Somatosensory impairment after stroke: Frequency of different deficits and their recovery

Division of Rehabilitation and Ageing, Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK.
Clinical Rehabilitation (Impact Factor: 2.24). 08/2008; 22(8):758-67. DOI: 10.1177/0269215508090674
Source: PubMed


To investigate the frequency of somatosensory impairment in stroke patients within different somatosensory modalities and different body areas, and their recovery.
Prospective observational study.
Two stroke rehabilitation units.
Seventy patients with a first stroke (36 men, 34 women; average age, 71, SD 10.00 years; average time since stroke onset, 15 days) were assessed on admission and two, four and six months after stroke.
Not applicable.
Nottingham Sensory Assessment.
Somatosensory impairment was common after stroke; 7-53% had impaired tactile sensations, 31-89% impaired stereognosis, and 34-64% impaired proprioception. When comparing somatosensory modalities within body areas the kappa values were low (kappa values<0.54). Recovery occurred over time, though not significantly in lower limb tactile sensations. Stroke severity was the main factor influencing initial somatosensory impairment, but accounted for a small amount of the variance (21-41%). Initial somatosensory impairment was significantly related to somatosensory ability at six months, accounting for 46-71% of the variance.
Proprioception and stereognosis were more frequently impaired than tactile sensations. The different somatosensory modalities showed only slight agreement between impairment within the same body areas, suggesting that the modalities are independent of each other and all should be assessed. High agreements were found between different body areas for each somatosensory modality. Somatosensory impairment was associated with stroke severity, however low variance indicated other factors were involved.

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Available from: Louise Anne Connell, Oct 13, 2015
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    • "It has also been shown that both the ipsilateral and contralateral limb (with respect to the side of the lesion) is affected after unilateral hemisphere stroke (Connell et al., 2008; Niessen et al., 2008). The pathophysiological mechanisms, which result in deficits of the ipsilateral upper extremity, are largely unknown. "
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    ABSTRACT: The world's population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover , the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist-and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.
    Frontiers in Neuroscience 04/2015; 9(15). DOI:10.3389/fnhum.2015.00120 · 3.66 Impact Factor
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    • "Rehabilitation after stroke has a strong emphasis on reducing motor impairment to improve the quality of life (Kwakkel et al. 2004). Within rehabilitation practice, sensory impairment does not receive as much attention as motor impairment does, although it is known that sensory impairment is common after stroke (Connell et al. 2008) and related to motor impairment (Schabrun and Hillier 2009). "
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    ABSTRACT: The possibility to regain motor function after stroke depends on the intactness of motor and sensory pathways. In this study, we evaluated afferent sensory pathway information transfer and processing after stroke with the coherence between cortical activity and a position perturbation (position-cortical coherence, PCC). Eleven subacute stroke survivors participated in this study. Subjects performed a motor task with the affected and non-affected arm while continuous wrist position perturbations were applied. Cortical activity was measured using EEG. PCC was calculated between position perturbation and EEG at the contralateral and ipsilateral sensorimotor area. The presence of PCC was quantified as the number of frequencies where PCC is larger than zero across the sensorimotor area. All subjects showed significant contralateral PCC in affected and non-affected wrist tasks. Subjects with poor motor function had a reduced presence of contralateral PCC compared with subjects with good motor function in the affected wrist tasks. Amplitude of significant PCC did not differ between subjects with good and poor motor function. Our results show that poor motor function is associated with reduced sensory pathway information transfer and processing in subacute stroke subjects. Position-cortical coherence may provide additional insight into mechanisms of recovery of motor function after stroke.
    Experimental Brain Research 02/2015; 233(4). DOI:10.1007/s00221-015-4206-z · 2.04 Impact Factor
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    • "There is no widely-accepted or standardized test of sensory impairments after stroke [34]. Impairments in cutaneous sensation are usually assessed at the index fingertip [9], [35], or clinically by descriptors such as ‘present’, ‘absent’ or ‘impaired’ [8], [18], [36], [37]. The Fugl-Meyer Assessment (FMA) is a common measure of post-stroke motor performance. "
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    ABSTRACT: Sensation is commonly impaired immediately post-stroke but little is known about the long-term changes in cutaneous sensation that have the capacity to adversely impact independence and motor-function. We investigated cutaneous sensory thresholds across the hand in the chronic post-stroke period. Cutaneous sensation was assessed in 42 community-dwelling stroke patients and compared to 36 healthy subjects. Sensation was tested with calibrated monofilaments at 6 sites on the hand that covered the median, ulnar and radial innervation territories and included both glabrous (hairless) and hairy skin. The motor-function of stroke patients was assessed with the Wolf Motor Function Test and the upper-limb motor Fugl-Meyer Assessment. Impaired cutaneous sensation was defined as monofilament thresholds >3 SD above the mean of healthy subjects and good sensation was ≤3 SD. Cutaneous sensation was impaired for 33% of patients and was 40-84% worse on the more-affected side compared to healthy subjects depending on the site (p<0.05). When the stroke patient data were pooled cutaneous sensation fell within the healthy range, although ∼1/3 of patients were classified with impaired sensation. Classification by motor-function revealed low levels of impaired sensation. The magnitude of sensory loss was only apparent when the sensory-function of stroke patients was classified as good or impaired. Sensation was most impaired on the dorsum of the hand where age-related changes in monofilament thresholds are minimal in healthy subjects. Although patients with both high and low motor-function had poor cutaneous sensation, overall patients with low motor-function had poorer cutaneous sensation than those with higher motor-function, and relationships were found between motor impairments and sensation at the fingertip and palm. These results emphasize the importance of identifying the presence and magnitude of cutaneous sensory impairments in the chronic period after stroke.
    PLoS ONE 08/2014; 9(8):e104153. DOI:10.1371/journal.pone.0104153 · 3.23 Impact Factor
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