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Frontiers in Neuroscience 2019Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life....
Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life. Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity, indicating a potential mechanism which may mediate recovery. However, rehabilitation specifically focusing on somatosensory function receives little attention. To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke. Electronic databases and trial registries were searched from inception until November 2018, in addition to hand searching systematic reviews. Study selection included randomized controlled trials for adults of any stroke type with an upper and/or lower limb sensorimotor impairment. Participants all received a sensory-based intervention designed to improve activity levels or impairment, which could be compared with usual care, sham, or another intervention. The primary outcomes were change in activity levels related to sensorimotor function. Secondary outcomes were measures of impairment, participation or quality of life. A total of 38 study trials were included ( = 1,093 participants); 29 explored passive sensory training (somatosensory; peripheral nerve; afferent; thermal; sensory amplitude electrical stimulation), 6 active (sensory discrimination; perceptual learning; sensory retraining) and 3 hybrid (haptic-based augmented reality; sensory-based feedback devices). Meta-analyses (13 comparisons; 385 participants) demonstrated a moderate effect in favor of passive sensory training on improving a range of upper and lower limb activity measures following stroke. Narrative syntheses were completed for studies unable to be pooled due to heterogeneity of measures or insufficient data, evidence for active sensory training is limited however does show promise in improving sensorimotor function following stroke. Findings from the meta-analyses and single studies highlight some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, evidence for active sensory training continues to be limited. Further high-quality research with rigorous methods (adequately powered with consistent outcome measures) is required to determine the effectiveness of sensory retraining in stroke rehabilitation, particularly for active sensory training.
PubMed: 31114472
DOI: 10.3389/fnins.2019.00402 -
BMC Musculoskeletal Disorders Apr 2017Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome.
METHODS
Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate.
RESULTS
Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function.
CONCLUSIONS
There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area.
Topics: Biomechanical Phenomena; Evaluation Studies as Topic; Exercise Therapy; Feedback, Sensory; Humans; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Resistance Training; Shoulder Impingement Syndrome; Shoulder Pain; Treatment Outcome
PubMed: 28416022
DOI: 10.1186/s12891-017-1518-0 -
Healthcare (Basel, Switzerland) Nov 2023Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs.... (Review)
Review
Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs. Virtual reality (VR) and/or sensory feedback (FB) therapy has shown positive effects in other neurologic conditions such as stroke. However, consensus regarding their effectiveness in the DPN population is lacking. This study aims to analyze existing scientific evidence about the effects of VR and/or FB on improving gait and balance and reducing the risk of falls in patients with DPN (pwDPN). A thorough search was conducted in scientific databases including PubMed, Scopus, and EMBASE, up until November 2023. CMSQ, the PEDro scale, and the Cochrane Collaboration's tool were used to assess the methodological quality and risk of bias of the studies. A total of 10 studies were selected for qualitative analysis, with three contributing information to the meta-analysis. The combined results suggest a positive trend in favor of VR and FB rehabilitation; however, significant differences were not observed in balance (SMD = -0.81, 95% CI = -1.90, 0.29; = 0.15; I = 86%) or gait speed improvements (MD = -1.05, 95% CI = -2.96, 0.85; = 0.28; I = 89%). Therefore, further randomized controlled studies are still needed to achieve stronger conclusions regarding the benefits of VR and/or FB in pwDPN.
PubMed: 38063604
DOI: 10.3390/healthcare11233037 -
Brain Sciences Apr 2021Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent... (Review)
Review
Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed.
PubMed: 33921655
DOI: 10.3390/brainsci11040518 -
Journal of Neural Engineering Sep 2022Electrical stimulation can induce sensation in the phantom limb of individuals with amputation. It is difficult to generalize existing findings as there are many... (Review)
Review
Electrical stimulation can induce sensation in the phantom limb of individuals with amputation. It is difficult to generalize existing findings as there are many approaches to delivering stimulation and to assessing the characteristics and benefits of sensation. Therefore, the goal of this systematic review was to explore the stimulation parameters that effectively elicited referred sensation, the qualities of elicited sensation, and how the utility of referred sensation was assessed.We searched PubMed, Web of Science, and Engineering Village through January of 2022 to identify relevant papers. We included papers which electrically induced referred sensation in individuals with limb loss and excluded papers that did not contain stimulation parameters or outcome measures pertaining to stimulation. We extracted information on participant demographics, stimulation approaches, and participant outcomes.After applying exclusion criteria, 49 papers were included covering nine stimulation methods. Amplitude was the most commonly adjusted parameter (= 25), followed by frequency (= 22), and pulse width (= 15). Of the 63 reports of sensation quality, most reported feelings of pressure (= 52), paresthesia (= 48), or vibration (= 40) while less than half (= 29) reported a sense of position or movement. Most papers evaluated the functional benefits of sensation (= 33) using force matching or object identification tasks, while fewer papers quantified subjective measures (= 16) such as pain or embodiment. Only 15 studies (36%) observed percept intensity, quality, or location over multiple sessions.Most studies that measured functional performance demonstrated some benefit to providing participants with sensory feedback. However, few studies could experimentally manipulate sensation location or quality. Direct comparisons between studies were limited by variability in methodologies and outcome measures. As such, we offer recommendations to aid in more standardized reporting for future research.
