Investigation of acceptable dose of mobilisation and Tactile Stimulation (MTS) to enhance upper limb recovery after stroke. A Phase 1 trial.
The scientific evidence indicates that upper limb movement recovery may be enhanced with the appropriate dose of afferent (sensorimotor) stimulation normally arising from functional activities such as grasping a cup. Even if the appropriate dose was known, people with substantial paresis (muscle weakness) would not be able to participate repetitively in functional training. For these people Mobilisation and Tactile Stimulation (MTS) therapy might enhance upper limb (arm and hand) recovery.
The key question is: in patients with substantial paresis early after stroke which dose of therapy has the best effect for the least adverse effects?
Participants were randomised to 1 of 4 groups:
Routine therapy + 30 minutes MTS
Routine therapy + 60 minutes MTS
Routine therapy + 120 minutes MTS.
The allocated MTS intervention was given daily for 14 working days. Measures of ability to voluntarily contract paretic muscle (Motricity Index) and ability to use the paretic upper limb in functional activity (Action Research Arm Test) were made before and after the intervention.
Sensory input via massage and passive movement
No statistically significant difference was found between change in the control group compared with change in any of the MTS groups. Mean actual daily treatment time for all MTS groups was less than planned. Field notes and informal reports from the research therapists suggest that the reason for a shortfall in dose could be the result of post-strike fatigue and ward activities/routines.
The clinical trends observed in the data suggest that the most feasible dose to take forward for further evaluation might range from 37 minutes to 66 minutes a day.
Hunter SM, Hammett L, Ball S, Smith N, Anderson C, Clark A, Tallis RC, Rudd A, Pomeroy VM. Appropriate dose of Mobilisation and Tactile Stimulation Therpay for the upper extremity early after stroke: a Phase I trial. Neurorehabilitation and Neural Repair 2011, 25(4):314-322
Professor Valerie Pomeroy
Faculty of Medicine and Health Sciences
University of East Anglia