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.
Highlights
Somatosensory information is processed when interacting with the environment by touching and manipulating objects
Somatosensory upper limb (UL) impairment is common after stroke and negatively impacts upon activities of daily living
Allocation was conducted by the principal investigator of the trial, who had no contact with the eligible patients and who was not involved in assessment or therapy provision
Summary
Somatosensory information is processed when interacting with the environment by touching and manipulating objects. Somatosensory function can be divided in three modalities. Somatosensory upper limb (UL) impairment is common after stroke and negatively impacts upon activities of daily living. Exteroception is impaired in 7–53% of patients, 34–64% encounter proprioceptive deficits and 31–89% have impaired higher cortical function [3]. The majority of patients encounter an impairment in more than one modality. A longitudinal study of our research group indicated that in the first week and at 6 months post stroke, respectively, 66 and 28% of the patients with an UL impairment encounter somatosensory impairments in more than one modality, and 50 and 13% in all three modalities [4]. 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?
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