Effects of Somatosensory Training on Upper Limb for Postural Control and Locomotion in Hemiplegic Stroke with Unilateral Neglect

  • Song, Bo-Kyoung (Department of Occupational Therapy, College of Health Science, Kangwon National University)
  • Received : 2015.09.16
  • Accepted : 2015.10.19
  • Published : 2015.10.25

Abstract

Purpose: The purpose of this study was to examine the effect of postural control and locomotion on improvement of two point discrimination (TPD), stereognosis (ST) through somatosensory training (SST) on the upper limb (UL). Methods: The subjects were 20 hemiplegia patients who have problems with unilateral neglect after stroke. The patients were divided into two groups, the experimental group (EG) and the control group (CG). In the EG, SST for TPD, ST was performed 18 times, three times a week for six weeks, together with physical therapy (PT) and occupational therapy (OT). In the CG conventional PT and OT without SST was performed for six weeks. Several assessment tools were used in comparison of groups; two point discrimination test (TPDT) on forearm (F), thenar (T), hypothenar (TH), thumb tip (TH-T), index finger tip (IN-T), stereognosis test (ST), postural assessment scale for stroke (PASS), and clinical test of sensory interaction on balance (CTSIB) and timed up and go test (TUG). Results: In the CG, conventional PT and OT resulted in statistically improved TPDT (F), ST, PASS, and TUG. In the EG, SST resulted in statistically improved TPDT (F, T, HT, TH-T, IN-T), ST, PASS, and TUG. TPDT-T, ST, and CTSIB with length of displacement with eye open (LDEO) also showed significant improvement between the groups. Conclusion: In both groups TPDT ST, PASS and TUG, and SST had effects on the UL and TPDT, ST and static postural control had greater effects compared with the PG. Therefore, we could assume that TPD and ST are very important in performing human activities including postural control and locomotion.

