Sensory loss in the hand after sensory stroke: therapeutic rationale.
Rehabilitation programs require techniques for reeducation of sensory appreciation. Current treatments focus on the return of motor function despite the fact that the full potential of motor function is not used in limbs with sensory deficits. A rationale based upon current neurophysiologic concepts is presented with a program of sensory reeducation of the hand. The organization and use of sensory inputs is analyzed to determine the modalities critical to hand function and the body surfaces important for daily tasks. The treatment program is rationalized in terms of the rules governing somatosensory cortical reorganization after trauma, and a case history is presented. Therapy begins with the delivery of sensory inputs to many receptors and pathways from important sensory surfaces. Inputs are delivered at an intensity sufficient for appreciation in a task structured to motivate the patient. Initially, electric stimuli are used. Then cutaneous mechanoreceptors are stimulated by stroking selected skin surfaces with inputs that have high frictional or shearing components, such as Velcro. As therapy progresses, tools are modified to enhance sensory appreciation during retraining of important tasks. Skills related to tactile form recognition and exploration are carefully shaped. A pilot project with six patients suggests some recovery of sensation and manipulative functions.
Dannenbaum
R M
RM
Physiotherapy Department, Royal Victoria Hospital, McGill University, Montreal, Canada.
Dykes
R W
RW
D002561:Cerebrovascular Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D006225:Hand / Q000502:physiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008465:Mechanoreceptors / Q000503:physiopathology; D009420:Nervous System / Q000503:physiopathology; D009422:Nervous System Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D009424:Nervous System Physiological Phenomena; D009434:Neural Pathways; D012677:Sensation; D013003:Somatosensory Cortex / Q000503:physiopathology