Original article
Effects of Mobilization and Tactile Stimulation on Chronic Upper-Limb Sensorimotor Dysfunction After Stroke

https://doi.org/10.1016/j.apmr.2012.11.028Get rights and content

Abstract

Objective

To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in chronic stroke (>12mo) when upper limb (UL) “performance” has reached a clear plateau.

Design

Replicated single-system experimental study with 8 single cases using A-B-A design (baseline-intervention-withdrawal phases); length of baseline randomly determined; intervention phase involved 6 weeks of daily MTS to the contralesional UL.

Setting

Community setting, within participants' place of residence.

Participants

Individual stroke survivors (N=8; male-to-female ratio, 3:1; age range, 49–76y; 4 with left hemiplegia, 4 with right hemiplegia) discharged from ongoing therapy, more than 1 year post stroke (range, 14–48mo). Clinical presentations were varied across the sample.

Interventions

Participants received up to 1 hour of daily (Monday to Friday) treatment with MTS to the UL for 6 weeks during the intervention (B) phase.

Main Outcome Measures

Motor function (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index [MI] arm section) of the UL.

Results

UL performance was stable during baseline for all participants. On visual analysis, improvements in motor impairment were seen in all participants, and clinically significant improvements in motor function were seen in 4 of 8 participants during the intervention phase. Latency between onset of intervention and improvement ranged from 5 to 31 days (ARAT) and from 0 to 28 days (MI). Improvements in performance were maintained on withdrawal of the intervention. Randomization tests were not significant.

Conclusions

MTS appears to improve UL motor impairment and functional activity many months, even years, after stroke onset. Improvement can be immediate, but more often there is latency between the start of intervention and improvement; recovery can be distal to proximal.

Section snippets

Methods

We used an exploratory, replicated, single-system, A-B-A randomized, multiple baseline design (also known as randomized n-of-1 design16) to identify individual responses to MTS over time in stroke survivors living with a dysfunctional contralesional UL. Single-system experimental design has been described as an accepted and appropriate means of evaluating clinical change.17, 18, 19 Direct replication of a single-system experiment that follows a predictable pattern and produces the same result

Results

All 8 participants completed all phases of the study series with no adverse effects. This was considered to be a positive result. Table 3 summarizes individual participant profiles on entry to the study. Absence of computed tomography scan results accounts for the missing data in table 3.

Table 4 shows the mean amount of treatment received by each participant during the intervention (B) phase.

Discussion

We recruited participants to this study on the basis of their having persistent UL dysfunction at least 12 months after the onset of their stroke. ARAT scores for all participants remained stable throughout baseline, confirming that recovery in the UL at this stage post stroke appeared to have stabilized, with no further spontaneous recovery. Therefore, since further spontaneous improvement in performance was highly unlikely for this stage post stroke, we could be more confident that any

Conclusions

This exploratory study has generated hypotheses for further study and identified several important clinical messages:

  • •

    A 6-week daily program of therapist-led mobilization of joints and soft tissues coupled with tactile stimulation of the hand and forearm (MTS)—a module of conventional therapy—appears to improve motor impairment and motor activity.

  • •

    Clinically significant recovery of persistent UL dysfunction is possible even 12 months or more post stroke.

  • •

    Distal UL recovery can occur with targeted

Supplier

  • a.

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Acknowledgment

We thank West Midlands Stroke Research Network for assistance in recruitment.

References (43)

  • V. Sirtori et al.

    Constraint-induced movement therapy for upper extremities in stroke patients

    Cochrane Database Syst Rev

    (2009)
  • J. Winter et al.

    Hands-on therapy interventions for upper limb motor dysfunction following stroke

    Cochrane Database Syst Rev

    (2011)
  • Medical Research Council (MRC)

    A framework for development and evaluation of RCTs for complex interventions to improve health

    (2000)
  • S.M. Hunter et al.

    Dose-response study of mobilisation and tactile stimulation for the upper extremity early after stroke: a phase I trial

    Neurorehabil Neural Repair

    (2011)
  • A.M. Wing et al.

    Hand and brain. The neurophysiology and psychology of hand movements

    (1996)
  • Medical Research Council (MRC)

    Developing and evaluating complex interventions: new guidance

    (2000)
  • A.E. Kazdin

    Single-case research designs: methods for clinical and applied settings

    (1982)
  • D. Barlow et al.

    Single case experimental designs: strategies for studying behavior change

    (1984)
  • K.J. Ottenbacher

    Evaluating clinical change: strategies for occupational and physical therapists

    (1986)
  • C. Robson

    Real world research: a resource for social scientists and practitioner-researchers

    (2002)
  • F.I. Mahoney et al.

    Functional evaluation: the Barthel Index

    Md State Med J

    (1965)

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