Somatosensory Rehabilitation Research Articles

Effects of Vestibular vs. Somatosensory Rehabilitation on Balance and Quality of Life of Sub-acute Stroke Patients with Vestibular Syndrome

Background: Stroke is one of the most common causes of disability worldwide, affecting millions of people per year, and it has a large burden on health care systems. In the early subacute phase, patients who survive a stroke usually show impairments in balance, often due to sensory and vestibular deficits; this influences their quality of life. Methods: A double-blind, randomized controlled trial was conducted to assess the effectiveness of vestibular and somatosensory interventions on balance and quality of life in early subacute stroke patients with vestibular syndrome. Fifty-two patients were randomly divided into a vestibular or somatosensory rehabilitation group or a control group receiving usual care. The trial was completed by 49 patients who were evaluated onon the Berg Balance Scale and the Vestibular Quality of Life Questionnaire at baseline and 12 weeks post-intervention. Results: The study found that both vestibular and somatosensory rehabilitation interventions led to significant improvements in balance, as indicated by the Berg Balance Scale scores, and quality of life, based on vestibular Quality of Life Questionnaire scores, compared to the control group (p<0.05). There was no significant difference between the two intervention groups in terms of their impact on either balance or quality of life outcomes. Conclusion: Vestibular and somatosensory rehabilitation interventions represent effective strategies for improving balance and quality of life in early subacute stroke patients with vestibular syndrome. These findings underline the importance of including targeted rehabilitation approaches within stroke care protocols to achieve optimal functional outcomes and long-term recovery. Keywords: Balance, Stroke, Quality of Life, Vestibular Symptoms.

The effect of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance after stroke: a randomized controlled trial

ABSTRACT Background The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. Objective The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. Design and setting A randomized controlled trial was conducted at a university hospital. Methods The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. Results The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. Conclusions Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance.

Electrical nerve stimulation for sensory-neural pathway reconstruction in upper-limb amputees.

The loss of the neural sensory function pathways between the stump limbs and the brain greatly impacts the rehabilitation of limb function and the daily lives of amputees. Non-invasive physical stressors, such as mechanical pressure and transcutaneous electrical nerve stimulation (TENS), could be potential solutions for recovering somatic sensations in amputees. Previous studies have shown that stimulating the residual or regenerated nerves in the stumps of some amputees can produce phantom hand sensations. However, the results are inconclusive due to unstable physiological responses caused by inaccurate stimulus parameters and positions. In this study, we developed an optimal TENS strategy by mapping the distribution of the nerves in the stump skin that elicitsphantom sensations known as a "phantom hand map." We evaluated the effectiveness and stability of the confirmed stimulus configuration in a long-term experiment using single- and multi-stimulus paradigms. Additionally, we evaluated the evoked sensations by recording electroencephalograms (EEG) and analyzing brain activities. The results demonstrated that various types of intuitive sensations for amputees could be stably induced by adjusting TENS frequencies, particularly at 5 and 50 Hz. At these frequencies, 100% stability of sensory types was achieved when the stimuli were applied to two specific locations on the stump skin. Furthermore, at these locations, the stability of sensory positions was 100% across different days. Moreover, the evoked sensations were objectively supported by specific patterns of event-related potentials in brain responses. This study provides an effective method for developing and evaluating physical stressor stimulus strategies, which could play an important role in the somatosensory rehabilitation of amputees and other patients suffering from somatomotor sensory dysfunction. The paradigm developed in this study can provide effective guidelines for stimulus parameters in physical and electrical nerve stimulation treatments for a variety of symptoms related to neurological disorders.

Chronic Pain Due to Pelvis Fracture and Perceptive Rehabilitation

Recently, somatosensory rehabilitation is knowing a growing interest in chronic pain condition. In fact, new evidences have associated an impaired lumbopelvic control with a decreased tactile acuity, generating and sustaining chronic low back pain mechanisms. Consequently, an adequate tactile rehabilitation, entailing a discrimination training with a stimulation tasks, seems to be effective on pain, reducing lumbopelvic impairments.
 Also the use of perceptual surfaces can be effective on back pain, favouring a tactile and proprioceptive sensory stimulation on the trunk and improving the postural control through a body midline realignment.
 The aim of this manuscript was to describe the preliminary evidences on two cases of chronic pain due to pelvis fracture treated with the perceptive surfaces. Furthermore, we have tried to clarify the mechanisms involved in chronic back pain and the effect of a somatosensory rehabilitation. Finally, it was analyzed the role of craniocaudal body midline with the gravitational vertical axis in the setting of correct alignment for improving postural control in these conditions.

