Understanding the science and believing in the possibility of change
The brain has the capacity to learn and adapt. The time window of recovery that we are targeting is from days and weeks post stroke to months and years. While various mechanisms operate in the early phases of recovery after stroke, neural plastic changes are experience and learning dependent, and so we can extend the window of opportunity to include periods of weeks, months and even years after stroke through learning-based rehabilitation. From this foundation we can aim for a more restorative approach to upper limb stroke rehabilitation and sensory rehabilitation.
SENSe Therapy requires the stroke survivor to change. The aim is for the person to regain the sense of touch that has been affected by the stroke. SENSe Therapy is based on principles of perceptual learning, learning-dependent neural plasticity, and has a restorative focus. The link between neuroscience principles and SENSe Therapy are made explicit in the video animation below.
We know that the sensory receptors in the hands and other parts of the body are still working after the stroke. It is the processing and ‘making sense’ of that information that has been disrupted by the stroke. You as a therapist can help your client understand this potential and relearn a sense of touch. We can all improve our senses by learning to make finer discriminations. For example, you could learn to better discriminate the odours and tastes in wines. In tennis, you could learn to discriminate the proprioceptive feeling of an ace tennis serve versus a serve that goes into the net.
In SENSe Therapy you will train your client to make easy and then more difficult discriminations. You will help them to learn how to make these discriminations in relation to different types of sensory stimuli, e.g. tactile, proprioceptive, object recognition. You will also help them to apply the principles in the context of personally-important activities that they have selected. The goal of discrimination training is to achieve long-term transfer—that is, teaching stroke survivors in a way that will be relevant when they encounter novel stimuli and new situations. SENSe training principles are also designed to help you achieve transfer of training effects.
How would you explain the science behind SENSe Therapy to your client?
Practise an introductory explanation that you might use with a client with sensory impairment. This would ideally acknowledge the impact of their sensory difficulties, the science behind our belief in the ability to change and learn new things, and the SENSe therapy approach. Remember to fully engage the client – we need them to have a reason to believe that change is possible, and that this intervention can bring about change. (It’s okay to quote research in a user-friendly way!)