Somatosensory stimulation to improve lower-limb recovery after stroke

Introduction Increasing lower-limb sensation could improve walking post-stroke but evidence for this is limited. This thesis reports: 1) Review of published literature on somatosensory stimulation of the foot to enhance lower-limb function post-stroke. 2) Development of standardised intervention protocols for testing in a feasibility trial. 3) Feasibility trial of somatosensory stimulation interventions combined with functional activity. Methods 1) Systematic review with narrative synthesis of somatosensory stimulation to the foot to improve balance and gait post-stroke. 2) Modified Nominal Group Technique with experienced therapists, informed by literature, to develop and seek consensus on three standardised therapy protocols. a) lower-limb mobilization and tactile stimulation (MTS) b) textured insole wearing (TI) c) task-specific gait training (TSGT) 3) Mixed-methods, single-blind feasibility study explored: recruitment, participant characteristics, attrition, intervention and outcome measures acceptability (responses, feasibility, costs), sample size requirements, and participants’ experiences. Adults 42–112 days post-stroke were randomized to either TIs+TSGT or MTS+TSGT. Lower-limb sensorimotor and functional outcomes were measured pre-randomization, post-intervention, and one-month later. Participants’ experiences and acceptability of interventions and outcomes were explored in focus groups, with qualitative data analysed thematically. Quantitative feasibility outcomes were analysed using descriptive statistics, and within-group changes calculated. Results 1) Seventeen trials included in the review confirmed that evidence for somatosensory stimulation to improve lower-limb function post-stroke is limited. 2) Validated trial intervention protocols for MTS, TIs and TSGT were developed, with consensus. 3) Thirty-four stroke survivors were recruited and completed the trial, with acceptable recruitment (48.57%) and attrition (5.88%) rates. Feasibility of outcomes, costs, delivery and acceptability of interventions and outcome measures were confirmed. Potential response to treatment was noted. Conclusion Somatosensory stimulation of the foot post-stroke warrants investigation. Feasibility of a larger trial of somatosensory stimulation interventions was confirmed. Participant characteristics, response over time, and variance of outcome measures will inform a future larger trial