Development of the Interactive Rehabilitation Game System for Children with Autism Based on Game Psychology

Autism is a widespread neurodevelopmental disorder. The cause of autism is still unclear. Once it occurs, it will be accompanied for life. Intervention treatment is currently recognized as an effective method. With the rise of somatosensory technology, Kinect has gradually been applied to the field of autism rehabilitation with its natural human-computer interaction and game rehabilitation psychology. Because there is a great demand for autism rehabilitation training resources in China and the existing somatosensory rehabilitation equipment has some shortcomings, this study designed a set of somatosensory rehabilitation system for autistic children based on Kinect and carried out its rehabilitation effect with experimental demonstration. The specific research work mainly includes the following contents: first, aiming at the rehabilitation needs of children with autism, this article combines mainstream intervention treatment methods, using C# programming language and Windows Presentation Foundation (WPF) development technology to develop Kinect-based somatosensory game modules. The somatosensory rehabilitation game involves the training of the language communication, behavioral movement, daily life, sensory integration, and other comprehensive abilities of children with autism, which improves the shortcomings of the previous rehabilitation training in the scope of intervention. A variety of game types and diversified game modes are designed to meet the individual needs of rehabilitation training for children with autism. Second, experiments were carried out to verify the rehabilitation effect of the system. Using the Childhood Autism Rating Scale (CARS) and Pediatric Evaluation of Disability Inventory (PEDI) scale as the rehabilitation effect evaluation tools of this system, the experimental subjects were divided into the experimental group and control group, and different comparative experiments were conducted, respectively. Through the analysis of the scoring data of the CARS, it is found that the comprehensive ability of the experimental group of children receiving somatosensory rehabilitation training is significantly improved. Through the analysis of the scoring data of the PEDI scale, it is found that the children’s language communication, behavioral activities, and daily life abilities of the experimental group have been significantly enhanced. This article focuses on the design of the somatosensory game module of the autistic somatosensory rehabilitation system and the analysis of the system’s rehabilitation effect. It satisfies the training and rehabilitation needs of children with autism and has strong practical significance.

What is “usual care” in the rehabilitation of upper limb sensory loss after stroke? Results from a national audit and knowledge translation study

Purpose To characterise the assessments and treatments that comprise “usual care” for stroke patients with somatosensory loss, and whether usual care has changed over time. Materials and methods Comparison of cross-sectional, observational data from (1) Stroke Foundation National Audit of Acute (2007–2019) and Rehabilitation (2010–2018) Stroke Services and (2) the SENSe Implement multi-site knowledge translation study with occupational therapists and physiotherapists (n = 115). Descriptive statistics, random effects logistic regression, and content analysis were used. Results Acute hospitals (n = 172) contributed 24 996 cases across audits from 2007 to 2019 (median patient age 76 years, 54% male). Rehabilitation services (n = 134) contributed organisational survey data from 2010 to 2014, with 7165 cases (median 76 years, 55% male) across 2016–2018 clinical audits (n = 127 services). Somatoensory assessment protocol use increased from 53% (2007) to 86% (2019) (odds ratio 11.4, 95% CI 5.0–25.6). Reported use of sensory-specific retraining remained stable over time (90–93%). Therapist practice reports for n = 86 patients with somatosensory loss revealed 16% did not receive somatosensory rehabilitation. The most common treatment approaches were sensory rehabilitation using everyday activities (69%), sensory re-education (68%), and compensatory strategies (64%). Conclusion Sensory assessment protocol use has increased over time while sensory-specific training has remained stable. Sensory rehabilitation in the context of everyday activities is a common treatment approach. Clinical trial registration number: ACTRN12615000933550 IMPLICATIONS FOR REHABILITATION Only a small proportion of upper limb assessments conducted with stroke patients focus specifically on sensation; increased use of standardised upper limb assessments for sensory loss is needed. Stroke patients assessed as having upper limb sensory loss frequently do not receive treatment for their deficits. Therapists typically use everyday activities to treat upper limb sensory loss and may require upskilling in sensory-specific retraining to benefit patients.

