The impact of proprioception impairment on gait function in stroke survivors: a comprehensive review

 Absolutely useless! NO protocol created on how to fix proprioception deficits! What the hell are you doing in research if not to get survivors recovered?

The impact of proprioception impairment on gait function in stroke survivors: a comprehensive review

Maciej Kochman^1*Marta Kasprzak¹Aleksandra Kielar²

• ¹Department of Clinical Physiotherapy in Musculoskeletal Disorders, Institute of Physiotherapy, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszów, Rzeszów, Poland
• ²Faculty of Medicine, Collegium Medicum, University of Rzeszów, Rzeszów, Poland

Stroke survivors often experience sensory, cognitive, and motor consequences with gait disorders as a common problem. Therefore, there is a need for a deeper understanding of how neurological deficits affect the functioning of patients after a stroke. Current scientific literature lacks research on proprioception impairment, and gait recovery after stroke. In this narrative review, we discussed and summarized the current knowledge about the abnormal post-stroke gait pattern, the role of proprioception in motor control, methods of proprioception assessment, and the association between abnormal gait and proprioception deficit in stroke survivors. The present findings must be interpreted with some caution as current evidence is limited, as well as the correlation does not imply causation and might be underestimated by attributes of current tests for proprioception and motor function. Further studies are needed to better explain the mechanisms behind proprioception deficits and their association with functional recovery, as well as to investigate the cause-effect relationship.

1 Introduction

Stroke is a serious health problem exploiting a significant proportion of health care system budgets worldwide (1). The World Health Organization (WHO) indicates that stroke is the incoming epidemic of the 21st century and a further increase in stroke rates is expected worldwide, especially in younger patients (2). According to the World Stroke Organization (WSO), stroke remains the second most common cause of death and the third most common cause of combined death and disability expressed by disability-adjusted life-years lost (DALYs) worldwide (3). The definition of stroke includes rapidly developing clinical symptoms of focal or global disturbance of cerebral function, while signs last at least 24 h or lead to death and their cause is no other than vascular origin (4).

Despite a decline in stroke mortality rates, the prevalence of people living with stroke consequences has risen due to an increasing and aging population. This leads to a greater need for long-term rehabilitation (5). People after a stroke often experience sensory, cognitive, and motor consequences (6). Gait disorders are a common problem in stroke survivors as they constitute one of the main functional limitations that affect the quality of life and increase the risk of falls. Moreover, independent walking is an important factor in overall health and one of the fundamental goals of stroke rehabilitation (7). Stroke survivors may have different gait patterns depending on the variety of sensorimotor disorders (8). However, the relationship between sensory impairment and other impairments or functional deficits following a stroke is unclear and has not been widely explored in the literature. Moreover, despite the expectation that sensory or motor deficits may be associated with stroke severity due to lesion size and location, the association between these impairments is still not well understood (9). Previous studies showed that lesions in the supramarginal gyrus, arcuate fasciculus, and Heschl’s gyrus are linked to poor proprioceptive recovery. Also, proprioception impairment is common and persistent after stroke, particularly in the cortical and subcortical lesions (10).

Due to the constantly increasing incidence of stroke and the increasing number of people living with its consequences, there is a need for a deeper understanding of how neurological deficits, including proprioception deficit, affect the functioning of patients after a stroke. As this topic is underexplored in the scientific literature, we were prompted to perform this narrative literature review, which, according to the best knowledge of authors, is the very first review providing a comprehensive understanding of the role of proprioception in post-stroke gait recovery. In this review, we present and summarize the current knowledge about the abnormal post-stroke gait pattern, role of proprioception in motor control, methods of proprioception assessment, and the association between abnormal gait and proprioception deficit in stroke survivors.

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