Browsing by Author "Zastron, Tania"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    The effect of sensory-motor training on brain activation and functional recovery in chronic stroke survivors
    (2018-10) Zastron, Tania; Welman, Karen Estelle; Reer, Rudiger; Hollander, Karsten; Stellenbosch University. Faculty of Medicine and Health Sciences.
    ENGLISH ABSTRACT: Introduction: Functional loss is greatly determined by postural control impairment in chronic stroke survivors causing reduced ability to execute activities of daily living, impaired mobility and increases the risk of falling. It is known that the basal ganglia network play an important role in postural control, however the effect of sensory-manipulated balance training on structural connectivity in chronic stroke survivors remains unknown. Objective: To assess the influence of sensory-manipulated balance training, i.e. sensory-motor training (SMT), on structural connectivity and functional recovery in chronic stroke survivors. Study design: Double-blind randomised controlled trial. Methods: Twenty-two individuals with chronic stroke (≥6 months post-stroke) were randomly divided into two groups, namely the sensory-motor training (SMT; n = 12) and attention-matched control group (CON; n = 10). The SMT group participated in task-specific balance training, which focused on manipulating the visual, vestibular and somatosensory systems, three times a week for 45 to 60-minute sessions, over an eight-week period. The CON group attended educational talks regarding various lifestyle topics for the same duration as the SMT group. Both interventions were delivered by experienced clinical exercise therapists and were executed in a group setting. Primary outcome measures included changes in structural connectivity strength (diffusion tensor magnetic resonance imaging (MRI) scan), postural sway and sensory dependency (modified Clinical Test for Sensory Interaction and Balance (m-CTSIB), as well as functional mobility (Timed-Up and Go (TUG). Structural connectivity strength was specifically investigated between the twosubcortical basal ganglia nuclei, caudate and lentiform nucleus, with other regions of interest. Furthermore, the m-CTSIB and TUG tests were executed with APDM’s Mobility LabTMbody-worn inertial sensors. Secondary outcome measures were health-related quality of life (Short Form Health Survey (SF-36)) and fall efficacy (Fall Efficacy Scale - International (FES-I)). Participants were tested pre- and post-intervention. Results: Diffusion tensor MRI results showed interaction effects for increased connectivity strength between the basal ganglia and sensory-motorfronto-parietal areas in the SMT group (n = 5; p<0.05), where as the CON group (n = 4 ) presented increased structural connectivity in the higher cognitive orbitotemporal and frontal lobe areas (p<0.05). For the behavioural outcome measures, interaction effects were found for turning performance(p = 0.02), perceived physical functioning (p = 0.005) and fall efficacy (p= 0.03). Moreover, the SMT group (n = 12) showed improved postural sway when standing on a foam pad with eyes open (p = 0.04, ES = 0.61M, 95% CI= -0.27 to 1.36), reduced somatosensory dependence (p = 0.02, ES = 0.63M,95% CI = -0.24 to 1.40), improved turning performance (p≤0.05) as well as improvements in perceived physical (p = 0.01, ES = 0.52M, 95% CI = -0.33to 1.29) and social functioning (p = 0.02, ES = 1.03L, 95% CI = 0.11 to 1.80)after participating in the SMT programme. Lastly, a group difference wasobserved for perceived physical (p = 0.003, ES = 0.90L, 95% CI = -0.05 to1.70) and social functioning (p = 0.02, ES = 1.01L, 95% CI = 0.04 to 1.81) at post-intervention. Conclusions: This study highlights postural control-related improvements induced by SMT, which may be associated with structural connectivity changes in chronic stroke survivors. Therefore, the preliminary results support the notion that the human brain has the ability to undergo activity-dependent neuroplasticity.