Localization of Impaired Kinesthetic Processing Post-stroke

Abstract

Kinesthesia is our sense of limb motion, and allows us to gauge the speed, direction, and amplitude of our movements. Over half of stroke survivors have significant impairments in kinesthesia, which leads to greatly reduced recovery and function in everyday activities. Despite the high reported incidence of kinesthetic deficits after stroke, very little is known about how damage beyond just primary somatosensory areas affects kinesthesia. Stroke provides an ideal model to examine structure-function relationships specific to kinesthetic processing, by comparing lesion location with behavioral impairment. To examine this relationship, we performed voxel-based lesion-symptom mapping and statistical region of interest analyses on a large sample of sub-acute stroke subjects (N = 142) and compared kinesthetic performance with stroke lesion location. Subjects with first unilateral, ischemic stroke underwent neuroimaging and a comprehensive robotic kinesthetic assessment (~9 days post-stroke). The robotic exoskeleton measured subjects' ability to perform a kinesthetic mirror-matching task of the upper limbs without vision. The robot moved the stroke-affected arm and subjects' mirror-matched the movement with the unaffected arm. We found that lesions both within and outside primary somatosensory cortex were associated with significant kinesthetic impairments. Further, sub-components of kinesthesia were associated with different lesion locations. Impairments in speed perception were primarily associated with lesions to the right post-central and supramarginal gyri whereas impairments in amplitude of movement perception were primarily associated with lesions in the right pre-central gyrus, anterior insula, and superior temporal gyrus. Impairments in perception of movement direction were associated with lesions to bilateral post-central and supramarginal gyri, right superior temporal gyrus and parietal operculum. All measures of impairment shared a common association with damage to the right supramarginal gyrus. These results suggest that processing of kinesthetic information occurs beyond traditional sensorimotor areas. Additionally, this dissociation between kinesthetic sub-components may indicate specialized processing in these brain areas that form a larger distributed network.

Proprioception and motor performance after stroke: An examination of diffusion properties in sensory and motor pathways

“…Our previous work has documented that damage to the SMG and HG is related to poor performance on the position matching and kinesthetic matching tasks (Findlater et al, ; Kenzie et al, ). Thus, we queried whether participants with SMG and HG lesions in the present sample would also demonstrate poor performance on the robotic proprioception tasks.…”

“…Lesions of the SMG and HG are known to lead to impairments in proprioceptive function (Findlater et al, , ; Kenzie et al, ). The SMG, as part of the parietal sensory association area, is an important region for integration of somatosensory information (Iwamura, ; Lynch, ; Pandya & Seltzer, ).…”

“…Our previous work has documented that damage to the SMG and HG is related to poor performance on the position matching and kinesthetic matching tasks Kenzie et al, 2016).…”

“…Compared to the motor system, the anatomy underlying proprioception is less well understood. Our group has recently examined cortical and subcortical lesion locations associated with poor proprioception in the subacute (Findlater et al, ; Kenzie et al, ) and chronic phases poststroke (Findlater et al, ) and have highlighted the importance of the primary somatosensory cortex, the supramarginal gyrus (SMG) and Heschl's gyrus (HG; also referred to as the transverse temporal gyrus) for proprioception. The relevance of the white matter tracts thought to underlie proprioception has yet to be investigated after stroke, despite numerous (>20) investigations into the relationship of the corticospinal tracts (CST) and motor impairment (see Kim & Winstein, for a review).…”

The Influence of External Forces on Wrist Proprioception

“…Several conditions can result in proprioceptive impairments leading to a reduced functional independence. Stroke in the post-central gyrus, supramarginal, angular, pre-central, and superior temporal gyri and insula can affect kinesthetic processing (Kenzie et al, 2016 ) and lesions in the thalamus, internal capsule, and post-central gyrus have been associated with “abnormal” position sense (Tong et al, 2010 ). The sense of effort can result defective in subjects affected by dystonia (Carment et al, 2017 ).…”