Effectiveness of temporary deafferentation of the arm on somatosensory and motor functions following stroke: a systematic review protocol

摘要

Review question/objective The primary objective of this systematic review is to present the best available evidence related to the temporary deafferentation of the affected arm on motor function and activity of the upper limb (arm and hand) recovery following stroke. Further, this review aims to assess the effects of temporary deafferentation on sensory function, activities of daily living, impact of stroke and quality of life, the acceptability and safety of the intervention as well as adverse events. Background In industrialized countries, stroke is one of the most common causes of acquired disability in adulthood. Stroke is defined according to the World Health Organization as “a syndrome of rapidly developing symptoms and signs of focal, and at times global, loss of cerebral function lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin”.37 Following stroke, up to 85% of patients have hemiparesis, sensory perception and/or motor function impairments of the upper limb in the acute stage. Six months post-stroke, only 5% to 20% of these patients show a complete functional recovery and 30% to 60% remain with a non-functional paretic arm.1 These deficiencies limit activities and restrict participation in situations of everyday life. The work of therapists is fully oriented towards the recovery of function or strategy by appropriate therapies;2 motor recovery may also reduce the impact of complications such as pain following stroke.3-4 The initial severity of the stroke is one of the most important predictors but variability remains high, likely influenced by therapeutic interventions. The benefit of the latter was also noted in several brain imaging studies showing cortical reorganization.2 Regaining functional use of the upper limb remains one of the biggest challenges for patients and their therapists after stroke. However, with regard to the rehabilitation of the upper limb, the lack of evidence for the effectiveness of interventions remains prominent.5-8 Some of the therapeutic interventions aimed at motor recovery after stroke have shown potential benefit for arm function; namely constraint-induced movement therapy (CIMT),9 mental practice with motor imagery,10 virtual reality,11 mirror therapy,12 and electromechanical and robot-assisted arm training.13 For other interventions applicable to the upper limb (electrostimulation, biofeedback with electromyography, repetitive task training, bimanual simultaneous therapy), there is not yet enough reliable data to recommend their routine use in neurorehabilitation.14-17 Among other recent intervention strategies for the recovery of motor function, non-invasive techniques of brain stimulation, such as transcranial magnetic stimulation (TMS, repetitive TMS), transcranial direct current stimulation (tDCS) or a more invasive approach as epidural cortical stimulation (ECS) have also been used.18-20 For the recovery of sensory perception at the hemiparetic upper limb, several interventions were also identified but again, there is insufficient evidence to support or refute their effectiveness.1 Yet, sensory deficits significantly limit the patient's ability to use the upper limb and the quality of movement. Three therapeutic principles are reported in the literature, namely the inhibition of the contralesional motor cortex (e.g. the constraint-induced movement therapy (CIMT)), activation of the ipsilesional motor cortex (e.g. the mental practice, bimanual therapy, CIMT) and modulation of sensory afferents (e.g. mirror therapy).21 For modulation of sensory afferents, different sources of information are available: proprioceptive, tactile, vestibular, visual and to a lesser extent, auditory. In this regard, Kwakkel et al.,22 have noted the dependency between the availability of information provided during sensory and motor activity and the efficiency and speed of the process of motor recovery in patients with stroke. Movements need the s