Recovery of somatosensory deficits in acute stroke (original) (raw)
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Assessing and treating higher level somatosensory impairments post stroke
Topics in stroke rehabilitation
Poststroke somatosensory impairment is prevalent, yet commonly used clinical measures lack the sensitivity needed to quantify impairment and detect change due to intervention. This selective review, prepared and presented as a part of the I-Treat Conference (June 22, 2013, Columbus, Ohio), discusses the prevalence of somatosensory impairment after stroke, highlights measures of higher level somatosensory processing, and briefly reviews sensorimotor rehabilitation. The goal of this article is to encourage dialogue regarding the development and use of measures of higher level somatosensory function that will enable personalization of sensorimotor rehabilitation.
Neurorehabilitation and Neural Repair, 2007
Objective: To characterize the nature of sensory impairments after stroke, identify associated factors, and assess the relationships between sensory impairment, disability, and recovery. Methods: Prospective cross-sectional survey of 102 people with hemiparesis following their first stroke. Tactile and proprioceptive sensation in the affected arm and leg were measured using the Rivermead Assessment of Somatosensory Perception 2-4 weeks post-stroke. Demographics, stroke pathology, weakness, neglect, disability, and recovery were documented. Results: Tactile impairment was more common than proprioceptive ( P < .000), impairment of discrimination was more common than detection ( P < .000), and tactile sensation was more severely impaired in the leg than the arm ( P < .000). No difference in proprioception between the arm and leg ( P = .703) or between proximal and distal joints ( P = .589, P = .705) was found. The degree of weakness and the degree of stroke severity were signi...
A comparison of somatosensory evoked and motor evoked potential in stroke
Annals of Neurology, 1989
Nineteen patients with radiologically confirmed stroke, and varying degrees of hemiparesis, were studied using somatosensory evoked potentials and the recently developed technique of transcutaneous motor cortex stimulation. The functional deficit caused by stroke was assessed at the time of evoked potential testing and again on follow-up 2 months after stroke. Stroke location and degree of recovery were compared with the evoked potentials elicited an average of 8 days after the acute event. The motor response was better (p < 0.01) than somatosensory response at predicting an outcome in terms of functional recovery, both overall and when comparing patients with similar degrees of weakness. Normal somatosensory evoked potentials also predicted recovery but were not as sensitive as the motor evoked potentials (0.01 < p < 0.05). Motor evoked potentials in conjunction with clinical assessment may offer a means of more accurately predicting functional outcome following stroke than can be achieved with clinical assessment, with or without somatosensory evoked potentials. The additional finding that cortically evoked motor evoked potentials were delayed only by subcortical lesions is of interest and may extend the understanding of the pathophysiological mechanism of this response in humans. Macdonell RAL, Donnan GA, Bladin PF. A comparison of somatosensory evoked and motor evoked potentials in stroke.
Neurorehabilitation and Neural Repair
Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recovery influences motor recovery. Methods. Motor (Fugl-Meyer upper-extremity [FM-UE]) and somatosensory impairments (Erasmus modification of the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks and at 5, 12, and 26 weeks after a first-ever ischemic stroke. The longitudinal association between FM-UE and EmNSA-UE was examined in patients with motor and somatosensory impairments (FM-UE ≤ 60 and EmNSA-UE ≤ 37) at baseline. Results. A total of 94 patients were included in the longitudinal analysis. EmNSA-UE increased significantly up to 12 weeks poststroke. The longitudinal association between motor and somatos...
Archives of Physical Medicine and Rehabilitation, 2003
Objective: To assess the effectiveness of a rehabilitative training program for deficits in somatic sensation and motor control of the hand in patients with pure sensory stroke. Design: Multiple baseline and before-after follow-up trial with behavioral analysis of single cases. Setting: Rehabilitation unit of a university hospital in Italy. Participants: Four patients were studied: 2 had a unilateral lesion confined to the parietal lobe (patients 1, 2), and 2 had a unilateral lesion of the thalamus (patients 3, 4) that also lapped the posterior limb of the internal capsule. All 4 patients had chronic deficits in somatic sensation and motor control of the contralesional hand. Intervention: Behavioral training consisting of exercises aimed at improving somatic sensation and motor control of the affected, contralesional hand. Thirty treatment sessions, each lasting 50 minutes, were performed. Main Outcome Measures: Somatic deficit was evaluated with 5 tests, and motor control deficit was assessed with 4 tests. One functional test estimated the influence of somatic deficit on daily activities. A visual analog scale (VAS) was also submitted to the patients' relatives to evaluate the amount of use of the affected arm in daily life activities. A baseline was obtained by recording each measure, except for the VAS, 4 times at the first evaluation session. Evaluation sessions were conducted before, after, and 6 months after the end of the experimental treatment. Results: All patients showed a stable baseline in at least 8 of the outcome measures. Patients 1 and 2 significantly improved in 9 and 7 outcome measures, respectively. Patients 3 and 4 improved in 4 and 7 outcome measures, respectively. With the exception of case 3, all patients considerably increased their use of the affected arm during daily life. The improvement was generally stable over a 6-month period, suggesting that the treatment had a long-term effect. Conclusions: Results suggest the possible effectiveness of our training program for treating somatic and motor control deficits of the hand in patients with cortical or subcortical pure sensory stroke.
