Author: Wei, Xijun
Title: Effect of sensory cueing on paretic upper extremity recovery for patients after stroke
Advisors: Fong, N. K. Kenneth (RS)
Degree: Ph.D.
Year: 2018
Subject: Hong Kong Polytechnic University -- Dissertations
Cerebrovascular disease -- Patients -- Rehabilitation
Arm -- Treatment
Department: Department of Rehabilitation Sciences
Pages: xx, 213 pages : color illustrations
Language: English
Abstract: The recovery for the hemiparetic upper extremity is usually slow after stroke because of both intrinsic reason such as the complex movement of the arm, and extrinsic reason such as learned nonuse, etc. Sensory cueing, later operationalized as 'Remind-to-move' treatment was effective in boosting up upper extremity recovery in stroke patients according to previous studies, but the feasibility in subacute stroke patients and related mechanism are still unknown. The purposes of this thesis included: 1) to review the evidence of current approaches for upper extremity rehabilitation, return-to-work in young stroke patients, and the theories related to learned nonuse and sensory cueing; 2) to explore the relationship between learned nonuse and upper extremity motor performance; 3) to examine the translation of delivering sensory cueing in animals; 4) to investigate the mechanism of sensory cueing in stroke and healthy persons through activated patterns of haemodynamics using functional near infrared spectroscopy; and 5) to investigate the effect of sensory cueing in subacute stroke patients on promoting upper extremity recovery in a multi-centred randomized controlled trial. Chapter one of this thesis begins with the description of the cause of stroke and its aetiology. The impairments leading by stroke, such as the motor deficits, particularly on upper extremities and their recovery patterns, are described. The phenomenon of learned nonuse observed in most stroke patients and the theories supporting concurrent treatments are reviewed. The theories and evidence of 'Remind-to-move' is following the evidence of the contemporary treatments. Chapter two shows current evidence of conventional and vocational rehabilitation on promoting return-to-work in stroke patients, particularly those young stroke patients. This systematic review revealed that currently it is still too early to conclude the effect of conventional and vocational rehabilitation on the rate of return-to-work in the working age stroke patients, however the improvement of fatigue and cognitive function promoted by rehabilitation showed correlation with the outcome of return-to-work. Either specialized vocational rehabilitation, conventional stroke rehabilitation or their combination of both are needed for increasing the rate of return-to-work and promoting the quality of life for working age stroke patients. Chapter three describes a study on the relationship between learned nonuse and motor performances in outpatient subacute stroke patients. This study found the learned nonuse, as assessed by the Motor Activity Log, got strong correlations with other standardized laboratory upper extremity assessments-Fugl-Meyer Assessment, Action Research Arm Test, and Box and Block Test, while the movement parameters recorded by the unilateral accelerometer wearing on the wrist does not reflect the actual arm use of the hemiparetic arm in activities of daily living.
Chapter four presents a pilot animal study on the effects of sensory cueing on the feeding behavior of healthy rats. This study used flashing white light emitted by the device mounted on rats with light cueing on either side of the rat could not affect the laterality preference of food exploring on either side. The shortfall of the study method was suggested. Chapter five shows a case study investigated the cortical mechanism of sensory cueing by functional near infrared spectroscopic topography. The results revealed that different topographic patterns on cortices were activated by sensory cueing between stroke and healthy participants, and different cortical haemodynamic performances were observed in patients with high and low arm functioning stroke respectively. Sensory cueing elicited the increase of oxyhaemoglobin and total haemoglobin over the prefrontal cortex which might suggest that the effect of sensory cueing on promoting upper extremity recovery could be contributed by enhanced attention in the prefrontal cortex. Chapter six describes a multi-centre randomized controlled trial on 'Remind-to-move' by means of sensory cueing using wearable devices in home-based treatment for hemiparetic upper extremity in patients with subacute stroke. The improvement of the hemiparetic arm performance in the experimental group, which received 'Remind-to-move', was significantly greater than those in the sham and control groups. This study revealed that 'Remind-to-move' promoted the use of upper extremity as revealed by the increase in movement percentage, hence leading to the improvement in the fine motor function. Chapter seven summarizes the contents of the thesis and concludes that 'Remind-to-move' by means of sensory cueing on the hemiparetic upper extremity in subacute stroke patients is effective in boosting up the recovery, especially the distal hand function. The mechanism behind 'Remind-to-move' might be contributed by the enhanced attention in the prefrontal cortex.
Rights: All rights reserved
Access: open access

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