Keywords

References

  1. Shumway-Cook A, Woollacott MA. Motor control translating research into clinical practice. 3rded. Baltimore, Lippincott William & Wilkins, 2007:299-309.
  2. Inman VT. Human Locomotion. Can Med Assoc J. 1966;94(14):1047-54.
  3. Kim JH.Relationship between gait symmetry and functional balance, walking performance in subjects with stroke. J Kor Phys Ther. 2014; 26(1):1-8. https://doi.org/10.1589/jpts.26.1
  4. Patla AE. Neurobiomechanical base for the control of human locomotion. In: Bronstein A, Brandt T, Woollacott M, eds. Balance posture and gait. Arnold. London, 1996:19-40.
  5. Karnath HO, Rennig J, Johannsen L et al. The anatomy underlying acute versus chronic spatial neglect: A longitudinal study. Brain. 2011;134(1):903-12. https://doi.org/10.1093/brain/awq355
  6. Karnath HO, Rorden C. The anatomy of spatial neglect. Neuropsychologia. 2012;50(1):1010-7. https://doi.org/10.1016/j.neuropsychologia.2011.06.027
  7. Kerkhoff G, Schenk T. Rehabilitation of neglect: An update. Neuropsychologia. 2012;50(1):1072-9. https://doi.org/10.1016/j.neuropsychologia.2012.01.024
  8. Ladavas E, Bonifazi S, Catena L et al. Neglect rehabilitation by prism adaptation: Different procedures have different impacts. Neuropsychologia. 2011;49(5):1136-45. https://doi.org/10.1016/j.neuropsychologia.2011.01.044
  9. Tsang MH, Sze KH, Fong KN. Occupational therapy treatment with right half-field eye-patching for patients with subacute stroke and unilateral neglect: A randomised controlled trial. Disabil Rehabil. 2009;31(1):630-7. https://doi.org/10.1080/09638280802240621
  10. Borchers S, Hauser TK, Himmelbach M. Bilateral hand representations in human primary proprioceptive areas. Neuropsychologia. 2011;49(1):3383-91. https://doi.org/10.1016/j.neuropsychologia.2011.08.013
  11. Morch CD, Andersen OK, Quevedo AS et al. Exteroceptive aspects of nociception: Insights from graphesthesia and two-point discrimination. Pain. 2010;342(3):187-90.
  12. Julkunen L, Tenovuo O, Jääskeläinen SK et al. Recovery of somatosensory deficits in acute stroke. Acta Neurol Scand. 2005;111(1):366-72. https://doi.org/10.1111/j.1600-0404.2005.00393.x
  13. Hwang BY. Effects of proprioceptive control program on the balance and walking in the persons with chronic stroke. Keimyung University. Dissertation of Doctorate Degree. 2002.
  14. Benaim C, Perennou DA, Villy J et al. Validation of a standardized assessment of postural control in stroke patients: The Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999;30(1):1862-8. https://doi.org/10.1161/01.STR.30.9.1862
  15. Podsiadlo D, Richardson S. The timed up & go: A test of basic functional mobility for trail elderly persons. J Am Geriatr Soc. 1991;39(1):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  16. Morris S. Morris ME, Iansek R. Reliability of measurements obtained with the times up and go test in people with parkinson disease. Phys Ther, 2001;83(2):810-8.
  17. Song BK. Effect of somatosensory stimulation on upper limb in sensory, hand function, postural control and ADLs within sensorimotor deficits after stroke. J Kor Phys Ther. 2012;24(5):291-9. https://doi.org/10.1589/jpts.24.291
  18. Jung MS, Park JW. The relationship between balance test and fear of falling in community dwelling elderly. J Kor Phys Ther. 2012;24(1):23-8. https://doi.org/10.1589/jpts.24.23
  19. Park SK, Kang YH. Effects of weight distribution and balance with foot orthotics in hemiplegic patients. J Kor Phys Ther. 2012;24(3):241-6. https://doi.org/10.1589/jpts.24.241
  20. Utz KS, Keller I, Artinger F et al. Multimodal and multispatial deficits of verticality perception in hemispatial neglect. Neuroscience. 2011;188(1):68-9. https://doi.org/10.1016/j.neuroscience.2011.04.068
  21. Ladavas E, Berti A, Ruozzi E et al. Neglect as a deficit determined by an imbalance between multiple spatial representations. Exp Brain Res. 1997;16(3):493-500.
  22. Petersen SE, Posner MI. The attention system of the human brain: 20 years after. Annu Rev Neurosci. 2012;35(1):73-89. https://doi.org/10.1146/annurev-neuro-062111-150525
  23. Ptak R, Schnider A. The attention network of the human brain: Relating structural damage associated with spatial neglect to functional imaging correlates of spatial attention. Neuropsychologia. 2011;49(11):3063-70. https://doi.org/10.1016/j.neuropsychologia.2011.07.008
  24. Kinsbourne M. Mechanisms of unilateral neglect. In: Jeannerod M, eds. Neurophysiological and neuropsychological aspects of spatial neglect. Amsterdam, North-Holland, 1987:69-86.
  25. Zoltan B, Siev E. Freishtat B. The adult stroke patient a manual for evaluation and treatment of perceptual and cognitive dysfunction reversed 2nd ed. Thorofare, Slack, 1991:51-70.
  26. Coslett HB. Evidence for a disturbance of the body schema in neglect. Brain Cogn. 1998;37(3):527-44. https://doi.org/10.1006/brcg.1998.1011
  27. Robert IH, North N. Active and passive activation of left limb: Influence on visual and sensory neglect. Neuropsychologia.1993;31(3):293-300. https://doi.org/10.1016/0028-3932(93)90093-F
  28. Eskes GA, butler B, Mcdonald A. Limb activation effects in hemispatial neglect. Arch Phys Med Rehabil. 2003;84(1):323-8. https://doi.org/10.1053/apmr.2003.50012
  29. Kim JH. Effect of Visual feedback training on standing-balance in stroke with neglect and sensory deficit. Daegu University. Dissertation of Doctorate Degree. 2007.
  30. Balslev D, Odoj B, Karnath, HO. Role of somatosensory cortex in visuospatial attention. J Neurosci. 2013;33(46):18311-8. https://doi.org/10.1523/JNEUROSCI.1112-13.2013
  31. Dickstein R, Shefi S, Marcovitz E et al. Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients. Arch Phys Med Rehabil. 2004;85(1):261-7. https://doi.org/10.1016/j.apmr.2003.05.011
  32. Peterka RJ. Sensorimotor integration in human postural control. J Neuphy. 2002;88(1):1097-18.
  33. Baldan AMS, Alouche SR, Araujo IMG et al. Effect of light touch on postural sway in individuals with balance problems: A systematic review. Gait & Posture 40(1), 2014;1-10. https://doi.org/10.1016/j.gaitpost.2013.12.028
  34. Kirker SGB, Simpson DS, Jenner JR et al. Stepping before standing: Hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry. 2000;68(1):458-64. https://doi.org/10.1136/jnnp.68.4.458
  35. Martinelli AR, Coelho DB, Magalhaes FH et al. Light touch modulates balance recovery following perturbation from fast response to stance restabilization. Exp Brain Res. 2015;233(5):1399-408. https://doi.org/10.1007/s00221-015-4214-z
  36. Chang J, Lee S, Lee M et al. The correlations between gait speed and muscle activation or foot pressure in stroke patients. J Kor Soc Phys Ther. 2009;21(3):47-52.
  37. Kim GH, Choe HS, Lee HI et al. The effects of scapular stabilization exercising on dynamic standing balance in stroke patients. J Kor Phys Ther. 2014;26(1):15-20. https://doi.org/10.1589/jpts.26.15