Definition and effects of physical therapy treatment for sensorimotor dysfunction in the hemiplegic upper limb after stroke
Objectives: The purpose of this work was to define and explore effects of one module of physical therapy treatment, known as 'mobilisation and tactile stimulation' (MTS) to improve sensory and motor function in the hemiplegic upper limb after stroke. Methods: Equipment to measure grip responses was designed and constructed and its validity and reliability established. Upper limb function (Action Research Arm Test (ARAT), Nine-Hole Peg Test (NHPT), touch/pressure sensory thresholds, grip response latency) following stroke was estimated from a longitudinal study, at six weeks, three months and six months post-stroke. Scores were compared with those obtained from a cross-sectional study of healthy volunteers. Using a modified nominal group technique, seven expert participants (senior clinical physiotherapists) defined and described techniques and interventions involved in MTS. Effects of this treatment on sensory and motor function were
subsequently explored (ARAT, NHPT, Motricity Index, sensory thresholds, grip response latency) through a series of six replicated single case studies (A-BA design) following first
ever stroke resulting in upper limb dysfunction. Results: Significant differences in sensorimotor performance were found in both hemiplegic and non-hemiplegic limbs
compared to healthy limbs. A clinically validated treatment schedule was created that clearly defined and described MTS. All six subjects treated with MTS in the single case
series improved in ARAT and Motricity Index scores, and sensory thresholds improved in four out of six subjects during the intervention phase, with minimal or no further
improvements in performance on withdrawal of intervention. Conclusions: Both hemiplegic and non-hemiplegic upper limbs are affected by stroke. However, sensorimotor function in the hemiplegic limb can improve following a 6-week programme
of daily MTS therapy. Further work is required to identify the optimum dose of MTS therapy and mode of delivery, and effects on specific clinical problems.