This is an interesting study of six patients admitted to a stroke rehabilitation ward in a community hospital in the UK. An ABA design was used to investigate how sixty minutes of daily mobilisation and tactile stimulation to the paretic arm and hand for 6 weeks in addition to the usual rehabilitation program affected the recovery of activity in the upper limb. The conclusion of the study was that using mobilisation and tactile stimulation did improve motor recovery after severe paresis and there was therefore justification for conducting dose-finding studies as a precursor to multicentre phase III clinical trials.
The main outcome measures used were the Action Research Arm Test [ARAT] for focal disability and the Motricity Index arm section for motor impairment. Improvements were found in all six patients. Clear differences in total ARAT and Motricity Index (arm) scores between baseline and intervention phases after 6 weeks of daily mobilisation and tactile stimulation applied to the paretic limb were identified. Because these improvements have been replicated in all six participants, they are attributed to the intervention.
The intervention consisted of different techniques applied in combination by a skilled therapist, according to the patient’s initial problems and individual response to handling. Techniques included soft-tissue mobilization, including massage and active soft-tissue stretch, passive and accessory movements of joints, active movement and assisted or guided movement (when active movement was not possible) and cutaneous sensory input through touch and pressure including weight bearing through the hand. The authors state that they believe this treatment reflects current practice in treating biomechanical changes in the upper limb such as soft-tissue shortening and loss of range of movement, neurophysiological problems such as hyper- sensitivity and sensory loss, and perceptual problems such as unilateral neglect and inattention. However, they also acknowledge the effects of this treatment for the hemiplegic upper limb have not been explored or evaluated.
