It is estimated that somatosensory deficits (SSD) are present in more than half of ischemic strokes. SSD can influence motor outcomes and thereby impair participation in activities of daily living ...(ADL). Rather few studies have investigated SSD after stroke. Previous studies showed a negative correlation between SSD following stroke, the functional prognosis of rehabilitation. The aim of this study is to illustrate the influence of SSD in functional outcomes as measured by the functional independence measure (FIM).
Prospective observational study, with retrospective analysis of admission and discharge data, after a 1st inpatient rehabilitation program. Four groups were created: A - no SSD, B - only superficial SSD, C - only deep SSD, and D - both types of SSD. Functionality was measured by the FIM, subdivided in ADL, motor outcomes, cognitive outcomes and total outcome. The results were analyzed with Anova.
From a total of 119 patients who were discharged in 2014, complete data on SSD were available for 79, of which 57% were women. Mean age was 60.84 years. In 68% of cases the stroke was ischaemic. On average, patient stay was 65.82 days (SD 13.66). At admission, 22 patients had no SSD, 9 patients had changes only in superficial sensitivity, 3 had only deep sensitivity and 45 had both types of SSD. There are significant differences between having no SSD and having both types of SSD, regarding ADL, motor scores and total FIM scores, at admission. At discharge, the differences were statistically significant for: ADL, motor scores, cognitive and total FIM scores, as well as for the change of ADL scores and total FIM scores.
SSD had an impact in the functional outcomes, especially when both SSD were impaired. In agreement with previously published data, SSD after stroke have a negative effect on motor and functional performance.
Central nervous system diseases are often associated with somatosensory dysfunction. Somatosensory deficits affect postural and motor control. However, postural and motor control can be improved by ...using visual and vestibular sensory information, and by emphasizing somatosensory information. An understanding of somatosensory function should distinguish it from other dysfunctions.
Central nervous system diseases are often associated with somatosensory dysfunction. Somatosensory deficits affect postural and motor control. However, postural and motor control can be improved by ...using visual and vestibular sensory information, and by emphasizing somatosensory information. An understanding of somatosensory function should distinguish it from other dysfunctions.
Somatosensory deficits are common symptoms post stroke. Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex is able to promote motor rehabilitation, whereby its impact on ...somatosensory functioning remains unknown. This study was designed to evaluate the association between somatosensory deficits and corticospinal excitability following stroke, with the purpose to provide insights on rTMS interventions for the management of somatosensory deficits.
Somatosensory functioning and corticospinal excitability (motor-evoked potential, MEP; cortical silence period, CSP) were evaluated from a group of sixteen patients with unilateral ischemic stroke in the acute or subacute phase.
Results indicated that the uncommon presentation of larger MEPs in ipsilesional
contralesional motor cortex was associated with worse somatosensory function compared to those with a smaller MEP in ipsilesional motor cortex. Moreover, increased MEP ratio (ipsilesional
contralesional motor cortex) was associated with better somatosensory function in patients with well-preserved somatosensory function.
In well-recovered patients, an increased MEP ratio between the ipsilesional and contralesional motor cortex could be an indicator of improved somatosensory functioning following stroke.
In the past years, there have been increasing research activities focusing on somatosensory symptoms following stroke. However, as compared to the large number of clinical and neuroimaging studies on ...motor symptoms, the number of studies tracing somatosensory symptoms after stroke and their recovery is rather small. It is an ongoing discussion, to which extent somatosensory deficits after stroke influence patient's long-term outcome in motor and sensory performance and functional independence in activities of daily living. Modern brain imaging techniques allow for studying the impact of stroke lesion localization and size on acute and persisting clinical impairment. Here, we review the literature on somatosensory symptoms after stroke. We summarize epidemiological information on frequency and characteristics of somatosensory symptoms affecting all parts of the body in the acute and chronic stage of stroke. We further give an overview of brain imaging studies of stroke affecting the somatosensory system. Finally, we identify open questions which need to be addressed in future research and summarize the implications for clinical practice.
Somatosensory deficits after stroke are a major health problem, which can impair patients' health status and quality of life. With the developments in human brain mapping techniques, particularly ...magnetic resonance imaging (MRI), many studies have applied those techniques to unravel neural substrates linked to apoplexy sequelae. Multi-parametric MRI is a vital method for the measurement of stroke and has been applied to diagnose stroke severity, predict outcome and visualize changes in activation patterns during stroke recovery. However, relatively little is known about the somatosensory deficits after stroke and their recovery. This review aims to highlight the utility and importance of MRI techniques in the field of somatosensory deficits and synthesizes corresponding articles to elucidate the mechanisms underlying the occurrence and recovery of somatosensory symptoms. Here, we start by reviewing the anatomic and functional features of the somatosensory system. And then, we provide a discussion of MRI techniques and analysis methods. Meanwhile, we present the application of those techniques and methods in clinical studies, focusing on recent research advances and the potential for clinical translation. Finally, we identify some limitations and open questions of current imaging studies that need to be addressed in future research.
