Exploring Sensory Processing Patterns and Their Relationship With Fatigue Perception and Motor Changes in People After Stroke

Abstract

Date Presented 4/20/2018

Understanding a person’s sensory processing pattern improves occupational therapists’ ability to design effective interventions that consider different parts of the individual’s lived experience, including environmental adaptation to fit specific sensory processing preferences.

Primary Author and Speaker: Dua'a Alwawi

Additional Authors and Speakers: Evan Dean

Contributing Authors: Winifred Dunn, Jeff Radel

PURPOSE AND BACKGROUND: The purpose of this study was to explore sensory processing patterns in people after stroke and how these patterns relate to perceived level of fatigue and motor abilities. Adults after stroke may experience changes in motor, sensory, and cognitive abilities that influence functional performance and quality of life. Although sensory changes are common after stroke (Connell et al., 2014) and are related to motor changes (Campfens et al., 2015), rehabilitation strategies tend to focus on motor changes and neglect when addressing sensory changes. Fatigue poststroke can cause a decrease in self-efficacy and functional ability. Activity-related fatigue and mental fatigue were found to be most common after stroke (Muina-Lopez & Guidon, 2013). However, the relationship between sensory processing patterns and perceived level of fatigue has not been studied among stroke survivors. It is important to understand fatigue poststroke to use more effective treatment strategies in rehabilitation.

The process through which the nervous system receives and responds to internal and external sensory information is called sensory processing (Dunn, 1997). Dunn’s framework outlines four patterns of sensory processing: registration, sensation seeking, sensory sensitivity, and sensation avoiding. These patterns reflect the interaction between neurological threshold and self-regulation strategies. Galvin et al. (2009) highlighted the importance of considering sensory processing preferences in rehabilitation for people with traumatic brain injury. Such evidence related to sensory processing abilities is limited for stroke survivors.

METHOD: We recruited stroke survivors aged ≥18 living in the community at least 1 year poststroke. To ensure that participants were able to understand and respond to study questionnaires, we included only potential participants who scored ≥20 on the Montreal Cognitive Assessment and excluded those with receptive aphasia. We also excluded potential participants with a history of other central nervous system disease besides stroke.

We used the Adolescent/Adult Sensory Profile to measure sensory processing and the Fugl-Meyer Assessment to evaluate upper extremity function. To understand participants’ perception of fatigue after stroke and its impact on daily occupational engagement, we used the Fatigue Short Form Questionnaire from the Neuro–QoL measures. To identify sensory patterns, we used descriptive analysis, and we also compared means of each sensory pattern with established normative data. Correlational analysis was used to identify relationships among sensory processing patterns, motor function, and fatigue perception.

RESULTS: Six participants (M age = 63 ± 7; 3 male, 3 female) who had had a stroke (M = 4 ± 3 yr earlier) participated in the study. Participants showed lower scores in the sensory avoiding pattern compared with the norming sample (M = 29.80 ± 1.79), t(5) = –5.96, p = .004. We found an inverse correlation between perceived level of fatigue and the sensation seeking pattern (r _s = –.89, p =.041). We found no correlations between motor abilities and sensory processing patterns.

CONCLUSION: Findings suggest the importance of considering sensory processing patterns in rehabilitation and their impact on client function, especially fatigue. People’s sensory processing patterns remain constant throughout life, but a stroke may affect the self-regulation strategies they use to react to environmental stimuli. Understanding a person’s sensory processing pattern can improve occupational therapists’ ability to design effective interventions that consider different parts of the individual’s lived experience, including environmental adaptation to fit specific sensory processing preferences.

References

Campfens, S. F., Zandvliet, S. B., Meskers, C. G. M., Schouten, A. C., van Putten, M. J. A. M., & van der Kooij, H. (2015). Poor motor function is associated with reduced sensory processing after stroke. Experimental Brain Research, 233, 1339–1349. https://doi.org/10.1007/s00221-015-4206-z

Connell, L. A., McMahon, N. E., & Adams, N. (2014). Stroke survivors’ experiences of somatosensory impairment after stroke: An interpretative phenomenological analysis. Physiotherapy, 100, 150–155. https://doi.org/10.1016/j.physio.2013.09.003

Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9(4), 23–25. https://doi.org/10.1097/00001163-199704000-00005

Galvin, J., Froude, E. H., & Imms, C. (2009). Sensory processing abilities of children who have sustained traumatic brain injuries. American Journal of Occupational Therapy, 63, 701–709. https://doi.org/10.5014/ajot.63.6.701

Muina-Lopez, R., & Guidon, M. (2013). Impact of post-stroke fatigue on self-efficacy and functional ability. European Journal of Physiotherapy, 15, 86–92. https://doi.org/10.3109/21679169.2013.792868