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Table 1 Experimental intervention as per the type of sensory impairment and motor recovery stage of the hand

From: Effect of NEuroplasticity-Principles-based SEnsory-Rehabilitation (NEPSER) on sensori-motor recovery in stroke: study protocol for a randomized controlled trial

Sensory Impairment Level of therapy Motor Recovery Stage
  BRS-H 1 & 2 BRS-H 3 BRS-H 4 BRS-H 5 & 6
Light touch Level-I MT (unilateral) – cotton / wool /soft toy MT (bimanual) – cotton / wool /soft toy MT (bimanual) – grasp-release, lateral prehension-release using cotton / wool /soft toy MT (bimanual) – grasp and release, prehensile activity using cotton / wool /soft toy
Level-II Bilateral and unilateral perception of cotton / wool / soft toy (therapist applied) Bilateral and unilateral perception of cotton / wool / soft toy Bilateral and unilateral perception of cotton / wool / soft toy by grasp-release, lateral prehension and release Bilateral and unilateral perception of cotton / wool / soft toy by prehensile activity
Level-III Bilateral movements of upper limb joints holding cotton /wool /soft toy Unilateral movements of upper limb joints holding cotton /wool /soft toy Unilateral perception of cotton / wool / soft toy by grasp-release, lateral prehension and release Unilateral movement (constraining the non-paretic limb) for prehensile activity using cotton / wool /soft toy
Level-IV Bilateral functional tasks – lifting cloth / pillow Unilateral functional tasks – lifting cloth / pillow Unilateral functional tasks – grasp-release, lateral prehension and release of cloth / pillow Unilateral functional tasks (constraining the non-paretic limb) – grasp-release, lateral prehension and release of cloth / pillow
Pressure Level-I MT (unilateral) - clay (graded resistance) activity, ball squeezing MT (bimanual) - clay (graded resistance) activity, ball squeezing MT (bimanual) – grasp-release, lateral prehension and release of - clay (graded resistance) activity, ball MT (bimanual) – pinching clay (graded resistance) activity
Level-II Bilateral and unilateral perception of clay (graded resistance) activity, ball squeezing (therapist applied) Bilateral and unilateral perception of clay (graded resistance) activity, ball squeezing Bilateral and unilateral perception of– grasp-release, lateral prehension and release - clay (graded resistance) activity, ball Bilateral and unilateral perception of pinching clay (graded resistance) activity
Level-III Bilateral movements of upper limb joints holding high- density foam cylindrical blocks Unilateral movements of upper limb joints holding high- density foam cylindrical blocks Unilateral movements of grasp-release, lateral prehension and release - high- density foam blocks Unilateral movement (constraining the non-paretic limb) for pinching clay (graded resistance) activity
Level-IV Bilateral movements of upper limb joints holding textured water glass/bottle Uilateral movements of upper limb joints holding textured water glass/bottle Unilateral movements of grasp-release, lateral prehension and release - textured water glass/bottle, key, cardboard Unilateral functional tasks (constraining the non-paretic limb) – pinching and picking grains/coins
Pin prick Level-I MT (unilateral)– Scrubber / Steel wool/Velcro (rough) MT (bimanual) – Scrubber / Steel wool/Velcro (rough) MT (bimanual)– grasp-release, lateral prehension and release of Scrubber / Steel wool/Velcro (rough) MT (bimanual)– prehensile activity using Scrubber / Steel wool/Velcro (rough
Level-II Bilateral and unilateral perception of Scrubber / Steel wool/Velcro (therapist applied) Bilateral and unilateral perception of Scrubber / Steel wool/Velcro Unilateral perception of grasp-release, lateral prehension and release of Scrubber / Steel wool/Velcro Unilateral perception of prehensile activity of items textured with Scrubber / Steel wool/Velcro
Level-III Bilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) cylindrical blocks Unilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) cylindrical blocks Unilateral movements of upper limb joints comprises grasp-release, lateral prehension and release of textured (Scrubber / Steel wool/Velcro) blocks Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of items textured with Scrubber / Steel wool/Velcro
Level-IV Bilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) water glass/bottle Unilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) water glass/bottle Unilateral movements of grasp-release, lateral prehension and release of textured (Scrubber / Steel wool/Velcro) daily use items Unilateral movement (constraining the non-paretic limb) of prehensile activity of daily use items textured with Scrubber / Steel wool/Velcro
Sharp-blunt discrimination Level-I MT (unilateral)- Dellon’s Discriminator disc (therapist applied) MT (bimanual) - Dellon’s Discriminator disc (therapist applied) MT (bimanual) – sharp and blunt textured items alternatively MT (bimanual) – prehensile activity of sharp and blunt textured items
