Response to Mobilisation and Tactile Stimulation (MTS) applied to the hemiplegic left upper limb in a stroke survivor with unilateral hemineglect (ABSTRACT)

Introduction: Case: 64-year old male with right Total Anterior Circulation Stroke, presenting with increased tone in left upper limb (UL) held in a typical adducted posture, with elbow flexed, forearmpronated, wrist joint and digits held in flexion, and with resistance to passive movement. No selective movement in hand, wrist, elbow or shoulder joint, and no UL functional activity; able to produce slightshoulder girdle elevation. Pain reported on passive movement, and shoulder joint subluxed. Head rotated to the right, where attention was biased, and unilateral hemineglect apparent. Method: Design: single system experimental A-B-A design; conventional ward-based rehabilitation provided throughout, and intervention known as Mobilisation and Tactile Stimulation (MTS) delivered for up to 60minutes daily, for 6 weeks; MTS involves hands-on therapy and manipulation techniques to mobilise and sensitise forearm and hand, and retrain selective movement of the limb distally. Outcomes of function (Action Research Arm Test – ARAT), motor impairment (Motricity Index – MI), and sensation (Semmes-Weinstein Monofilaments – SWM) were recorded daily throughout all phases. Data analysed using primarilyvisual analysis of charted data. Results: During initial A phase, ARAT scores were consistently zero, MI scores were stable, and SWM scores was absent. Following onset of intervention, there was immediate improvement in MI and SWMscores, and unilateral hemineglect reduced substantially. ARAT scores improved after 4 treatment sessions. Clinically significant changes were seen during the intervention phase.Conclusion: MTS has potential to improve UL function, activity and sensation following stroke, and may have potential to reduce unilateral hemineglect. This warrants further study