin Rehabil. 2016;30(8):731–740. doi: 10.1177/0269215515603438.
    1. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014;11:Cd010820.
    1. Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014;9(2):e87987. doi: 10.1371/journal.pone.0087987.
    1. Almhdawi KA, Mathiowetz VG, White M, del Mas RC. Efficacy of occupational therapy task-oriented approach in upper extremity post-stroke rehabilitation. Occup Ther Int. 2016;23(4):444–456. doi: 10.1002/oti.1447.
    1. Teasell RW, Foley NC, Salter KL, Jutai JW. A blueprint for transforming stroke rehabilitation care in Canada: the case for change. Arch Phys Med Rehabil. 2008;89(3):575–578. doi: 10.1016/j.apmr.2007.08.164.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner