Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data

Tyson, Sarah; Crow, J Lesley; Connell, Louise; Winward, Charlotte E; Hillier, Susan

doi:10.1310/tsr2005-441

Cited by 47 publications

(41 citation statements)

References 35 publications

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Parsons

Mansfield

Inness

et al. 2016

Topics in Stroke Rehabilitation

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Section: Introductionmentioning

confidence: 99%

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

Parsons

Mansfield

Inness

et al. 2016

Topics in Stroke Rehabilitation

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“…People living with stroke present several sensorimotor deficits such as contralateral and ipsilateral muscular weakness [4,5], contralateral spasticity [6,7], lack of coordination [8], contralateral impaired sensitivity [9][10][11], and impaired balance [12]. These sensorimotor deficits are heterogeneous among individuals post stroke and vary according to the size and location of the lesion.…”

Section: Introductionmentioning

confidence: 99%

Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

Lauzière¹,

Betschart²,

Aïssaoui³

et al. 2014

Int J Phys Med Rehabil

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Gait asymmetry in spatial and temporal parameters and its impacts on functional activities have always raised many interesting questions in research and rehabilitation. The aim of this topical review is threefold: 1) to examine different equations of asymmetry of gait parameters and make recommendations for standardization, 2) to deepen the understanding of the relationships between sensorimotor deficits, spatiotemporal (step length, swing time and double support time) and biomechanical (kinematic, kinetic, muscular activity) parameter asymmetries during gait and, 3) to summarize the impacts of gait asymmetry on walking speed, falls, and energy cost in individuals post stroke. In light of current literature, we recommend quantifying spatiotemporal asymmetries by calculating symmetry ratios. However, for other gait parameters (such as kinetic or kinematic data), the choice will depend on the variability of the data and the objective of the study. Regardless of the selected asymmetry equation, we recommend presenting the asymmetry values in combination with the mean value of each side to facilitate comparisons between studies. This review also revealed that sensorimotor deficits clinically measured are not sufficient to explain the large variability of spatiotemporal asymmetries (particularly for step length and double support time) in individuals post stroke. Biomechanical analysis has been identified as a relevant approach to understanding gait deviations. Studies that linked biomechanical impairments to spatiotemporal asymmetries suggest that a balance issue and an impaired paretic forward propulsion could be among the important factors underlying spatiotemporal asymmetries. In our opinion, this paper provides meaningful information to aid in better understanding gait deviations in persons after stroke and establishes the need for future studies regrouping individuals post stroke according to their spatiotemporal asymmetries. Furthermore, further studies targeting efficacy of locomotor rehabilitation and the impacts of gait asymmetry on risk of falls and energy expenditure are needed.

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“…On the low end, changes in recruitment gain of motoneurone pools with non-uniform distribution of synaptic effects to low-and high-threshold motor units could explain previously reported sustained tonic motoneurone firing with little or no synaptic input in spastic paresis, especially in low-threshold units (Hultborn et al 2004;Heckmann et al 2005;Mottram et al 2009). Yet, reduced proprioception in hemiparesis may also contribute to a reduced range of effort perceptions but patients with major sensory impairment were not included in this study (see ''Methods'') (Carey et al 1996;Tyson et al 2013).…”

Section: Reduced Range Of Effort Perception In Spastic Paresismentioning

confidence: 99%

Stretch-sensitive paresis and effort perception in hemiparesis

et al. 2015

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In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p < 0.01) in healthy subjects (not on gastrocnemius medialis co-contraction) while it depended on both tibialis anterior agonist recruitment (βARI(TA) = 0.41, p < 0.001) and gastrocnemius medialis co-contraction (βCCI(MG) = 0.43, p < 0.001) in hemiparetic subjects. In hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.

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Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data

Cited by 47 publications

References 35 publications

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

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

Understanding Spatial and Temporal Gait Asymmetries in Individuals Post Stroke

Stretch-sensitive paresis and effort perception in hemiparesis

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