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Anatomical correlates of proprioceptive impairments following acute stroke: A case series

  • Jeffrey M. Kenzie
    Affiliations
    Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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  • Jennifer A. Semrau
    Affiliations
    Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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  • Sonja E. Findlater
    Affiliations
    Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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  • Troy M. Herter
    Affiliations
    Department of Exercise Science, University of South Carolina, 1300 Wheat St, Columbia, SC 29208, USA
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  • Michael D. Hill
    Affiliations
    Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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  • Stephen H. Scott
    Affiliations
    Department of Anatomy and Cell Biology, Queen's University, Botterell Hall, Room 219, Kingston, ON K7L 3N6, Canada

    Providence Care, St. Mary's of the Lake Hospital, 340 Union St, Kingston, ON K7L 5A2, Canada
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  • Sean P. Dukelow
    Correspondence
    Corresponding author at: 1403 29th St NW, South Tower Room 905, Calgary, Alberta T2N 2T9, Canada. Tel.: +1 403 944 5930; fax: +1 403 944 0977.
    Affiliations
    Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada

    Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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Published:April 27, 2014DOI:https://doi.org/10.1016/j.jns.2014.04.025

      Highlights

      • Stroke to somatosensory brain areas can result in measureable proprioceptive deficits.
      • Position sense and kinesthesia impairments may occur independently post-stroke.
      • Proprioceptive and reaching impairments post-stroke may occur independently.

      Abstract

      Background

      Proprioception is the sensation of position and movement of our limbs and body in space. This sense is important for performing smooth coordinated movements and is impaired in approximately 50% of stroke survivors. In the present case series we wanted to determine how discrete stroke lesions to areas of the brain thought to be critical for somatosensation (thalamus, posterior limb of internal capsule, primary somatosensory cortex and posterior parietal cortex) would affect position sense and kinesthesia in the acute stages post-stroke. Given the known issues with standard clinical measures of proprioception (i.e. poor sensitivity and reliability) we used more modern quantitative robotic assessments to measure proprioception.

      Methods

      Neuroimaging (MRI, n = 10 or CT, n = 2) was performed on 12 subjects 2–10 days post-stroke. Proprioception was assessed using a KINARM robot within the same time frame. Visually guided reaching was also assessed to allow us to compare and contrast proprioception with visuomotor performance.

      Results and Conclusions

      Proprioceptive impairments were observed in 7 of 12 subjects. Thalamic lesions (n = 4) were associated with position sense (n = 1) or position sense and kinesthesia (n = 1) impairments. Posterior limb of the internal capsule lesions (n = 4) were associated with primarily position sense (n = 1) or kinesthesia (n = 2) impairments. Lesions affecting primary somatosensory cortex and posterior parietal cortex (n = 2) were associated with significant position sense and kinesthesia impairments. All subjects with damage to hypothesized structures displayed impairments with performance on the visually guided reaching task. Across the proprioceptive tasks, we saw that position sense and kinesthesia were impaired to differing degrees, suggesting a potential dissociation between these two components of proprioception.

      Keywords

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