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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Article info
Publication history
Published online: April 27, 2014
Accepted:
April 21,
2014
Received in revised form:
March 31,
2014
Received:
January 15,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