Factors influencing allied health professionals’ implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation

ObjectivesSomatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between...

Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study

Background Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct to peripherally administered rehabilitation therapies. Objective To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity. Methods Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions. Results Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected (F(2, 76.163) = 3.5, P = .035) and unaffected arm (F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 (F(2, 133.027) = 3.518, P = .032) and N45-P60 (F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 (F(2, 69.64) = 3.37, P = .04), N60 (F(2, 47.343) = 4.375, P = .018), and P100 (F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later. Conclusions Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.

Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial.

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

Improvements in Cognition, Graded Symptom Checklist Score, Balance and Memory Following Neurological Rehabilitation for a 58-year-old Male Patient with Post-Concussion Syndrome: Case Report

To suggest the efficacy of multi-modal, intensive, neurologic rehabilitation approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome. A 58-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a previously diagnosed concussion. His symptoms followed rapidly after injury and included headaches, neck pain, and difficulty with sleeping. Upon intake, he reported on the graded symptom checklist (GSC) a symptom severity score of 59. A Comprehensive Assessment of Postural Systems (CAPS ®) was performed assessing balance and stability on both a solid and foamed surface with eyes opened, eyes closed, and multiple head positions. An average stability score upon intake was calculated as 53.9% overall. Neurocognitive testing utilizing C3 Logix Neurocognitive Assessment Suite, Trails A time was 28.6 and standardized assessment of cognition (SAC) score was a 28/30 with specific difficulty in delayed memory. A 5-day, intensive, multi-modal program of neurologic exercises was administered in 10 one-hour treatment sessions. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair. Upon exit, symptom severity score decreased to 35 (-40.6%); Trails A time decreased to 19.7 (-31.1%); balance improved from an average stability score of 75.5%-79.6% (+5.4%); and standardized assessment of cognition (SAC) score increased to an overall score of 30/10 (+7.1%) with an improvement in delayed memory. The authors suggest further investigation into multi-modal, intensive approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome.

Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review

Study DesignThis is a systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. IntroductionDiverse approaches based on tactile stimulation are used in hand rehabilitation settings to treat touch-evoked dysesthesias. However, there is a lack of literature synthesis on the description and the effectiveness of the various approaches based on tactile stimulation that can be used for treating hand dysesthesia after nerve injury. Purpose of the StudyThe purpose of the study was to summarize the current evidence on tactile stimulation programs for managing touch-evoked hand dysesthesia due to nerve injury. MethodsThe search was carried out on Medline, Embase, CINAHL, and the Cochrane Library databases. The selected studies had to present patients with touch-evoked dysesthesia after nerve injury who were treated with tactile stimulation approaches to reduce pain. The methodological quality of the included studies was assessed using the methodological index for nonrandomized studies scale, as well as the risk of bias. ResultsEleven studies met the inclusion criteria. These studies present tactile stimulation interventions that are heterogeneous relative to the target populations and the intervention itself (desensitization versus somatosensory rehabilitation method). Painful symptoms appear to diminish in patients with touch-evoked hand dysesthesia, regardless of the tactile stimulation program used. However, the included studies present significant risks of bias that limit the confidence in these results. DiscussionThe evidence does not unequivocally support the beneficial effects of tactile stimulation to treat touch-evoked hand dysesthesia. ConclusionFuture studies with more rigorous methodological designs, such as randomized controlled trials, are required to verify the potential benefits of these approaches.

Evaluating a sensitive issue: reliability of a clinical evaluation for allodynia severity

