Active Somatosensory Exercise for Chronic Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The current work aims to examine whether the proposed rehabilitation training or exercise
      will eventually yield improvements in both motor and somatosensory aspects at one goal. Here,
      the word 'somatosensory' refers to bodily sensations associated with proprioception or
      kinesthesia, not the sensation of touch, pain, and temperature. The study focuses on upper
      limb retraining for community-dwelling stroke survivors using a robotic device. At the end of
      training, both movement accuracy and somatosensory acuity in chronic stroke survivors are
      presumed to improve, and such paradigm is expected to provide reliable benefits as compared
      to conventional intervention alone.
    

Detailed description: 
      Long-term disability is common sequela among people with stroke. On top of motor impairment,
      many stroke survivors suffer from somatosensory impairment of their paretic arm, leading to
      their inability to perform activities of daily living using upper limb. In this respect,
      recent research on motor recovery following stroke has begun to place more emphasis on the
      inclusion of somatosensory retraining in stroke rehabilitation program. Although evidence is
      still scarce, training paradigms that simultaneously combine both somatosensory and motor
      aspects are considered useful for motor recovery in stroke survivors. Principally, studies
      focusing on such form of training paradigm sought to employ robotic technologies to assist in
      the retraining of both motor and somatosensory function in stroke survivors. Robotic
      technologies have gained popularity recently for assessing somatosensory function in clinical
      setting due to its objective quantification of patients' performance and high inter-rater
      reliability. Thus, with the purpose of improving both motor and somatosensory functions in
      chronic stroke survivors, this proposed study will provide an intensive robotic-based
      behavioral training intervention to chronic stroke survivors from the community. The
      intervention will require active participation of the patients through an exploratory
      strategy.
    

Intervention name(s): Active somatosensory training; Motor-based training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patients in the experimental group will be required to move the robotic handle using their paretic arm from the start position to a visual target shown on screen. However, patients' paretic arm will be occluded from vision throughout the training session. They will make the reaching movement by depending on their proprioception of the arm position in space, without relying too much on the vision of their arm. Haptic guidance will be provided as somatosensory cues while participants are actively moving. Positive reinforcement will also be given for each successful movement that reaches the target in the form of a pleasant audio tone, visual feedback, and a running score. Assessment will be performed before and after the completion of the whole 15 training sessions.; Patients in the control group will also be required to propel the robotic handle using their paretic arm to a target location. This training covers the same centre-out reaching movements but without any emphasis on proprioception, where the view of the paretic arm will not be occluded. However, no haptic guidance will be provided during the reaching movement. Positive reinforcement will still be given to inform the participants of their trial outcomes. Assessment will be performed before and after the completion of the whole 15 training sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Somatosensory; Proprioception; Kinesthesia; Rehabilitation robotics; Positive reinforcement; Upper limb retraining