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
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    • "The RASP, which requires commercially registered equipment (Winward et al., 2002), involves more modalities than the previously mentioned instruments but does not include stereognosis, which is the most important component of hand sensation in people with stroke (Gaubert & Mockett, 2000). The Revised Nottingham Sensory Assessment (rNSA; Lincoln, Jackson, & Adams, 1998), a shorter version of the original Nottingham Sensory Assessment (Lincoln et al., 1991), contains all the sensory modalities, including stereognosis, based on those used in everyday clinical practice (Connell et al., 2008) and might be considered for clinicians to assess comprehensive somatosensory impairments in people with stroke. The rNSA has acceptable interrater reliability, but its validity and responsiveness have not been reported (Lincoln et al., 1998). "
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    ABSTRACT: Objectives: To establish the concurrent validity, predictive validity, and responsiveness of the revised Nottingham Sensation Assessment (rNSA) during rehabilitation in individuals with stroke. Method: The study recruited 147 patients with stroke. The main measure was the rNSA, and outcome 10 measures were the Fugl-Meier Assessment (FMA) sensory subscale (FMA-S) and motor subscale (FMA-M), and the Nottingham Extended Activities of Daily Living (NEADL). Results: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a strong predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for FMA-M and NEADL, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = 0.51–0.83). Conclusion: The results of our study might support the concurrent validity, predictive validity, and responsiveness of the rNSA for individuals with stroke. We recommended the use of all of the rNSA sensory modalities to represent concurrent somatosensory function, motor performance, and participation in activities of daily living. In contrast, the specific sensory 3 modality of the rNSA could predict functional and participation conditions. That is, after an intervention, proprioception could possibly predict somatosensory functions, and stereognosis and tactile-pinprick for proximal upper limb could possibly predict motor performance and daily activities, respectively. The tactile sensation subscale of the rNSA was more responsive in detecting a change after an intervention for stroke rehabilitation than the proprioception and stereognosis subscales.
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    • "c o m / l o c a t e / y n i c l the ability to recognize the location and movement of our limbs in space (Sherrington, 1907). Although somatosensory symptoms are present in a large number of stroke patients, detailed reports on the affected components of somatosensation are rare (Carey and Matyas, 2011; Connell et al., 2008; Tyson et al., 2008). "
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    ABSTRACT: The aim of this study was to investigate the relationship between stroke lesion location and the resulting somatosensory deficit. We studied exteroceptive and proprioceptive somatosensory symptoms and stroke lesions in 38 patients with first-ever acute stroke. The Erasmus modified Nottingham Sensory Assessment was used to clinically evaluate somatosensory functioning in the arm and hand within the first week after stroke onset. Additionally, more objective measures such as the perceptual threshold of touch and somatosensory evoked potentials were recorded. Non-parametric voxel-based lesion-symptom mapping was performed to investigate lesion contribution to different somatosensory deficits in the upper limb. Additionally, structural connectivity of brain areas that demonstrated the strongest association with somatosensory symptoms was determined, using probabilistic fiber tracking based on diffusion tensor imaging data from a healthy age-matched sample. Voxels with a significant association to somatosensory deficits were clustered in two core brain regions: the central parietal white matter, also referred to as the sensory component of the superior thalamic radiation, and the parietal operculum close to the insular cortex, representing the secondary somatosensory cortex. Our objective recordings confirmed findings from clinical assessments. Probabilistic tracking connected the first region to thalamus, internal capsule, brain stem, postcentral gyrus, cerebellum, and frontal pathways, while the second region demonstrated structural connections to thalamus, insular and primary somatosensory cortex. This study reveals that stroke lesions in the sensory fibers of the superior thalamocortical radiation and the parietal operculum are significantly associated with multiple exteroceptive and proprioceptive deficits in the arm and hand.
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    • "Active sensation or haptic touch is the ability to use movement of the hand and arm to solicit somatosensory information from the environment (Lederman and Klatzky, 1997). Haptic impairment is a common result of stroke identified in 31–89% of cases (Kim and Choi-Kwon, 1996; Gaubert and Mockett, 2000; Connell et al., 2008; Carey and Matyas, 2011; Borstad et al., 2012a). The functional consequence of haptic impairment can be conceptualized in two ways. "
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    ABSTRACT: Frontoparietal white matter supports information transfer between brain areas involved in complex haptic tasks such as somatosensory discrimination. The purpose of this study was to gain an understanding of the relationship between microstructural integrity of frontoparietal network white matter and haptic performance in persons with chronic stroke and to compare frontoparietal network integrity in participants with stroke and age matched control participants. Nineteen individuals with stroke and 16 controls participated. Haptic performance was quantified using the Hand Active Sensation Test (HASTe), an 18-item match-to-sample test of weight and texture discrimination. Three tesla MRI was used to obtain diffusion-weighted and high-resolution anatomical images of the whole brain. Probabilistic tractography was used to define 10 frontoparietal tracts total; Four intrahemispheric tracts measured bilaterally 1) thalamus to primary somatosensory cortex (T-S1), 2) thalamus to primary motor cortex (T-M1), 3) primary to secondary somatosensory cortex (S1 to SII) and 4) primary somatosensory cortex to middle frontal gyrus (S1 to MFG) and, 2 interhemispheric tracts; S1-S1 and precuneus interhemispheric. A control tract outside the network, the cuneus interhemispheric tract, was also examined. The diffusion metrics fractional anisotropy (FA), mean diffusivity (MD), axial (AD) and radial diffusivity (RD) were quantified for each tract. Diminished FA and elevated MD values are associated with poorer white matter integrity in chronic stroke. Nine of 10 tracts quantified in the frontoparietal network had diminished structural integrity poststroke compared to the controls. The precuneus interhemispheric tract was not significantly different between groups. Principle component analysis across all frontoparietal white matter tract MD values indicated a single factor explained 47% and 57% of the variance in tract mean diffusivity in stroke and control groups respectively. Age strongly correlated with the shared variance across tracts in the control, but not in the poststroke participants. A moderate to good relationship was found between ipsilesional T-M1 MD and affected hand HASTe score (r=−0.62, p=0.006) and less affected hand HASTe score (r=−0.53, p=0.022). Regression analysis revealed approximately 90% of the variance in affected hand HASTe score was predicted by the white matter integrity in the frontoparietal network (as indexed by MD) in poststroke participants while 87% of the variance in HASTe score was predicted in control participants. This study demonstrates the importance of frontoparietal white matter in mediating haptic performance and specifically identifies that T-M1 and precuneus interhemispheric tracts may be appropriate targets for piloting rehabilitation interventions, such as noninvasive brain stimulation, when the goal is to improve poststroke haptic performance.
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