Purpose/Aim: Allodynia is a common feature of neuropathic pain with few validated clinical evaluation options. We identified a need to estimate the measurement properties of the standardised evaluation procedure for static mechanical allodynia severity popularised by the somatosensory rehabilitation of pain method, known as the rainbow pain scale. This study (www.clinicaltrials.gov. NCT02070367) undertook preliminary investigation of the inter-rater and test-retest reliability of the rainbow pain scale.Methods: Persons with pain in one upper extremity after Complex Regional Pain Syndrome, a peripheral nerve injury or a recent hand fracture were recruited for assessment of static mechanical allodynia threshold using calibrated monofilaments by two raters at baseline, and repeated assessment one week later.Results: Single measures estimates suggested inter-rater reliability was substantial for the rainbow pain scale [intra-class correlation coefficient = 0.78 (n = 31), p < 0.001]. Test-retest reliability was also excellent at with an intraclass correlation coefficient of 0.87 [n = 28, p < 0.001]. However, confidence intervals suggest the true values could be more moderate, with lower bounds of the 95% confidence interval at 0.60 and 0.74, respectively.Conclusions: This pilot study has generated preliminary support for the inter-rater and test-retest reliability of the rainbow pain scale. Future studies should seek to increase confidence in estimates of reliability, and estimate validity and responsiveness to change in persons with somatosensory disorders.

Topographic Somatosensory Imagery for Real-Time fMRI Brain-Computer Interfacing.

Real-time functional magnetic resonance imaging (fMRI) is a promising non-invasive method for brain-computer interfaces (BCIs). BCIs translate brain activity into signals that allow communication with the outside world. Visual and motor imagery are often used as information-encoding strategies, but can be challenging if not grounded in recent experience in these modalities, e.g., in patients with locked-in-syndrome (LIS). In contrast, somatosensory imagery might constitute a more suitable information-encoding strategy as the somatosensory function is often very robust. Somatosensory imagery has been shown to activate the somatotopic cortex, but it has been unclear so far whether it can be reliably detected on a single-trial level and successfully classified according to specific somatosensory imagery content. Using ultra-high field 7-T fMRI, we show reliable and high-accuracy single-trial decoding of left-foot (LF) vs. right-hand (RH) somatosensory imagery. Correspondingly, higher decoding accuracies were associated with greater spatial separation of hand and foot decoding-weight patterns in the primary somatosensory cortex (S1). Exploiting these novel neuroscientific insights, we developed—and provide a proof of concept for—basic BCI communication by showing that binary (yes/no) answers encoded by somatosensory imagery can be decoded with high accuracy in simulated real-time (in 7 subjects) as well as in real-time (1 subject). This study demonstrates that body part-specific somatosensory imagery differentially activates somatosensory cortex in a topographically specific manner; evidence which was surprisingly still lacking in the literature. It also offers proof of concept for a novel somatosensory imagery-based fMRI-BCI control strategy, with particularly high potential for visually and motor-impaired patients. The strategy could also be transferred to lower MRI field strengths and to mobile functional near-infrared spectroscopy. Finally, given that communication BCIs provide the BCI user with a form of feedback based on their brain signals and can thus be considered as a specific form of neurofeedback, and that repeated use of a BCI has been shown to enhance underlying representations, we expect that the current BCI could also offer an interesting new approach for somatosensory rehabilitation training in the context of stroke and phantom limb pain.

Assessment of somatosensory rehabilitation for neuropathic and chronic pains after knee injury or surgery

One of the complications after trauma or knee surgery is neuropathic pain associated with epicritic sensitive disorders, such as hypoesthesia, hyperesthesia or mechanical allodynia (MA). Different sensory rehabilitation techniques are proposed to relieve pain. After a first somatosensory and pain evaluation, we used vibro-tactile in situ or remote stimulation, respectively for hypoesthesia and allodynia, and desensitization for hyperesthesia or low MA. These techniques are essentially based on auto-exercises. The main objective is to evaluate the effect of this somatosensory rehabilitation protocol on neuropathic pain. In a retrospective study, we included patients admitted for neuropathic pain and sensitive disorders after surgery or knee injury treated by this somatosensory rehabilitation protocol between 2012 and 2016. For 47 patients, we evaluated, before and after rehabilitation pain and sensitive disorders. Pain was assessed with maximal numerical scale at rest (NSmax) and McGill questionnaire (MGQ). First, the sensitive disorder was qualified and mapped. Second, hypoesthesia was quantified through the pressure and vibration perception (respectively PPT, VPT), and allodynia through a rainbow color (RC) code using the monofilaments of Semmes-Weinstein. Thirty-three patients had hypoesthesia treated with tactile and or vibratory stimulation of the site. Twenty patients had MA: 14 of them treated with remote vibro-tactile rehabilitation, and 8 with desensitization in case of low MA, or both methods successively. Five patients had hyperesthesia, treated with desensitization. After rehabilitation, the MCQ decreased significantly of 29.9% ( P < 0.0001) and NSmax of 40.7% ( P = 0.002). We observed a significant improvement of the PPT (diminution of 69.3%, P < 0.0001) and RC (improvement of 84.7%, P = 0.03) between first and last evaluations. Fifteen patients did not achieve the protocol. In 32 patients who finished the protocol, the median duration of rehabilitation was 4 months (sd = 2.72). This protocol allows an improvement of sensitive disorders associated with pain decrease. Despite the duration of protocol (several successive methods, necessity of intermediate evaluations), adherence to this method, based on self-exercises, is good. Efficiency could be improved by identifying patients who are likely to cooperate with the method.