Topics: Amputees; Artificial Limbs; Feedback, Sensory; Humans; Phantom Limb; Sensation
PubMed: 36001115
DOI: 10.1088/1741-2552/ac8c38 -
Disability and Rehabilitation Oct 2022To address the gap in the literature and clarify the expanding role of wearable sensor data in stroke rehabilitation, we summarized the methods for upper extremity (UE)... (Review)
Review
PURPOSE
To address the gap in the literature and clarify the expanding role of wearable sensor data in stroke rehabilitation, we summarized the methods for upper extremity (UE) sensor-based assessment and sensor-based treatment.
MATERIALS AND METHODS
The guideline outlined by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews was used to complete this scoping review. Information pertaining to participant demographics, sensory information, data collection, data processing, data analysis, and study results were extracted from the studies for analysis and synthesis.
RESULTS
We included 43 articles in the final review. We organized the results into assessment and treatment categories. The included articles used wearable sensors to identify UE functional motion, categorize motor impairment/activity limitation, and quantify real-world use. Wearable sensors were also used to augment UE training by triggering sensory cues or providing instructional feedback about the affected UE.
CONCLUSIONS
Sensors have the potential to greatly expand assessment and treatment beyond traditional clinic-based approaches. This capability could support the quantification of rehabilitation dose, the nuanced assessment of impairment and activity limitation, the characterization of daily UE use patterns in real-world settings, and augment UE training adherence for home-based rehabilitation.IMPLICATIONS FOR REHABILITATIONSensor data have been used to assess UE functional motion, motor impairment/activity limitation, and real-world use.Sensor-assisted treatment approaches are emerging, and may be a promising tool to augment UE adherence in home-based rehabilitation.Wearable sensors may extend our ability to objectively assess UE motion beyond supervised clinical settings, and into home and community settings.
Topics: Humans; Stroke; Stroke Rehabilitation; Upper Extremity; Wearable Electronic Devices
PubMed: 34328803
DOI: 10.1080/09638288.2021.1957027 -
Journal of Biomechanics Jan 2022To establish the comparative effects of conservative interventions on modifying foot progression angle (FPA) in children and adults with orthopaedic and neurological... (Meta-Analysis)
Meta-Analysis Review
To establish the comparative effects of conservative interventions on modifying foot progression angle (FPA) in children and adults with orthopaedic and neurological disease was the main aim of the literature review. Pubmed, Embase, Cinahl, and Web of Science were systematically searched for studies evaluating the effects of conservative interventions on correcting the FPA. The study protocol was registered with PROSPERO (CRD42020143512). Two reviewers independently assessed studies for inclusion and quality. Studies that assessed conservative interventions that could have affected the FPA and objectively measured the FPA were included. Within group Mean Differences (MD) and Standardized Mean Differences (SMDs) of the interventions were calculated for the change in FPA and gait performance (walking speed, stride/step length) and clinical condition (pain). Intervention effects on FPA were synthesized via meta-analysis or qualitatively. 41 studies were identified. For patients with knee osteoarthritis gait training interventions (MD = 6.69° and MD = 16.06°) were significantly more effective than mechanical interventions (MD = 0.44°) in modifying the FPA towards in-toeing (p < 0.00001). Increasing or decreasing the FPA significantly improved pain in patients with medial knee OA. Results were inconclusive for the effectiveness of gait training and mechanical devices in patients with neurological diseases. Gait feedback training is more effective than external devices to produce lasting improvements in FPA, reduce pain, and maintain gait performance in patients with medial knee OA. However, in neurological patients, the effects of external devices on improvements in FPA depends on the interaction between patient-specific impairments and the technical properties of the external device.
Topics: Adult; Biomechanical Phenomena; Child; Foot; Gait; Humans; Orthopedics; Osteoarthritis, Knee
PubMed: 34741811
DOI: 10.1016/j.jbiomech.2021.110831 -
Journal of Clinical Medicine Jul 2023Parkinson's disease is characterised by the loss of balance and the presence of walking difficulties. The inclusion of rehabilitation therapies to complement... (Review)
Review
BACKGROUND
Parkinson's disease is characterised by the loss of balance and the presence of walking difficulties. The inclusion of rehabilitation therapies to complement pharmacological therapy allows for comprehensive management of the disease. In recent years, virtual reality has been gaining importance in the treatment of neurological diseases and their associated symptoms. Therefore, the objective of this systematic review was to analyse the effectiveness of virtual reality on balance and gait in patients with Parkinson's disease.
