Abstract
Background: Frequent and extensive disturbances to the somatosensory and motor hand functions after stroke are common. This study explores a new therapeutic approach that may improve the effectiveness of rehabilitation for these upper limb impairments. Objective: To assess the effect of rehabilitation combining standard therapy and somatosensory stimulation on sensorimotor hand functions. To compare the effect of this method with the standard method of rehabilitation. Methods: Two groups of patients were used to compare the effect of standard therapy (group A, n = 15, age = 59.8 ± 9.4 years), and the effect of therapy with targeted somatosensory stimulation (group B, n = 15, age = 65.5 ± 8.2). The groups consisted of patients after an ischemic stroke in post-acute phase, with hemiparesis, aged from 45 to 75 years, both men and women. The methods used to assess patients comprised a neurological clinical examination, two batteries of tests of somatosensory function (Rivermead Assessment of Somatosensory Performance, Fabric Matching Test), two batteries of tests of motor function (Nine Hole Peg Test, Test of Manipulation Functions), and activities of daily living assessment. Results: The results show that before therapy a deficit of somatosensory function occurred on the paretic upper limb in more than 50% of patients in both groups. Motor functions were impaired more frequently than somatosensory functions. Somatosensory stimulation therapy had an enhanced improvement of somatosensory functions, especially tactile discrimination of the object surface. Conclusions: Major improvement, particularly of tactile discrimination sensation, occurred in group B, where therapy focused on somatosensory deficit was applied. We did not show that such considerable improvement in discrimination sensation in group B was associated with any change in motor function. Clinical improvement in the motor function of the paretic limb occurred in both samples. However, more significant improvement was evident for the group with standard therapy.
Highlights
Disorders of the motor and somatosensory function of the upper limb are frequent clinical symptoms in strokes
Group B included 15 subjects (Table 1)
We compared the results of the neurological, somatosensory, motor and activities of daily living tests at the beginning and end of the rehabilitation (Table 2, 3)
Summary
Disorders of the motor and somatosensory function of the upper limb are frequent clinical symptoms in strokes. The significant role of sensation is especially apparent when checking tweezer or pinch grip, as well as the capacity to maintain and adjust the appropriate strength without eye control (Blennerhassett, Carey, & Matyas, 2008; Blennerhassett, Matyas, & Carey, 2007), discrimination of the surfaces of objects held in the hand, and adaptation to sensory conflict conditions such as rough surfaces (Carey et al, 2006) This can result in disuse syndrome of the limb and further deterioration in motor function (Smania, Montagnana, Faccioli, Fiaschi, & Aglioti, 2003; Yekutiel & Guttman, 1993). More significant improvement was evident for the group with standard therapy
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