Despite the high prevalence and impact of sensory loss on outcome, an evidence-practice gap exists. Our national survey of 172 Australian occupational therapists and physiotherapists revealed that more than half were unaware of best practice in this area (Pumpa, Cahill, & Carey, 2015). Eighty percent used non-specific treatments such as compensatory strategies and one third used no specific/published treatments. Less than half reported satisfaction with the assessments and treatments they were using, or confidence in their ability to treat sensory impairment after stroke, signaling to a readiness to change practice.
Pumpa, L., Cahill, L.S. & Carey, L.M. (2015). Somatosensory assessment and treatment after stroke: An evidence-practice gap. Australian Occupational Therapy Journal, 62(2), 93-104. doi: 10.1111/1440-1630.12170
Evidence-based Stroke Guidelines
Sensation is identified within the Stroke guidelines as an essential component of stroke rehabilitation. Please see link below (click logo) for current recommendation from the Australian National Stroke Foundation guidelines:
For stroke survivors with sensory loss of the upper limb, sensory-specific training may be provided. (de Diego et al. 2013 ; Carey et al. 2011 ; Doyle et al. 2010 )
Best-practice for arm recovery post-stroke: An international application
An international team of experts in rehabilitation of the arm after stroke have developed the Viatherapy App to guide therapists in application of best-practice therapies for arm recovery after stroke. This included 22 experts from disciplines of physiotherapy and occupational therapy, across 7 countries, over 5 years. The smartphone app can be used to identify the best practices for each stroke patient depending on the time post-stroke and their severity of impairment. The app is regularly being updated for evidence. It can be downloaded for free from the following site: www.viatherapy.org
Best-practice guidelines recommend evidence-based sensory retraining, involving 10 or more 45-minute sessions over a period of 3-4 weeks.
It includes: Training to make sense of reduced body sensations with selected discrimination tasks, including texture, limb position sense and tactile object recognition. Training involves the matching of the sensation between the hands and with vision.
Wolf, S.L., Kwakkel, G., Bayley, M., McDonnell, M.N., Baum, C., Blanton, S., Carey, L.M., Deutsch, J., Eng, J., Hager, C., Lang, C., Levin, M.F., MacKay-Lyons, M., Pomeroy, V., Richards, C.L., Salbach, N., Salter, K., Stinear, C., Teasell, B., Vliet, P.V. & Winstein, C.J., (2016). Best practice for arm recovery post-stroke: An international application. Physiotherapy, 102(1), 1-4, doi: 10.1016/j.physio.2015.08.007