Level-II Bilateral and unilateral sharp and blunt discrimination (therapist applied) Bilateral and unilateral sharp and blunt discrimination Unilateral sharp and blunt discrimination Unilateral prehensile activity of sharp and blunt textured items
Level-III Bilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) cylindrical blocks Unilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) cylindrical blocks Unilateral movements of upper limb joints comprises sharp and blunt textured items along with manipulation; grasp-release, lateral prehension and release Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of sharp and blunt textured items
Level-IV Bilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) water glass/bottle Unilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) water glass/bottle Unilateral sharp and blunt textured daily use items manipulation; grasp-release, lateral prehension and release Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of sharp and blunt textured daily use items
Proprioception Level-I MT (unilateral)- task-based movements of shoulder, elbow, wrist;
Movement of non-paretic upper limb and perceiving the limb position and movement with vision occluded.
MT (bimanual) - task-based movements of shoulder, elbow, wrist;
Movement of the upper limbs and perceiving the limb position and movement with vision occluded.
MT (bimanual) - task-based movements of shoulder, elbow, wrist, hand, thumb and fingers;
Movement of the joints and perceiving the limb position and movement with vision occluded.
MT (bimanual) - task-based movements of all upper limb especially fingers; Movement of the joints and perceiving the finger position and movement with vision occluded.
Level-II Bilateral movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral movements of shoulder, elbow, wrist hand, thumb and fingers;
with visual feedback followed by vision occluded
Unilateral movements (constraining the non-paretic limb) of all upper limb especially fingers;
with visual feedback followed by vision occluded
Level-III Bilateral activity-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral activity-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral activity-based movements of shoulder, elbow, wrist hand, thumb and fingers; with visual feedback followed by vision occluded Unilateral activity based movements (constraining the non-paretic limb) of all upper limb especially fingers;
with visual feedback followed by vision occluded
Level-IV Bilateral functional task-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral functional task-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded Unilateral functional task-based movements of shoulder, elbow, wrist, hand, thumb and fingers; with visual feedback followed by vision occluded Unilateral functional task-based movements (constraining the non-paretic limb) of all upper limb especially fingers;
with visual feedback followed by vision occluded
Stereognosis Level-I MT (unilateral) – 10 objects MT (bimanual) – 10 objects; similar objects on both the sides. MT (bimanual) – 10 objects; similar objects on both the sides; manipulation of objects by grasp-release, lateral prehension and release MT (bimanual) – 10 small objects such as beads; similar objects on both the sides along with the manipulation of objects
Level-II Perceiving the 10 objects bilaterally with visual feedback followed by vision occluded Perceiving the 10 objects unilaterally with visual feedback followed by vision occluded Perceiving the 10 objects unilaterally with visual feedback followed by vision occluded; manipulation of objects by grasp-release, lateral prehension and release Perceiving the 10 small objects unilaterally with visual feedback followed by vision occluded
Level-III Bilateral manipulation (reaching, lifting, placing) of 10 objects with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing) of 10 objects with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing, grasp-release, lateral prehension and release) of 10 objects (mixed together) with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing, in-hand manipulation) of 10 small objects (mixed together) with visual feedback followed by vision occluded
Level-IV Bilateral manipulation (reaching, lifting, placing) of variety of daily use items with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing) of variety of daily use items with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing, grasp-release, lateral prehension and release) of 10 daily use items (mixed together) with visual feedback followed by vision occluded Unilateral manipulation (reaching, lifting, placing, in-hand manipulation) of 10 small daily use objects (mixed together) with visual feedback followed by vision occluded
  1. BRS-H Brunnstrom Recovery Stage – Hand, MT Mirror therapy