METHODS
This study is a systematic review conducted following PRISMA's statements. An electronic search of the literature was carried out in the following databases: PubMed, Cochrane, Dialnet, Scopus, Web of Science, PsycINFO and Science Direct PEDro. The inclusion criteria were controlled and non-controlled clinical trials published in the last 12 years in English or Spanish, in which virtual reality was applied to treat balance and gait impairments in patients with Parkinson's disease.
RESULTS
20 studies were finally included in this review. A total of 480 patients participated in the included studies. All patients were diagnosed with Parkinson's disease. Most of the investigations used the Nintendo Wii + Balance Board or the Microsoft Kinect TM combined with the Kinect Adventures games as a virtual reality device.
CONCLUSIONS
According to the results of this literature review, virtual reality-based interventions achieve good adherence to treatment, bring innovation and motivation to rehabilitation, and provide feedback as well as cognitive and sensory stimulation in patients with Parkinson's disease. Therefore, virtual reality can be considered an alternative for personalised rehabilitation and for home treatment.
PubMed: 37568298
DOI: 10.3390/jcm12154896 -
Musculoskeletal Science & Practice Jun 2018Deficits in the sensorimotor system and its peripheral and central processing of the affected body part might be a contributing factor to chronic low back pain (CLBP).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Deficits in the sensorimotor system and its peripheral and central processing of the affected body part might be a contributing factor to chronic low back pain (CLBP). Hence, sensorimotor assessment is important. Valid and reliable sensorimotor measurement instruments are needed.
OBJECTIVE
To investigate the reliability and validity of sensorimotor measurement instruments for people with chronic low back pain (CLBP).
DESIGN
Systematic review and meta-analysis.
METHODS
The review was undertaken using the COSMIN guidelines. Databases were searched for studies investigating the clinimetric properties of sensorimotor tests in people with CLBP. The methodological study quality was rated by two independent reviewers using the COSMIN 4-point rating checklist.
RESULTS
Ten studies were included covering six sensorimotor measurement instruments with findings for reliability/measurement error, known-groups validity and convergent validity. The methodological quality ranged from poor to good, with only one study rated as good. There was insufficient evidence of enough quality to assess reliability/measurement error or convergent validity. Two-point discrimination, laterality judgement and movement control tests had moderate evidence supporting their ability to distinguish between healthy people and those with CLBP.
CONCLUSIONS
Two-point discrimination, laterality judgment and movement control tests demonstrate the greatest level of known-groups validity for people with CLBP. However, as the reliability of these measurement tools has yet to be established, this validity data should be interpreted cautiously. Further research is warranted to investigate the clinimetric properties of these sensorimotor techniques.
Topics: Chronic Pain; Feedback, Sensory; Female; Humans; Low Back Pain; Male; Psychomotor Performance; Reproducibility of Results; Severity of Illness Index
PubMed: 29549815
DOI: 10.1016/j.msksp.2018.02.007 -
European Journal of Physical and... Feb 2022The objective was to assess the impact of movement representation techniques (MRT) through motor imagery (MI), action observation (AO) and visual mirror feedback (VMF)... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The objective was to assess the impact of movement representation techniques (MRT) through motor imagery (MI), action observation (AO) and visual mirror feedback (VMF) and cross-education training (CE) on strength, range of motion (ROM), speed, functional state and balance during experimental immobilization processes in healthy individuals, in patients with injuries that did not require surgery and in those with surgical processes that did or did not require immobilization.
EVIDENCE ACQUISITION
MEDLINE, EMBASE, CINAHL and Google Scholar were searched. Thirteen meta-analyses were conducted.
EVIDENCE SYNTHESIS
Regarding the immobilized participants, in the healthy individuals, MI showed significant results regarding maintenance of strength and ROM, with low-quality evidence. Regarding the process with no immobilization, VMF and MI techniques showed significant changes in maintaining ROM in patients with injury without surgery, with very low-quality evidence. Results had shown that MI demonstrated significantly higher maintenance of strength and speed in patients undergoing surgery, with low-quality evidence. No significant results were found in ROM. Low-quality evidence showed better results in AO plus usual care compared with usual treatment in isolation with respect to maintenance of functional state and balance. CE training demonstrated maintenance of strength in patients undergoing surgery, with moderate evidence; however, not in healthy experimentally immobilized individuals. VMF did not show significant results in maintaining ROM after surgery without immobilization, nor did MI in maintaining strength after surgery and immobilization.
CONCLUSIONS
MRT and CE training have been shown to have a significant impact on the improvement of various motor variables and on physical maintenance in general.
Topics: Feedback, Sensory; Humans; Imagery, Psychotherapy; Movement; Range of Motion, Articular
PubMed: 34105921
DOI: 10.23736/S1973-9087.21.06893-3