Journal of Stroke and Cerebrovascular Diseases, 2009
Background: Predicting motor recovery in the arm of patients with stroke is generally based on clinical examination. However, neurophysiologic measures may also have a predictive value. Objective: We sought to assess the value of somatosensory evoked potentials (SSEPs) in predicting motor recovery of the upper limb and to determine whether any of the SSEPs components can predict the severity of the deficit so that it can document the size of the stroke (lacunar or large-vessel stroke). Method:
Journal of Rehabilitation Medicine, 2014
Objective: To investigate whether somatosensory impairments are more common in individuals with post-stroke shoulder pain than in those without post-stroke shoulder pain and healthy controls. Design: Descriptive analysis of a convenience sample. Participants: Forty-nine individuals with stroke, 24 with and 25 without post-stroke shoulder pain (median age 65 years), and 11 age-and sex-matched healthy controls. Methods: Perception and pain thresholds for cold, warm and heat (thermal thresholds), and pain thresholds for pressure and pin prick (mechanical thresholds) were assessed using quantitative sensory testing (QST). Passive range of motion, motor function, resistance to passive movements, light touch and proprioception were assessed in the upper extremities. Shoulder pain characteristics were recorded in the poststroke shoulder pain group. Results: There were no significant differences between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain in any of the QST assessments, but more participants in the post-stroke shoulder pain group reported abnormal cold sensation in the affected side. Both stroke groups had generally higher thermal thresholds and more extreme low or high mechanical thresholds than the healthy controls. Conclusion: Somatosensory impairments are common among individuals with stroke compared with healthy controls. The non-significant differences in QST thresholds between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain indicate that somatosensory impairments have only a small impact on post-stroke shoulder pain.
Frontiers in Human Neuroscience, 2022
Background: We investigated whether transcranial magnetic stimulation (rTMS) over the primary somatosensory cortex (S1) and sensory stimulation (SS) could promote upper limb recovery in participants with subacute stroke. Methods: Participants were randomized into four groups: rTMS/Sham SS, Sham rTMS/SS, rTMS/SS, and control group (Sham rTMS/Sham SS). Participants underwent ten sessions of sham or active rTMS over S1 (10 Hz, 1,500 pulses, 120% of resting motor threshold, 20 min), followed by sham or active SS. The SS involved active sensory training (exploring features of objects and graphesthesia, proprioception exercises), mirror therapy, and Transcutaneous electrical nerve stimulation (TENS) in the region of the median nerve in the wrist (stimulation intensity as the minimum intensity at which the participants reported paresthesia; five electrical pulses of 1 ms duration each at 10 Hz were delivered every second over 45 min). Sham stimulations occurred as follows: Sham rTMS, coil was held while disconnected from the stimulator, and rTMS noise was presented with computer loudspeakers with recorded sound from a real stimulation. The Sham SS received therapy in the unaffected upper limb, did not use the mirror and received TENS stimulation for only 60 seconds. The primary outcome was the Body Structure/Function: Fugl-Meyer Assessment (FMA) and Nottingham Sensory Assessment (NSA); the secondary outcome was the Activity/Participation domains, assessed with Box and Block Test, Motor Activity Log scale, Jebsen-Taylor Test, and Functional Independence Measure. Results: Forty participants with stroke ischemic (n = 38) and hemorrhagic (n = 2), men (n = 19) and women (n = 21), in the subacute stage (10.6 ± 6 weeks) had a mean age of 62.2 ± 9.6 years, were equally divided into four groups (10 participants in each
Somatosensory Impairment and Chronic Pain Following Stroke: An Observational Study
International Journal of Environmental Research and Public Health
Background: Chronic pain and somatosensory impairment are common following a stroke. It is possible that an interaction exists between pain and somatosensory impairment and that a change in one may influence the other. We therefore investigated the presence of chronic pain and self-reported altered somatosensory ability in individuals with stroke, aiming to determine if chronic pain is more common in stroke survivors with somatosensory impairment than in those without. Methods: Stroke survivors were invited to complete an online survey that included demographics, details of the stroke, presence of chronic pain, and any perceived changes in body sensations post-stroke. Results: Survivors of stroke (n = 489) completed the survey with 308 indicating that they experienced chronic pain and 368 reporting perceived changes in somatosensory function. Individuals with strokes who reported altered somatosensory ability were more likely to experience chronic pain than those who did not (OR = 1...