- Title
- Combined somatosensory and motor training to improve upper limb recovery after stroke
- Creator
- Gopaul, Urvashy
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Stroke is a leading cause of disability worldwide. Upper limb motor and somatosensory impairments are common following stroke, making performance of everyday tasks difficult. Interventions directed at motor deficits have traditionally been separated from interventions directed at somatosensory deficits. By treating motor and somatosensory impairments separately, the potential beneficial effects of combining somatosensory training to further enhance sensorimotor function and action are not utilised. Hence, there is a critical need for the development of new and more effective treatments addressing both somatosensory and motor function to improve long-term disability after stroke. Also, there is a lack of objective outcome measures with good responsiveness to evaluate sustained grasp performance in people with stroke indicating a need for new outcome measures to quantify grasp deficits after stroke. Overall aim: This thesis aimed to investigate whether combined somatosensory and motor training improves upper limb recovery after stroke. Objectives: This thesis studied the effects of combining somatosensory and motor training to improve upper limb recovery after stroke. This thesis also investigated the reliability of measures of maximal tactile pressures and forces during grasping using the TactArray device in healthy people and people with stroke. There are four distinct but complementary studies included in this thesis to address these research objectives. Methods: Study 1: A systematic scoping review was conducted to identify combined somatosensory and motor training interventions for the upper limb and their training components, and to review the efficacy of the combined interventions. Study 2: This report describes the rationale and development of a new upper limb stroke rehabilitation intervention known as COMPoSE: “COMbined Physical and somatoSEnsory training” and, designed to improve somatosensory and motor deficits in the upper limb after stroke. A standardised training matrix was developed to facilitate intervention delivery. Study 3: A trial was conducted to assess the feasibility of the COMPoSE trial using a single-case experimental study design. The outcomes from this feasibility trial included: 1) feasibility of the recruitment of participants; 2) review of intervention protocol and feasibility of study design; 3) acceptability of the intervention and trial; 4) appropriateness of data collection procedures; and the 5) evaluation of resources required. The preliminary impact of the COMPoSE intervention on somatosensory and motor deficits and upper limb function after stroke were also assessed. Study 4: A test-retest reliability study was conducted to evaluate the reliability of measures of maximal tactile pressures and forces during sustained grasping using the TactArray device in healthy participants and participants with stroke. Results: Study 1: Ten studies (n= 219) were included and the interventions consisted of combinations of tactile stimulation/discrimination, proprioceptive stimulation/discrimination, haptic object discrimination/recognition, movement training, and functional training. Only one group study (n=45), a non-randomized controlled study with multiple active components and the largest dose of treatment (72 hours), found significant improvements in fine motor and somatosensory measures. Study 2: The essential features of COMPoSE include: combined somatosensory-motor training variables (grasp pressure, distance, object size, crushability, surface texture and friction), feedback using a haptic device providing measures of grasp pressure, and high dose repetitive task practice with and without vision. It was planned for ten treatment sessions to be delivered over three weeks, using a standardised matrix for treatment delivery. Study 3: Findings from this feasibility trial (n=5) indicated that training with the combination of somatosensory and motor variables synchronously, i.e., within the same task, was feasible. The delivery of the COMPoSE intervention using the standardised training matrix was feasible, however modifications to allow more specific tailoring to participant deficits is recommended. This trial identified components of the COMPoSE intervention such as the combinations of somatosensory-motor variables, amount of practice, and the duration of treatment, that would need to be modified in order to maximise improvement of upper limb function after stroke. Additionally, operational aspects of the trial methods, such as the number of outcome measures and timing of outcome measures were identified that would need to be addressed prior to subsequent trials. Study 4: The TactArray device demonstrates satisfactory reliability for measures of maximal tactile pressures during complete grasp duration of 8s (from finger contact to grasp release) for within-day and between-day testing sessions using an average of three trials with and without vision, in healthy people and those with stroke. Measures of maximal tactile forces are less reliable than maximal tactile pressures. Conclusion: Findings from this thesis makes an important contribution to advancing our understanding of various factors that influence the effects of combined somatosensory and motor training interventions. So far, there is little consistency across “combined somatosensory and motor training” interventions to improve upper limb function after stroke. The individual studies in the systematic scoping review and the COMPoSE trial provide preliminary evidence that combined somatosensory and motor training interventions have the potential to improve upper limb recovery after stroke, if they incorporate the appropriate active ingredients and dosage. Findings from this thesis identified research questions still to be answered with regards to active ingredients, recruitment capability, responsiveness of outcome measures for people with severe deficits after stroke, individualised somatosensory-motor training, dosage and intensity of intervention. Furthermore, results from this thesis indicated that it could be beneficial to deliberately train for somatosensory and motor training synchronously to improve upper limb recovery after stroke. Additionally, a novel means of measuring maximal grasp pressures during a sustained grasp using the TactArray device has been evaluated, which can be further explored in larger trials. Recommendations have been provided on optimisation of the intervention contents and study design of the COMPoSE intervention and trial in the future.
- Subject
- stroke; upper limb; motor; somatosensory; rehabilitation; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1407593
- Identifier
- uon:35746
- Rights
- Copyright 2019 Urvashy Gopaul
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT01 | Thesis | 12 MB | Adobe Acrobat PDF | View Details Download | ||
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