Putting the “Sensory” Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke

Abstract

Integration of sensory and motor information is one-step, among others, that underlies the successful production of goal-directed hand movements necessary for interacting with our environment. Disruption of sensorimotor integration is prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis of the hand reduces function and overall quality of life. Current rehabilitative methods are based on neuroplastic principles to promote motor learning that focuses on regaining motor function lost due to paresis, but the sensory contributions to motor control and learning are often overlooked and currently understudied. There is a need to evaluate and understand the contribution of both sensory and motor function in the rehabilitation of skilled hand movements after stroke. Here, we will highlight the importance of integration of sensory and motor information to produce skilled hand movements in healthy individuals and individuals after stroke. We will then discuss how compromised sensorimotor integration influences relearning of skilled hand movements after stroke. Finally, we will propose an approach to target sensorimotor integration through manipulation of sensory input and motor output that may have therapeutic implications.

Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

“…This can be explained by the nature of this task, which not only measures proprioception, but the combination thereof with motor function. Therefore, these subjects most likely could not follow the trajectory due to weakness, although it is also possible that the process of integrating sensory input to generate motor output was affected [7]. This indicates that the results of the trajectory following task, being the most complex task out of the assessment battery, can be best interpreted when considered together with the two other categories of tasks, in order to understand the different components of the impaired performance.…”

“…This sensory input is then integrated by the central nervous system to shape the motor output, a process called sensorimotor integration [7,8]. Subsequently, the motor system is responsible for eliciting and executing the planned movement [9].…”

“…However, some symptoms that seem to originate from a motor function impairment may be caused by disturbed proprioceptive feedback [7]. Somatosensory function is in fact frequently affected and has been shown to be associated with poor functional recovery and higher activity limitations, although the reporting prevalence varies between 23% and 67% [16][17][18][19][20][21].…”

Somatosensory versus cerebellar contributions to proprioceptive changes associated with motor skill learning: A theta burst stimulation study

“…Here we consider two possible neural substrates that may be important for proprioceptive changes associated with motor skill learning: the cerebellum and primary somatosensory cortex (S1). Both regions process proprioceptive information from the periphery, and are interconnected with other cortical areas important for sensorimotor integration (Edwards et al, 2019;Gilman, 2002;Ostry & Gribble, 2016;Proske & Gandevia, 2012). Cerebellar involvement in proprioception is thought to be more nonconscious, contributing to online movement corrections (Baumann et al, 2015;Riemann & Lephart, 2002).…”

Exploratory study of how cognitive multisensory rehabilitation restores parietal operculum connectivity and improves upper limb movements in chronic stroke 

“…Despite current well-developed standard of care regarding motor and sensorimotor rehabilitation in the United States, about 70% of adults with stroke (+/-7 million Americans) still are unable to use their affected hand in daily life and live on with signi cant disability for many years [1][2][3][4][5][6][7][8][9][10][11][12][13][14], calling for more effective therapies to restore motor function, especially for those with severe motor impairments [13].…”