The Prevalence and Magnitude of Impaired Cutaneous Sensation across the Hand in the Chronic Period Post-Stroke

Abstract

Sensation is commonly impaired immediately post-stroke but little is known about the long-term changes in cutaneous sensation that have the capacity to adversely impact independence and motor-function. We investigated cutaneous sensory thresholds across the hand in the chronic post-stroke period. Cutaneous sensation was assessed in 42 community-dwelling stroke patients and compared to 36 healthy subjects. Sensation was tested with calibrated monofilaments at 6 sites on the hand that covered the median, ulnar and radial innervation territories and included both glabrous (hairless) and hairy skin. The motor-function of stroke patients was assessed with the Wolf Motor Function Test and the upper-limb motor Fugl-Meyer Assessment. Impaired cutaneous sensation was defined as monofilament thresholds >3 SD above the mean of healthy subjects and good sensation was ≤3 SD. Cutaneous sensation was impaired for 33% of patients and was 40–84% worse on the more-affected side compared to healthy subjects depending on the site (p<0.05). When the stroke patient data were pooled cutaneous sensation fell within the healthy range, although ∼1/3 of patients were classified with impaired sensation. Classification by motor-function revealed low levels of impaired sensation. The magnitude of sensory loss was only apparent when the sensory-function of stroke patients was classified as good or impaired. Sensation was most impaired on the dorsum of the hand where age-related changes in monofilament thresholds are minimal in healthy subjects. Although patients with both high and low motor-function had poor cutaneous sensation, overall patients with low motor-function had poorer cutaneous sensation than those with higher motor-function, and relationships were found between motor impairments and sensation at the fingertip and palm. These results emphasize the importance of identifying the presence and magnitude of cutaneous sensory impairments in the chronic period after stroke.

The relationship of plantar cutaneous sensation and standing balance post-stroke

“…[7][8][9] This is despite the fact that the prevalence of somatosensation deficits poststroke (which includes proprioception and cutaneous sensation) ranges from 33 to 65%. [10][11][12] These deficits are mainly caused by damage to the primary somatosensory cortex which results in the inability to perceive, process, and interpret sensory feedback. This leads to altered motor responses which contribute further to abnormal sensory feedback creating a vicious cycle resulting in balance impairment.…”

Predictors of Hand Function Following Digit Replantation: Quantitative Review and Meta-Analysis

“…Maintaining sensation of the hand is important for fine motor control, prevention of injury, and quality of life. 25 The 2PD test serves as a reliable measure of sensory tactile function and is associated with nerve integrity following injury and/or surgery. 26 In the current study, we found static 2PD was influenced by age, mechanism of amputation, and level of amputation (Table 3, P < .05).…”

SITAR: a system for independent task-oriented assessment and rehabilitation

“…34 The AsTex® is a rectangular plastic board to measure edge detection capabilities, with parallel vertical ridges and grooves that logarithmically reduce in width and are printed on a specific test area laterally across the board. The errors that can occur due to changes in force applied by the index finger on the board or the velocity with which the finger is moved 35 were overcome by placing the AsTex® board on the SITAR table, which can sense the touch force and position on the AsTex® board. To assess the tactile resolution, participants placed their index finger on the rough end of the AsTex® board, which was slid slowly along the board by a therapist until the point where the surface started to feel smooth to the subject.…”