Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke

Abstract

Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery. Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy? Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke. Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center. Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy. Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up. Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003]. Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03236376.

Keywords: randomized controlled (clinical) trial; sensorimotor therapy; stroke; treatment outcome; upper extremity.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2020 De Bruyn, Saenen, Thijs, Van Gils, Ceulemans, Essers, Lafosse, Michielsen, Beyens, Schillebeeckx, Alaerts and Verheyden.

Figures

Figure 1

Flowchart based on CONSORT guidelines for RCT.

Figure 2

Lesion overlay map of stroke lesion location of patients with available magnetic resonance imaging (MRI) scan (n = 30). Color indicates increasing number of patients with inclusion of that voxel into the lesion from blue to red (low number: blue; high number: red).

Figure 3

Scatterplot of motor outcome variables for each group at each time point ? every dot (motor therapy) or triangle (sensorimotor therapy) at one time point represents the raw value of a patient; raw median scores indicated with horizontal bar. Vertical bars indicate significant differences in change scores between both groups for *p = 0.01, **p = 0.003; (A) ARAT: Action Research Arm Test, (B) FMA-UE: Fugl-Meyer assessment upper extremity part, (C) SULCS stroke upper limb capacity scale, (D) ABILHAND: ABILHAND questionnaire (logits).

Figure 4

Scatterplot of somatosensory outcome variables for each group at each time point - every dot (motor therapy) or triangle (sensorimotor therapy) at one time point represents the raw value of a patient; raw median scores indicated with horizontal bar. (A) Em-NSA: Erasmus modification of Nottingham Sensory Assessment, (B) PTT: perceptual threshold of touch (mA), (C) WPST: wrist position sense test mean error (degrees), (D) TDT_AUC: texture discrimination test area under curve score, (E) fTORT: functional tactile object recognition test.