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

Margaret Yekutiel is the author of Sensory Re-Education of the Hand after Stroke, published by Wiley. 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