The effect of somatosensory stimulation on postural control in post-acute stroke patients with and without hemi-neglect
01 / 2002 - 12 / 2006
- Purpose: In 1993, Johansson et al. reported an RCT showing that sensory stimulation by electro-acupuncture facilitates functional recovery in post-acute stroke patients in terms of their balance, mobility, and ADL performance. These beneficial effects were still present 12 months after stroke onset. Yet, until now, these results have not been widely replicated. Recently, short-term beneficial effects of transcutaneous electric nerve stimulation have been reported in stroke patients with hemi-neglect on postural control by Pérennou et al. However, still little is known about the beneficial effects of SSS on the functional consequences of hemi-neglect in the long term using repeated applications over a longer time period. The primary research question in this project is whether repeated and intensive somatosensory stimulation has a facilitating effect on balance recovery and related ADL performance in post-acute stroke patients and whether this effect is greater in patients with hemi-neglect compared to patients without hemi-neglect. The primary candidate for SSS is whole body vibration because it stimulates muscle spindles essential to proprioceptive feedback. Whole body vibration is easily applicable. Patients stand on a vibration platform with or without support, depending on their FAC-score. This project is part of a national research program called 'Efficacy of cognitive rehabilitation in the Netherlands: a comprehensive program involving disorders in information processing, attention and executive functions and in the interaction between cognitive and motor processes'. - Methodology: All stroke patients with a first hemispheric infarction or haemorrhage who are admitted within six weeks after their stroke as an inpatient to the rehabilitation center for retraining balance and ambulation skills will be eligible. Whole body vibration is given in the experimental group during 6 weeks, 5 times a week and 3 x 45 seconds each session. The control group will receive movement training during the same amount of time. Outcome is primarily determined by clinical assessment aimed at gross motor abilities using different functional scales. As secondary measures, kinesiological techniques aimed at sitting and standing balance (posturography) will be used to determine which processes underlying balance performance change during rehabilitation. Both static and dynamic (weight-shifting) balance tasks are applied using different task constraints. During all test conditions, a dual-plate force platform is used to register the fluctuations of the 'center of pressure' under each foot separately while standing. A similar assessment procedure will be used to register the CP fluctuations at the support surface while sitting. Finally, patients will be subjected to tests of tactile extinction using monofilaments, to a semi-structured observation of self-care abilities and to related visuospatial exploration tests.