Relationship Between Touch Sensation of the Affected Hand and Performance of Valued Activities in Individuals With Chronic Stroke
Topics in Stroke Rehabilitation
iii Dedication I dedicate this manuscript to all of the stroke survivors who I have worked with through the years. It is you who has inspired me to dedicate my life to stroke research and motivated me to pursue the topic of my dissertation. Thank you for allowing me the opportunity to get to know you and learn from you and your story. Without you, I could not have completed my project and share my experience with other healthcare professionals, researchers, and students. iv Acknowledgements I
... uld like to acknowledge the members of my dissertation committee who provided invaluable support and guidance through-out this project. I would especially like to thank Dr. Thomas Fisher for his support and counsel as my dissertation committee chair. He has truly been a mentor and role model for not only my dissertation, but also for my academic career development. I am grateful for his persistence during challenging times as my committee chair. His dedication to the profession of occupational therapy and academia continue to inspire me. Dr. Jeffrey Crabtree provided thoughtful suggestions and continually broadened my theoretical perspective particularly in regards to rehabilitation and healthcare. His attention to detail and broad perspective are both appreciated for this project. He is dedicated to post professional education and serving society's occupational needs. Dr. Arlene Schmid helped me to become a better stroke rehabilitation researcher. Her expertise and experience in stroke rehabilitation helped guide me through this project particularly with the results and discussion. Dr. Stephen Page inspired me to pursue stroke rehabilitation and afforded me many opportunities. His expertise in stroke rehabilitation research, particularly motor control, helped develop my dissertation focus and has served as a support through-out this project. His dedication and commitment to excellence in stroke rehabilitation research is inspirational. Ms. Elaine Fess first exposed me to research and inspired me to pursue touch sensation in the stroke population. Her counsel and support with the study design and methodology contributed to the success of this project. It is because of her faith in the project that I was able to persevere through the challenging times during my dissertation. Dr. Linda Levin helped me with the statistical analyses for my dissertation. Her passion for statistics and determination was greatly appreciated through-out the results section. I would like to thank Dr. Kari Dunning and Mr. Johnny Wilkerson for supporting me through this project and serving as counsel with the institutional review board and study management. v I would like to acknowledge the students who helped collect data and make this project a reality. you for your hard work and commitment to this project! I would like to acknowledge the institutional review board at the University of Cincinnati and the Drake Center's outpatient occupational therapy clinic and Stroke Recovery Center for supporting this project, for helping to recruit participants, providing resources and housing the study. The therapists' and physicians' love and passion for stroke survivors is extraordinary. Most sincerely, I would like to thank all of the stroke survivors and their friends and family who participated in this project. You have all helped other stroke survivors and stroke rehabilitation by your contribution to this project. You are the reason I have dedicated my life's work to helping individuals with stroke live a healthier life filled with valued occupations. I would also like to thank my family, friends, colleagues, peers, and students for standing by me, cheering me on, and pushing me along. Your love, support, and faith in me gave me the strength to preserve. Thank you! Finally, I thank my parents, Denise and Greg, for their love, support, and dedication not only to help make my dissertation a success, but also for your guidance and love through-out my life. I am forever grateful for your continual and unconditional love and encouragement to strive to reach my dreams and do my best. Thank you! vi ABSTRACT Valerie A. Hill THE RELATIONSHIP BETWEEN TOUCH SENSATION OF THE HAND AND OCCUPATIONAL PERFORMANCE IN INDIVIDUALS WITH CHRONIC STROKE Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals' ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals' abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals' performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals' who have experienced a stroke. This study vii informs therapists, rehabilitation scientists, and other healthcare professionals that clientcentered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.