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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    • "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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    • "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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    • "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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