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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    • "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
    • "Prevalence of proprioceptive deficits was found to exceed that of tactile deficits after stroke [2]. Muscle stretch addresses the afferent volley involved in motor control, mainly proprioception , and activates cortical motor areas. "
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    ABSTRACT: Sensory feedback is of vital importance in motor control, yet rarely assessed in diseases with impaired motor function like stroke. Muscle stretch evoked potentials (StrEPs) may serve as a measure of cortical sensorimotor activation in response to proprioceptive input. The aim of this study was 1) to determine early and late features of the StrEP and 2) to explore whether StrEP waveform and features can be measured after stroke. Consistency of StrEP waveforms and features was evaluated in 22 normal subjects. StrEP features and similarity between hemispheres were evaluated in eight sub-acute stroke subjects. StrEPs of normal subjects had a consistent shape across conditions and sessions (mean cross correlation waveforms > 0:75). Stroke subjects showed heterogeneous StrEP waveforms. Stroke subjects presented a normal early peak (40ms after movement onset) but later peaks had abnormal amplitudes and latencies. No significant differences between stroke subjects with good and poor motor function were found (p > 0:14). With the consistent responses of normal subjects the StrEP meets a prerequisite for potential clinical value. Recording of StrEPs is feasible even in sub-acute stroke survivors with poor motor function. How StrEP features relate to clinical phenotypes and recovery needs further investigation.
    IEEE Transactions on Neural Systems and Rehabilitation Engineering 01/2015; 23(4). DOI:10.1109/TNSRE.2015.2388692 · 3.19 Impact Factor
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