Proprioceptive Training with Visual Feedback Improves Upper Limb Function in Stroke Patients: A Pilot Study
Jieying He, Chong Li, Jiali Lin, Beibei Shu, Bin Ye, Jianhui Wang, Yifang Lin, Jie Jia
Abstract
Proprioceptive deficit is one of the common sensory impairments following stroke and has a negative impact on motor performance. However, evidence-based training procedures and cost-efficient training setups for patients with poststroke are still limited. We compared the effects of proprioceptive training versus nonspecific sensory stimulation on upper limb proprioception and motor function rehabilitation. In this multicenter, single-blind, randomized controlled trial, 40 participants with poststroke hemiparesis were enrolled from 3 hospitals in China. Participants were assigned randomly to receive proprioceptive training involving passive and active movements with visual feedback (proprioceptive training group [PG]; <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>n</a:mi><a:mo>=</a:mo><a:mn>20</a:mn></a:math> ) or nonspecific sensory stimulation (control group [CG]; <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>n</c:mi><c:mo>=</c:mo><c:mn>20</c:mn></c:math> ) 20 times in four weeks. Each session lasted 30 minutes. A clinical assessor blinded to group assignment evaluated patients before and after the intervention. The primary outcome was the change in the motor subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-M). Secondary outcomes were changes in box and block test (BBT), thumb localization test (TLT), the sensory subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-S), and Barthel Index (BI). The results showed that the mean change scores of FMA-UE were significantly greater in the PG than in the CG ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"><e:mi>p</e:mi><e:mo>=</e:mo><e:mn>0.010</e:mn></e:math> for FMA-UE-M, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"><g:mi>p</g:mi><g:mo>=</g:mo><g:mn>0.033</g:mn></g:math> for FMA-UE-S). The PG group was improved significantly in TLT ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"><i:mi>p</i:mi><i:mo>=</i:mo><i:mn>0.010</i:mn></i:math> ) and BBT ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"><k:mi>p</k:mi><k:mo>=</k:mo><k:mn>0.027</k:mn></k:math> ), while there was no significant improvement in TLT ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"><m:mi>p</m:mi><m:mo>=</m:mo><m:mn>0.083</m:mn></m:math> ) and BBT ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"><o:mi>p</o:mi><o:mo>=</o:mo><o:mn>0.107</o:mn></o:math> ) for the CG group. The results showed that proprioceptive training was effective in improving proprioception and motor function of the upper extremity in patients with poststroke. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2000037808).