The prevalence, distribution, and functional importance of lower limb somatosensory impairments in chronic stroke survivors: a cross sectional observational study

Abstract

Lower limb somatosensory impairments are present in the majority of chronic stroke survivors and differ widely across modalities. Deficits of foot and ankle proprioception are most strongly associated with, but not predictive, of reported falls. The relative contribution of lower limb somatosensory impairments to mobility in chronic stroke survivors appears limited. Further investigation, particularly with regard to community mobility and falls, is warranted. Implications for Rehabilitation Somatosensory impairments in the lower limb were present in approximately half of this cohort of chronic stroke survivors. Tactile discrimination is commonly impaired; clinicians should include an assessment of discriminative ability. Deficits of foot and ankle proprioception are most strongly associated with reported falls. Understanding post-stroke lower limb somatosensory impairments may help inform therapeutic strategies that aim to maximise long-term participation, minimise disability, and reduce falls.

Assessing lower limb position sense in stroke using the gradient discrimination test (GradDT™) and step-height discrimination test (StepDT™): a reliability and validity study

“…Impaired proprioceptive function in the lower limbs is characteristic of several clinical populations and is associated with altered postural control, a varied unstable gait, and increased falls risk [6][7][8]. Following stroke, 30-56% of people have somatosensory deficits of the lower limbs [9,10], with somatosensory deficits and motor weakness resulting in worse functional outcomes at six months than motor weakness alone [11]. Moreover, difficulty sensing the position of the foot is reported by people with stroke to impact their ability to walk outdoors, maintain balance and is implicated in falls [7,12].…”

“…Despite this, evidence from cross-sectional studies of the stroke population is equivocal; several studies highlight only weak associations between lower limb proprioception and functional outcomes [9,13]. It is postulated that such findings may, in part, be explained by the methods used to quantify this complex sensory modality.…”

Assessing Plantar Sensation in the Foot Using the Foot Roughness Discrimination Test (FoRDT): A Reliability and Validity Study in Stroke

“…Evidence from cross‐sectional studies of stroke populations, however, does not demonstrate strong associations between lower limb tactile sensation and functional outcomes . Moreover, retraining of sensory impairments tend to be largely overlooked in favor of motor rehabilitation .…”

“…12 Evidence from cross-sectional studies of stroke populations, however, does not demonstrate strong associations between lower limb tactile sensation and functional outcomes. 10,13 Moreover, retraining of sensory impairments tend to be largely overlooked in favor of motor rehabilitation. 14,15 One interpretation contributing to this position may lie with the methods of tactile sensory assessment utilized in research and clinical settings.…”

“…Sensory impairment to this functionally important unit is characteristic of several neurological populations and is associated with reduced standing balance, increased falls, slower gait speed, and altered postural control . Following stroke, impairment of tactile sensation in the lower limb affects 30‐56% of people, with lower limb tactile sensation showing less recovery compared with proprioception and upper limb somatosensation . Reduced sensation in the foot is reported by people with stroke to affect walking and balance and is implicated in falls whereas somatosensory deficits and motor weakness result in worse functional outcomes than motor weakness alone …”