Sensory Function, Measured as Active Discriminative Touch, is Associated With Dexterity after Stroke

Abstract

Background Reduced dexterity is common after stroke, which can affect the ability to perform upper limb daily activities. To improve upper limb function after stroke, it is important to understand which factors are most associated with dexterity. Objective To evaluate how several factors are associated with dexterity after stroke. Design Cross‐sectional study. Setting A university hospital. Participants A convenience sample of 75 persons (54 men and 21 women, mean age 66 years) with mild to moderate impairments of the upper limb after stroke. Methods Dexterity and potentially associated factors (age, gender, affected hand, social situation, vocational situation, grip strength, spasticity, sensory function, and pain) were evaluated by linear regression models. Main Outcome Measurements Dexterity was measured with the mini Sollerman Hand Function Test, sensory function with both the Fugl‐Meyer Assessment of the Upper Extremity (to assess light touch and proprioception) and the Shape Texture Identification Test (to assess active discriminative touch), spasticity with the Modified Ashworth Scale, and grip strength with the Grippit dynamometer. Results Active discriminative touch had the strongest association with dexterity, explaining 46% of the variance. When spasticity and grip strength were added, the explained variance increased to 57% in the final multivariate model. Conclusions This study indicates that sensory function in terms of active discriminative touch is a major contributing factor to dexterity in persons with mild to moderate stroke, whereas spasticity and grip strength may be of lesser importance. Level of Evidence III

Anodal Transcranial Direct Current Stimulation Over S1 Differentially Modulates Proprioceptive Accuracy in Young and Old Adults

“…The clinical relevance of this problem is stressed by the fact that neurological diseases, such as stroke, often manifest at higher age, when a decline in proprioception additionally worsens symptoms and hampers sensorimotor recovery in the presence of such conditions. About 85% of acute stroke patients and approximately 50% of patients with stroke in the chronic phase suffer from motor deficits (Rathore et al, 2002; Carlsson et al, 2018), while up to 60% of patients also exhibit somatosensory and proprioceptive deficits (Connell et al, 2008; Carey and Matyas, 2011; Lima et al, 2015; Rand, 2018). Here, proprioceptive deficits are associated with motor deficits of the affected upper extremity (Rand, 2018).…”

SENSory re-learning of the UPPer limb (SENSUPP) after stroke: development and description of a novel intervention using the TIDieR checklist

“…The sensory system (including cutaneous mechanoreceptors, joint and muscle proprioceptors as well as vision) is important for the planning of a movement (the feedforward system), for the feedback control of a movement and for motor learning. Hence, an impaired sensory function of the UL after stroke disrupts the normal feedback to the motor network [ 27 ], which can affect the movement control of reaching and grasping [ 28 ] and force regulation during pinch grip [ 29 ] as well as dexterity [ 30 ].…”

Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke–A retrospective cross-sectional study

“…The fact that not only motor but also tactile sensation affects the daily use of paretic extremity emphasize the importance of training strategy targeting tactile sensation in the chronic stroke patients. Tactile sensory function as represented by discriminative touch is associated with dexterity in mild-to-moderate stroke patients in subacute-to-chronic phase [26]. However, it may be also true that the sensory recovery has been frequently overlooked in the clinics [27,28].…”