To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in chronic stroke (>12mo) when upper limb (UL) “performance” has reached a clear plateau.
Replicated single-system experimental study with 8 single cases using A-B-A design (baseline-intervention-withdrawal phases); length of baseline randomly determined; intervention phase involved 6 weeks of daily MTS to the contralesional UL.
Community setting, within participants' place of residence.
Individual stroke survivors (N=8; male-to-female ratio, 3:1; age range, 49–76y; 4 with left hemiplegia, 4 with right hemiplegia) discharged from ongoing therapy, more than 1 year post stroke (range, 14–48mo). Clinical presentations were varied across the sample.
Participants received up to 1 hour of daily (Monday to Friday) treatment with MTS to the UL for 6 weeks during the intervention (B) phase.
Main Outcome Measures
Motor function (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index [MI] arm section) of the UL.
UL performance was stable during baseline for all participants. On visual analysis, improvements in motor impairment were seen in all participants, and clinically significant improvements in motor function were seen in 4 of 8 participants during the intervention phase. Latency between onset of intervention and improvement ranged from 5 to 31 days (ARAT) and from 0 to 28 days (MI). Improvements in performance were maintained on withdrawal of the intervention. Randomization tests were not significant.
MTS appears to improve UL motor impairment and functional activity many months, even years, after stroke onset. Improvement can be immediate, but more often there is latency between the start of intervention and improvement; recovery can be distal to proximal.
List of abbreviations:ARAT (Action Research Arm Test), MI (Motricity Index), MRC (Medical Research Council), MTS (Mobilization and Tactile Stimulation), UK (United Kingdom), UL (upper limb)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Atlas of heart disease and stroke. Part 3: the burden—global burden of stroke.World Health Organization, 2004 (Available at: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf. Accessed February 21, 2012)
- Epidemiology of stroke-related disability.Clin Geriatr Med. 1999; 15: 785-799
- Neurological rehabilitation: optimizing motor performance.Butterworth-Heinmann, London1998
- Predicting Barthel ADL score at 6 months after an acute stroke.Arch Phys Med Rehabil. 1983; 64: 24-28
- The hemiplegic arm after stroke: measurement and recovery.J Neurol Neurosurg Psychiatry. 1983; 46: 521-524
- Loss of arm function after stroke: measurement, frequency and recovery.Int Rehabil Med. 1986; 8: 69-73
- The long-term outcome of arm function after stroke: results of a follow up study.Disabil Rehabil. 1999; 21: 357-364
- Cortical plasticity after stroke: implications for rehabilitation.Rev Neurol (Paris). 1999; 155: 713-717
- Constraint-induced movement therapy for upper extremities in stroke patients.Cochrane Database Syst Rev. 2009; : CD004433
- Hands-on therapy interventions for upper limb motor dysfunction following stroke.Cochrane Database Syst Rev. 2011; : CD006609
- Development of treatment schedules for research: a structured review to identify methodologies used and a worked example of ‘mobilisation and tactile stimulation’ for stroke patients.Physiotherapy. 2006; 92: 195-207
- A framework for development and evaluation of RCTs for complex interventions to improve health.MRC Health Services and Public Health Research Board, London2000
- Dose-response study of mobilisation and tactile stimulation for the upper extremity early after stroke: a phase I trial.Neurorehabil Neural Repair. 2011; 25: 314-322
- Effects of Mobilization and Tactile Stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies.Arch Phys Med Rehabil. 2008; 89: 2003-2010
- Hand and brain. The neurophysiology and psychology of hand movements.Academic Pr, San Diego1996
- Developing and evaluating complex interventions: new guidance.MRC, London2000 (Available at: http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871. Accessed September 10, 2012)
- Single-case research designs: methods for clinical and applied settings.Oxford University Pr, New York1982
- Single case experimental designs: strategies for studying behavior change.2nd ed. Allyn and Bacon, Boston1984
- Evaluating clinical change: strategies for occupational and physical therapists.Williams & Wilkins, Baltimore1986
- Real world research: a resource for social scientists and practitioner-researchers.2nd ed. Blackwell, Oxford2002
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Behavioural Inattention Test.Thames Valley Test Company, Bury St Edmunds1987
- The Star Cancellation Test in acute stroke.Clin Rehabil. 1992; 6: 23-30
- Mobility after stroke: reliability of measures of impairment and disability.Int Disabil Stud. 1990; 12: 6-9
- Assessing motor impairment after stroke: a pilot reliability study.J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
- Motricity Index scores are valid indicators of paretic upper extremity strength following stroke.J Phys Ther Sci. 1999; 11: 59-61
- Measurement in neurological rehabilitation.Oxford University Pr, Oxford1992
- A performance test for assessment of upper limb function in physical rehabilitation treatment and research.Int J Rehabil Res. 1981; 4: 483-492
- Measuring arm impairment and disability after stroke.Int Disabil Stud. 1989; 11: 89-92
- Inter-rater reliability and validity of the Action Research Arm Test in stroke patients.Age Ageing. 1998; 27: 107-113
- The Action Research Arm Test: is it necessary for patients being tested to sit at a standardized table?.Clin Rehabil. 2002; 16: 382-388
- Outcome measures in neurophysiotherapy for the arm and hand: have we lost our grip?.Clin Rehabil. 2006; 20: 459-460
- Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial.Stroke. 1999; 30: 2369-2375
- Effects of conventional physical therapy and functional strength training on upper limb motor recovery after stroke: a randomised phase II study.Neurorehabil Neural Repair. 2009; 23: 389-397
- MRC guidelines for good clinical practice in clinical trials.MRC Health Services and Public Health Research Board, London1998
- Research in health care: concepts, designs and methods.Nelson Thornes, Cheltenham2000
- A simplified time series analysis for evaluating treatment interventions.J Appl Behav Anal. 1982; 15: 423-429
- Interrupted time-series analysis and its application to behavioural data.J Appl Behav Anal. 1980; 13: 543-559
- Single-case and small-n experimental designs: a practical guide to randomization tests.Lawrence Erlbaum, Mahwah2001
- Statistical alternatives for single-case designs.in: Franklin R.D. Allison D.B. Gorman B.S. Design and analysis of single-case research. Lawrence Erlbaum, Mahwah1997: 159-214
- Single subject research: applications in educational and clinical settings.Singular Publishing, San Diego1999
- Serial dependency in single-case time series.in: Franklin R.D. Allison D.B. Gorman B.S. Design and analysis of single-case research. Lawrence Erlbaum, Mahwah1997: 215-243
- The ethics of single system (n=1) research.Physiother Theory Pract. 1994; 10: 111-122
Published online: November 30, 2012
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.