Somatosensory rehabilitation for allodynia in complex regional pain syndrome of the upper limb: A retrospective cohort study

Study DesignRetrospective cohort study. IntroductionSomatosensory rehabilitation is a standardized method of evaluation and conservative treatment of painful disorders of vibrotactile sensation, including the mechanical allodynia and burning pain of complex regional pain syndrome (CRPS). Purpose of the StudyThe purpose of this study was to examine the effectiveness of somatosensory rehabilitation for reducing allodynia in persons with CRPS of 1 upper limb in a retrospective consecutive cohort of patients. MethodsAn independent chart review of all client records (May 2004-August 2015) in the Somatosensory Rehabilitation Centre (Fribourg, Switzerland) identified 48 persons meeting the Budapest criteria for CRPS of 1 limb who had undergone assessment and treatment. Outcomes of interest were the French version of the McGill Pain Questionnaire (Questionnaire de la Douleur St-Antoine [QDSA]), total area of allodynia as recorded by mapping the area of skin where a 15-g monofilament was perceived as painful, and the allodynia threshold (minimum pressure required to elicit pain within the allodynic territory). ResultsThis cohort was primarily women (70%), with a mean age of 45 years (range: 18-74). Mean duration of burning pain was 31 months (range: 1 week-27.5 years), and baseline QDSA core was 48. The average primary area of allodynia was 66 cm2 (range: 2.6-320), and the most common allodynia threshold was 4.0 g. The average duration of treatment was 81 days. At cessation of treatment, the average QDSA score was 20 (effect size Cohen's d = 1.64). Allodynia completely resolved in 27 persons (56% of the total sample where only 58% completed treatment). DiscussionThis uncontrolled retrospective study suggests that somatosensory rehabilitation may be an effective treatment with a large effect size for reducing the allodynia and painful sensations associated with CRPS of the upper limb. More work is in progress to provide estimates of reliability and validity for the measurement tools for allodynia employed by this method. Level of Evidence2c.

Somatosensory Rehabilitation for Neuropathic Pain in Burn Survivors: A Case Series.

Neuropathic pain is an enormous rehabilitation challenge that has a substantial negative effect on patient function and quality of life. Somatosensory rehabilitation is a novel, nonpharmacological intervention described by Spicher based on the neuroplasticity of the somatosensory system. The rationale for somatosensory rehabilitation is that treating hypoesthesia will decrease neuropathic pain. Particularly for those with established neuropathic pain, the hypoesthesia may be masked by mechanical allodynia, which must be treated before treating the underlying hyposensitive zone. This case series describes the outcome of 17 burn survivors treated with somatosensory rehabilitation for their neuropathic pain. Before initiating treatment a modified version of the McGill Pain Questionnaire-short form (Questionnaire de la douleur St. Antoine, QDSA) was completed with the patients. The total score (×/64) was converted to percentage. The mechanical allodynia was assessed with the Rainbow Pain Scale that uses touch with the 15-g Semmes Weinstein Monofilaments (SWMs) and that was rated as painful on the visual analog scale (3/10 or resting pain + 1/10), as the criteria for mechanical allodynia. The severity level was assessed using seven predetermined SWMs to identify the smallest that elicited pain. The treatment consisted of avoiding all touch in the allodynic zone while concurrently providing proximal sensory and vibratory counter stimulation. Once the mechanical allodynia was eliminated, the underlying hypoesthesia was treated. Hypoesthesia was evaluated with the SWMs, and the percent improvement from baseline was calculated. The sensory reeducation treatment for hypoesthesia consisted of touch discrimination, texture perception, and vibratory stimulation. Seventeen patients (71/29% male/female, 21 ± 25% TBSA burned, 486 ± 596 days postburn) were evaluated and treated. Of these 15 initially presented with mechanical allodynia. The SWM scores had improved by 27 ± 21% (n = 14) and 29 ± 26% (n = 12) at 2 and 3 months posttreatment, respectively. The QDSA scores had improved by 9 ± 14% (n = 8) and 23 ± 23% (n = 6) at 2 and 3 months posttreatment, respectively. There were two patients who initially presented with hypoesthesia and six who had their zone of hypoesthesia treated after the mechanical allodynia had resolved. For these eight patients, their ability to perceive light touch improved by 27 ± 17% (n = 8) and 35 ± 25% (n = 6) at 2 and 3 months postsensory reeducation treatment initiation, respectively. The QDSA improved by 9 and 50% for the two patients who initially presented with hypoesthesia. In this case series, the majority of patients (13/17 or 76%) showed substantial improvements after somatosensory rehabilitation suggesting this is a treatment approach that should be considered with burn survivors experiencing neuropathic pain. There is a need, however, for future controlled studies to further investigate this approach and to determine if there is a subpopulation of burn survivors that are more likely than others to benefit from this approach.

