Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial.

After a stroke, many people lose some sensation in their leg or foot, and this can make balance and walking harder to recover. Researchers wanted to know whether it matters how sensory retraining is delivered, comparing an explicit approach, where people are guided to consciously identify and focus on stimuli, with an implicit approach, where people are simply repeatedly exposed to stimuli without being asked to actively judge them. Both groups received ten 45-minute sessions, and both showed improvements in sensation, balance, and mobility measures over the course of treatment, with changes described as ranging from about 10 to 31 percent depending on the measure. However, there was no statistically significant difference between the two approaches, and no interaction suggesting one method worked better over time than the other.

This suggests structured sensory-focused practice may help in this chronic population, but the trial cannot tell us which teaching style, explicit or implicit, drives that benefit, or whether the improvement stems from something other than the specific method used.

If you're living with reduced sensation in your leg or foot after a stroke, this affects how steady and confident you can feel while standing or walking. This study looked at two ways of retraining that lost sensation: one where you're asked to consciously notice and identify what you're feeling, and another where you're simply exposed to the same kinds of sensory stimulation repeatedly without being asked to focus on it. Both groups practiced for ten sessions, and both showed improvements in sensation, balance, and walking-related measures afterward.

But when researchers compared the two approaches directly, they found no statistically significant difference between them, meaning neither method stood out as clearly better than the other in this trial. This is encouraging in the sense that structured sensory practice, in either form, was linked to improvements, but it doesn't tell us definitively which style of training caused those changes, or whether some other factor was involved. The trial was also relatively small, so these findings would benefit from being confirmed in further research before drawing firm conclusions about which approach to prioritize.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses a question physiotherapists working in stroke rehabilitation often face: when retraining lower-limb sensory deficits in the chronic phase, does the learning style used, explicit versus implicit, influence outcomes in sensation, balance, and gait? The study randomised 64 participants with chronic post-stroke sensory impairment to ten sessions of either explicit sensory retraining, which involves conscious attention to and identification of stimuli, or implicit repeated exposure, which does not require active judgment of stimuli. Both groups showed within-group improvements across sensory, balance, mobility, and participation measures, described as 10 to 31 percent depending on the outcome, with the largest effect size (0.63) seen on the miniBEST balance measure. Critically, the intention-to-treat analysis found no statistically significant between-group difference and no time-by-group interaction, meaning the trial does not establish that either training style outperformed the other. For practice, this means the evidence supports that structured, sensory-focused training of some form was associated with improvement in this population, but it does not clarify whether explicit instruction or implicit exposure is preferable, or isolate which component of the intervention drove change.

The relatively small, two-arm sample and absence of a no-treatment or attention control group limit conclusions about causation, so the findings should be interpreted as informing feasibility and comparative delivery style rather than establishing superior effectiveness of either specific protocol.