Network of sites and ‘up-skilled’ therapists to deliver best-practice stroke rehabilitation of the upper limb.

Two participant groups are provided with interventions: 1. People with stroke and somatosensory loss 2. Therapists (occupational therapists and physiotherapists) Participant Group 1 (People with stroke) – will receive SENSe Therapy. SENSe Therapy (as outlined in the Study of the Effectiveness of Neuro-rehabilitation on Sensation, by Carey et al., 2011), is a science and evidence based rehabilitation therapy to improve the sense of touch when touching objects and using the hand in everyday tasks. The intervention will be delivered face to face by Occupational Therapists and/or Physiotherapists within specialist therapy centres. The intervention involves sensory discrimination training of texture discrimination, sensing the position of the upper limb in space, recognising objects through the sense of touch and learning how to apply these skills in daily tasks identified by the person with stroke. The intervention will be tailored according to level of impairment and functional goals. The dose will be 10 one-hour sessions, over a period of 6 weeks. The frequency of sessions will be 1 to 2 times a week. Fidelity of the intervention will be assessed using checklists (with self-evaluation and evaluation via an independent blinded SENSe Trainer) and audit of treatment notes. Carey, L.M., R. Macdonnell, and T. Matyas, SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation. A randomized controlled trial. Neurorehabilitation and Neural Repair, 2011. 25: p. 304-313. Participant Group 2 (Therapists) – will be involved in an implementation intervention to change behaviour. Occupational therapists and physiotherapists will be involved in an implementation intervention and receive training to deliver SENSe Therapy. Therapists will be up-skilled in delivery of SENSe Therapy using interactive workshops facilitated by trained clinical researchers and involving multimedia resources. The workshops will involve 3 x 4 hours sessions, and be supported by independent learning modules (estimated to take 1 to 2 hours each). The participants who are therapists will also receive supervision and mentoring so they can deliver SENSe Therapy to people with stroke within specialist therapy centres. The knowledge and skill of therapists will be measured before, during and after delivery of SENSe Therapy and during the up-skilling process. Confidence and ability to deliver SENSe Therapy will be evaluated, and will include assessment of treatment fidelity. Treatment fidelity will include self-evaluation and assessment by blinded SENSe Therapy Trainers. This process will use criterion checklists to rate fidelity of the intervention observed via video recordings, and documented in the treatment notes.