Article

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

ABSTRACT 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 · 3.70 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 · 2.17 Impact Factor
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    • "Somatosensory training has been reported to be frequently overlooked in current rehabilitation [7]. However, this is not surprising when one considers that there is both a lack of a gold standard measurement tool for assessing somatosensory impairment [5] [6] [8] along with a lack of evidence for the effectiveness of interventions in improving somatosensory impairment after stroke [9]. A recent systematic review concluded there to be both limited studies of individual interventions along with insufficient evidence to support or refute their effectiveness in improving sensory impairment, upper limb function or participants' functional status and participation after stroke [9]. "
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    ABSTRACT: Abstract Background Somatosensory ability is commonly impaired after stroke. Despite the growing recognition for the need to understand service users’ experiences and perspectives in health services provision, the experiences of stroke survivors’ living with somatosensory impairment have yet to be reported. Objective To gain an insight into how stroke survivors experience somatosensory impairment after stroke. Design A qualitative study design was used with data analysed using Interpretative Phenomenological Analysis. Methods Semi-structured in-depth interviews were carried out with purposively selected community dwelling stroke survivors who had somatosensory impairment. Results Five stroke survivors were interviewed in this study. Data analysis resulted in the emergence of three superordinate themes (i) making sense of somatosensory impairment, (ii) interplay of somatosensory impairment and motor control for executing tasks and (iii) perseverance versus learned non-use. The stroke survivors in this study were aware that their somatosensory ability was affected as a result of their stroke, but had difficulty in articulating their experiences of sensation and the impact of the impairment on functional ability. Most often somatosensory impairment was described in terms of difficulties with executing specific tasks, particularly by the upper limb. Conclusion It is important to be aware that somatosensory impairment is of concern to stroke survivors. Further research is needed to develop evidence-based and practice-appropriate clinical assessment tools and treatment strategies for somatosensory rehabilitation after stroke.
    Physiotherapy 06/2014; 100(2):150-155. DOI:10.1016/j.physio.2013.09.003 · 2.11 Impact Factor
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