Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies.

OBJECTIVE: To explore the effects on motor function and impairment of mobilization and tactile stimulation for the paretic arm and hand after stroke.
DESIGN: Replicated single-system series, ABA design.
SETTING: The stroke rehabilitation ward of a community hospital in the United Kingdom. PARTICIPANTS: Consecutive sample, men and women (N=6) with stroke (left or right), within 3 months of onset. INTERVENTION: Sixty minutes of daily mobilization and tactile stimulation to the paretic arm and hand for 6 weeks in addition to the usual rehabilitation program. MAIN OUTCOME MEASURES: Focal disability (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index arm section).
RESULTS: All participants showed visual change in 1 or more of trend, level, or slope between baseline and intervention phases for both the ARAT and the Motricity Index. The visual analysis was confirmed through statistical testing (c statistic and/or Mann-Whitney U test) for 5 of 6 participants (statistical analysis was precluded for 1 participant). No further improvements were made on intervention withdrawal.
CONCLUSIONS: This study shows proof of concept for using mobilization and tactile stimulation to improve motor recovery after severe paresis, justifying conducting dose-finding studies as a precursor to multicenter phase III clinical trials.