Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial

Abstract

Purpose

Sensory impairment post-stroke limits rehabilitation of balance and gait. This study aims to compare the effect of explicit sensory retraining (ESR) versus implicit repeated exposure (IRE) to stimuli of the lower extremity, assessing their effects on sensation, balance, and gait in individuals with chronic post-stroke sensory impairment.

Materials and methods

A two-arm parallel double-blind multicenter randomized controlled trial was conducted in physical therapy outpatient clinics. Volunteers with chronic sensory impairment post-stroke participated in 10 sessions of 45 min ESR or IRE, according to a detailed protocol. Outcome measures assessed sensation, balance, mobility, and participation.

Results

A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30). The intention-to-treat pre-post analysis demonstrated clinically meaningful changes for both interventions (10–31% improvement for the various measures), with no between-group difference or time × group interaction. The effect size for the time effect varied, with the largest being 0.63 for the miniBEST.

Conclusions

Sensory rehabilitation treatment by either ESR or IRE led to similar clinically significant changes in the performance of the lower extremity and participation in subjects with sensory loss post-stroke. Both treatment protocols are easy to implement in an outpatient clinic.  

ClinicalTrials.gov registration:

NCT01988220.

Implications for rehabilitation

• Standardized, structured, sensory-focused training can improve balance and gait in subjects with chronic post-stroke sensory impairment.

• Both explicit and implicit learning-based sensory protocols focused on the lower extremity effectively improved balance, mobility, and gait abilities, resulting in enhanced participation of individuals in the chronic post-stroke phase.

• A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.

Keywords:

• Stroke
• treatment
• sensation
• lower extremity
• sensory retraining
• physiotherapy
• explicit
• implicit

Acknowledgements

The authors thank all those who have volunteered for this study, both physiotherapists and patients.

Disclosure statement

The authors declare that there is no conflict of interest.