Deans' stroke musings: Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, July 17, 2018

Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke?

But what the hell are the protocols to get to that 70%, or 86%, or 69% recovery? Or are we on our own to read a Margaret Yekutiel book about this from 2001, 'Sensory Re-Education of the Hand After Stroke'? And figure it all out for ourselves?

Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke? Investigating Behavioral Outcome and Neural Correlates

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Leonardo Boccuni, BSc¹²*
, Sarah Meyer, PhD¹*

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Simon S. Kessner, MD³ , , ,

Nele De Bruyn, MSc¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Bea Essers, BSc¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Bastian Cheng, MD³

3University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
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, Götz Thomalla, MD³

3University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
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, André Peeters, MD⁴

4Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
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, Stefan Sunaert, PhD⁵

5KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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, Thierry Duprez, MD⁶

6Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
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, Lucio Marinelli, MD, PhD²⁷

2University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy7Department of Neuroscience, Ospedale Policlinico San Martino, Genova, Italy
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, Carlo Trompetto, MD, PhD²⁷

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, Vincent Thijs, PhD⁸

8University of Melbourne, Florey Institute of Neuroscience and Mental Health, Victoria, Australia; Department of Neurology, Austin Health, Victoria, Australia
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, Geert Verheyden, PhD¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Leonardo Boccuni, BSc¹²*

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium2University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy
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, Sarah Meyer, PhD¹*

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Simon S. Kessner, MD³

3University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
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, Nele De Bruyn, MSc¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Bea Essers, BSc¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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, Bastian Cheng, MD³

3University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
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, Götz Thomalla, MD³

3University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
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, André Peeters, MD⁴

4Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
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, Stefan Sunaert, PhD⁵

5KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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, Thierry Duprez, MD⁶

6Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
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, Lucio Marinelli, MD, PhD²⁷

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, Carlo Trompetto, MD, PhD²⁷

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, Vincent Thijs, PhD⁸

8University of Melbourne, Florey Institute of Neuroscience and Mental Health, Victoria, Australia; Department of Neurology, Austin Health, Victoria, Australia
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, Geert Verheyden, PhD¹

1KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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...

First Published July 10, 2018 Research Article

https://doi.org/10.1177/1545968318787060

Article Information

Article first published online: July 10, 2018

https://doi.org/10.1177/1545968318787060

Leonardo Boccuni, BSc¹^,²*, Sarah Meyer, PhD¹*, Simon S. Kessner, MD³, Nele De Bruyn, MSc¹, Bea Essers, BSc¹, Bastian Cheng, MD³, Götz Thomalla, MD³, André Peeters, MD⁴, Stefan Sunaert, PhD⁵, Thierry Duprez, MD⁶, Lucio Marinelli, MD, PhD²^,⁷, Carlo Trompetto, MD, PhD²^,⁷, Vincent Thijs, PhD⁸, Geert Verheyden, PhD¹

¹KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium

²University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy

³University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany

⁴Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium

⁵KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium

⁶Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium

⁷Department of Neuroscience, Ospedale Policlinico San Martino, Genova, Italy

⁸University of Melbourne, Florey Institute of Neuroscience and Mental Health, Victoria, Australia; Department of Neurology, Austin Health, Victoria, Australia

Corresponding Author: Geert Verheyden, PhD, Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Tervuursevest 101, Box 1501, Leuven, 3001, Belgium. Email: geert.verheyden@kuleuven.be

*Leonardo Boccuni and Sarah Meyer are joint-first authors

Abstract

Abstract

Background. Proportional motor recovery in the upper limb has been investigated, indicating about 70% of the potential for recovery of motor impairment within the first months poststroke.
Objective. To investigate whether the proportional recovery rule is applicable for upper-limb somatosensory impairment and to study underlying neural correlates of impairment and outcome at 6 months.
Methods. A total of 32 patients were evaluated at 4 to 7 days and 6 months using the Erasmus MC modification of the revised Nottingham Sensory Assessment (NSA) for impairment of (1) somatosensory perception (exteroception) and (2) passive somatosensory processing (sharp/blunt discrimination and proprioception); (3) active somatosensory processing was evaluated using the stereognosis component of the NSA. Magnetic resonance imaging scans were obtained within 1 week poststroke, from which lesion load (LL) was calculated for key somatosensory tracts.
Results. Somatosensory perception fully recovered within 6 months. Passive and active somatosensory processing showed proportional recovery of 86% (95% CI = 79%-93%) and 69% (95% CI = 49%-89%), respectively. Patients with somatosensory impairment at 4 to 7 days showed significantly greater thalamocortical and insulo-opercular tracts (TCT and IOT) LL (P < .05) in comparison to patients without impairment. Sensorimotor tract disruption at 4 to 7 days did not provide significant contribution above somatosensory processing score at 4 to 7 days when predicting somatosensory processing outcome at 6 months.
Conclusions. Our sample of stroke patients assessed early showed full somatosensory perception but proportional passive and active somatosensory processing recovery. Disruption of both the TCT and IOT early after stroke appears to be a factor associated with somatosensory impairment but not outcome.

Keywords stroke, upper extremity, recovery from impairment, motor recovery, somatosensory recovery