Sensory substitution with balance and weightbearing training after stroke : development of a prototype and mixed methods design /

Abstract

Introduction The aim of this doctoral thesis was to investigate the feasibility and effectiveness of sensory substitution interventions in improving weight-bearing symmetry and balance outcomes after stroke. Stroke is the third leading cause of death and number one cause of acquired disability in Ireland, with multiple impacts on individuals, health systems and society. Balance impairment (including weight-bearing asymmetry) is one of the principal dysfunctions observed. The exact physiological process explaining the relationship between variables influencing weight-bearing symmetry and balance after stroke was yet to be explored, a gap this thesis attempted to explain. Methods This thesis was structured as a PhD by publication and includes a mixed-methods approach. Systematic literature review and meta-analysis methodology was used to collect, appraise and synthesise current quantitative data investigating sensory substitution interventions. The NextStep™ prototype (developed for this research) was used to investigate combined tactile and auditory sensory substitution alongside weight bearing and balance training for a case study and pilot randomised controlled trial in a cohort of stroke survivors. Results The results indicated that sensory substitution interventions, including the NextStep™ prototype, were feasible and highlighted preliminary effectiveness of the interventions for improving weight-bearing symmetry and balance outcomes after stroke. Feasibility was indicated through positive findings of safety, retention, adherence, and acceptability. There were also positive findings for feasibility and preliminary effectiveness for these iv interventions to improve balance, weight-bearing symmetry, gait and subjective outcomes in patients with other neurological and orthopaedic disorders. Conclusion The findings of this thesis provide conceptual understanding of the relationship between variables which influence weight-bearing symmetry and balance after stroke. The findings also broadly contribute to existing knowledge on interventions to improve balance, weight-bearing symmetry, gait and subjective outcomes in patients with neurological and orthopaedic disorders. To better understand the implications of these results, future studies should explore the thesis recommendations.