Sensory retraining of the lower extremity post-stroke

Abstract

Sensory deficits are demonstrated in 50–85% of individuals post-stroke and lead to slower motor recovery and to poorer prognosis. Yet, sensory rehabilitation is often not set as a therapeutic target within the therapeutic setting. Sensory Retraining (SR) has been found effective for the upper extremity post-stroke. To study the effectiveness of Sensory Retraining (SR), an explicit perceptual learning approach focusing on sensation to the lower extremity post-stroke, and to compare it with Repeated Exposure (RE) to sensory stimuli, an implicit perceptual learning approach. An RCT was conducted comparing the two sensory rehabilitation approaches in subjects with chronic hemiparesis (> 6 months post-stroke) and lower extremity sensory loss. Sixty-four recruited volunteers (SR-34, RE-30) were assessed by a physical therapist blind to treatment allocation for sensory capabilities, activity performance and participation. Two pre-intervention assessments were conducted a week apart, followed by 10 treatment sessions of 45 minutes each, and two post-intervention assessments (immediately after treatment and following 3 months). ANOVA and post-hoc tests were used to determine treatment effects over time. Significance was set at P ≤ 0.05. The study demonstrated significant clinically meaningful differences for most sensory variables of the involved foot, and for all activity and participation variables. For example: A significant time effect ( P < 0.0001) for barefoot Timed Up and Go test demonstrated clinically significant decrease in time for both SR and RE groups (from 43.7 to 30.1 seconds and from 45.3 to 31.1 seconds respectively). A trend interaction effect ( P = 0.08) for tactile threshold was found, with post-hoc analysis demonstrating improvement only for the SR group. Sensory rehabilitation treatment by either SR or RE can make clinically significant changes in performance and participation in subjects with sensory loss post-stroke.