Therapeutic modalities influencing neuropathic pain in hand surgery patients

The treatment of neuropathic pain challenges not only doctors but also hand therapists, since a majority of patients don't experience a significant pain relief despite systemic pain treatment. Early diagnosis of neuropathic pain and a therapeutic concept is crucial to meet the individual needs of the patient. The complexity of a pain syndrome calls for a multidisciplinary approach using patient education, pharmacological and non-pharmacological therapies, such as graded motor imagery or somatosensory rehabilitation, behavioral therapy and physical measures. The evidence of the above mentioned therapies with regards to neuropathic pain is not yet completely established. Possible reasons are the lack of complete understanding of the pain causing mechanisms and the fact of treating the symptoms rather than the cause.

Stroke survivors’ experiences of somatosensory impairment after stroke: An Interpretative Phenomenological Analysis

BackgroundSomatosensory ability is commonly impaired after stroke. Despite the growing recognition for the need to understand service users’ experiences and perspectives in health services provision, the experiences of stroke survivors’ living with somatosensory impairment have yet to be reported. ObjectiveTo gain an insight into how stroke survivors experience somatosensory impairment after stroke. DesignA qualitative study design was used with data analysed using Interpretative Phenomenological Analysis. MethodsSemi-structured in-depth interviews were carried out with purposively selected community dwelling stroke survivors who had somatosensory impairment. ResultsFive stroke survivors were interviewed in this study. Data analysis resulted in the emergence of three superordinate themes (i) making sense of somatosensory impairment, (ii) interplay of somatosensory impairment and motor control for executing tasks and (iii) perseverance versus learned non-use. The stroke survivors in this study were aware that their somatosensory ability was affected as a result of their stroke, but had difficulty in articulating their experiences of sensation and the impact of the impairment on functional ability. Most often somatosensory impairment was described in terms of difficulties with executing specific tasks, particularly by the upper limb. ConclusionIt is important to be aware that somatosensory impairment is of concern to stroke survivors. Further research is needed to develop evidence-based and practice-appropriate clinical assessment tools and treatment strategies for somatosensory rehabilitation after stroke.

Somatosensory rehabilitation: Treatment of a complex regional pain syndrome type II

Somatosensory rehabilitation: Treatment of a complex regional pain syndrome type II

Neuroscientific Review on Sensory Stimulation Therapy and Virtual Reality for Somatosensory Rehabilitation

This study details the neuroscientific concept of somatosensation, general sensory stimulation therapy and virtual reality therapy. Somatosensation is a method that the human body uses to accept information from the inner and outer parts of the body. A traditional sensory stimulation therapy was designed to maximize neural recovery, but the neural recovery is most effective when the therapeutic environment is similar to real life. The virtual reality provides natural environment that users may perceive as meaningful and even participants with significant impairment can perform some of the activities of their daily lives within the virtual environment. The virtual reality will become a complementary part of somatosensory rehabilitation.