Background
Sensorimotor impairments of the upper limb (UL) are common after stroke, but there is a lack of evidence‐based interventions to improve functioning of UL.
Objective
To evaluate (1) the ...efficacy of sensory relearning and task‐specific training compared to task‐specific training only, and (2) the feasibility of the training in chronic stroke.
Design
A pilot randomized controlled trial.
Setting
University hospital outpatient clinic.
Participants
Twenty‐seven participants (median age; 62 years, 20 men) were randomized to an intervention group (IG; n = 15) or to a control group (CG; n = 12).
Intervention
Both groups received training twice weekly in 2.5‐hour sessions for 5 weeks. The training in the IG consisted of sensory relearning, task‐specific training, and home training. The training in the CG consisted of task‐specific training.
Main Outcome Measures
Primary outcome was sensory function (touch thresholds, touch discrimination, light touch, and proprioception). Secondary outcomes were dexterity, ability to use the hand in daily activities, and perceived participation. A blinded assessor conducted the assessments at baseline (T1), post intervention (T2), and at 3‐month follow‐up (T3). Nonparametric analyses and effect‐size calculations (r) were performed. Feasibility was evaluated by a questionnaire.
Results
After the training, only touch thresholds improved significantly from T1 to T2 (p = .007, r = 0.61) in the IG compared to the CG. Within the IG, significant improvements were found from T1 to T2 regarding use of the hand in daily activities (p = .001, r = 0.96) and movement quality (p = .004, r = 0.85) and from T1 to T3 regarding satisfaction with performance in meaningful activities (p = .004, r = 0.94). The CG significantly improved the performance of using the hand in meaningful activities from T1 to T2 (p = .017, r = 0.86). The training was well tolerated by the participants and performed without any adverse events.
Conclusions
Combined sensory relearning and task‐specific training may be a promising and feasible intervention to improve UL sensorimotor function after stroke.
Background
Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct ...to peripherally administered rehabilitation therapies.
Objective
To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity.
Methods
Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions.
Results
Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected (F(2, 76.163) = 3.5, P = .035) and unaffected arm (F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 (F(2, 133.027) = 3.518, P = .032) and N45-P60 (F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 (F(2, 69.64) = 3.37, P = .04), N60 (F(2, 47.343) = 4.375, P = .018), and P100 (F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later.
Conclusions
Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.
The incidence of stroke plays the foremost role in the genesis of central neuropathic pain. Central post-stroke pain (CPSP) is a central pain arising from a vascular lesion in the central nervous ...system that elicits somatosensory deficits, often contralateral to stroke lesions. It is expressed as continuous or intermittent pain accompanied by sensory abnormalities like dysesthesia and allodynia. CPSP remains de-emphasized due to the variation in onset and diversity in symptoms, besides the difficulty of distinguishing it from other post-stroke pains, often referred to as a diagnosis of exclusion. Spinothalamic dysfunction, disinhibition of the medial thalamus, and neuronal hyperexcitability combined with deafferentation in thalamocortical regions are the mechanisms underlying central pain, which play a significant role in the pathogenesis of CPSP. The treatment regimen for CPSP seems to be perplexed in nature; however, based on available studies, amitriptyline and lamotrigine are denoted as first-line medications and non-pharmacological choices may be accounted for cases intractable to pharmacotherapy. This review attempts to provide an overview of the mechanisms, existing management approaches, and emerging targets of CPSP. A profound understanding of CPSP aids in optimizing the quality of life among stroke sufferers and facilitates further research to develop newer therapeutic agents for managing CPSP.
In a patient suffering from tactile agnosia a comparison was made (using the ABABAB paradigm) between three blocks of neuropsychological rehabilitation sessions involving off-line anodal transcranial ...direct current stimulation (anodal-tDCS) and three blocks of rehabilitation sessions without tDCS. During the blocks with anodal-tDCS, the stimulation was administered in counterbalanced order to two sites: i) the perilesional parietal area (specific stimulation) and ii) an occipital area far from the lesion (nonspecific stimulation).
Rehabilitation associated with anodal-tDCS (in particular in the perilesional areas) is more efficacious than without stimulation.
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