Sensory Re-Education of the Hand after Stroke

Stroke patients continue to present a major challenge to the rehabilitation professions. In particular, the "rehabilitated" patient with a useless hand remains an all too common phenomenon. This book focuses on the sensory perceptual disturbances caused by stroke which, even if slight can be the crucial factor in poor hand function. A wide-ranging review is presented of the processes of functional reorganisation by which the brain responds to the demands posed by injury as well as by learning. An inescapable conclusion from this literature is that any therapy which aims to harness these processes for the restoration of function after stroke needs to engage the patient's attention and motivation. This is followed by a detailed description of the method of Sensory Re-education developed by the author through long experience with patients and culminating in a clinical trial which establised its effectiveness. While the book is intended primarily for physiotherapists and occupational therapists, it contains much to interest all who are concerned with brain function in health and disease, including neurologists and neuropsychologists, as well as stroke patients and their families. Contents Introduction The Challenge: Stroke and its Aftermath The Effectiveness of Therapy The Quest for a Different Approach Sensory Loss in Stroke: Sensory Testing and the Frequency and Types of Deficit The Functional Implications of Sensory Loss The Theoretical Basis of Sensory Re-education: Sources Peripheral Nerve Lesions; Central Lesions Guide-lines for Intervention Contributions from Psychology: Attention; Motivation The Essentials of Sensory Re-education: The Focus on the Hand The Therapeutic Relationship The Protocol for a Sensory Task Summary The Curriculum I: How to Use the Curriculum Lessons in Touch The Curriculum II: Lessons in Proprioception Lessons in the Recognition of Objects and Their Qualities Suggestions for Homework Validation of the Method: Theoretical Considerations A Controlled Trial The Next Step Wider Applications: Sensory Problems in Standing and Walking After Stroke Cerebral Palsy Other Conditions Wider Applications Conclusion

Foreword vii Derick T. Wade Preface ix Introduction 1 The Challenge 4 Stroke and its aftermath 4 The effectiveness of therapy 6 The quest for a different approach 12 Sensory Loss in Stroke 14 Sensory testing, and the frequency and types of deficit 14 The functional implications of sensory loss 22 The treatment of sensory loss 25 The Theoretical Basis of Sensory Re-education 29 Sources 29 Peripheral nerve lesions 33 Central lesions 38 Guidelines for intervention 42 Contributions from Psychology 48 Attention 48 Motivation 55 The Essentials of Sensory Re-education 63 The focus on the hand 63 The therapeutic relationship 64 The protocol for a sensory task 67 Summary 69 The Curriculum I 71 How to use the curriculum 71 Lessons in touch 73 The Curriculum II 86 Lessons in proprioception 86 Lessons in the recognition of objects and their qualities 93 Suggestions for homework 103 Validation of the Method 106 Theoretical considerations 107 A controlled trial 109 The next step 116 Wider Applications 118 Sensory problems in standing and walking after stroke 118 Cerebral palsy 119 Other conditions 121 Wider applications 122 Conclusion 123 References 124 Index 143