Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects

BACKGROUND

Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role.

OBJECTIVE

To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects.

METHODS

The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA).

RESULTS

The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side.

CONCLUSION

In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.

Levels of Gnostic Functions in Top Karate Athletes-A Pilot Study

High-quality sensory perception and body scheme (somatognosis) are important aspects for sport performance. This study compares stereognosis, body scheme, and kinesthesia in a group of 36 competitive karate athletes against a control group of 32 general population participants. The stereognosis Petrie test, two body scheme tests, and three kinesthesia tests served as outcome measurement tools. No significant difference was found in the stereognosis Petrie test, for the dominant (p = .389) or the nondominant (p = .791) hand, nor in the kinesthesia test (dominant, p = .661 and nondominant, p = .051). Karate athletes performed significantly better in the body scheme tests, that is, fist width estimation (p = .024) and shoulder width estimation (p = .019), as well as in karate-specific kinesthesia tests, that is, single punch (p = .010) and triple punch (p = .001). This study confirms competitive karate athletes have significantly better somatognosis, and better accuracy when performing quick dynamic movements compared with the general population.

Validation of Spanish Erasmus-Modified Nottingham Sensory Assessment Stereognosis Scale in Acquired Brain Damage

Acquired brain injury (ABI) is the third leading cause of death in Spain. The disability derived from ABI can include considerable difficulties in upper-limb use due to somatosensory deficits. One of the assessments most commonly used to evaluate ABI is the Nottingham Sensory Assessment (NSA); however, there is no complete psychometric analysis or standardized version in Spanish. We aimed to develop and validate a Spanish version of the stereognosis component of the NSA for evaluating Spanish adults with ABI via a single-center, observational, cross-sectional study. The Spanish version of the NSA was developed in two steps. The first was based on the standardization and collection of normative data in 120 asymptomatic participants. For the second, we recruited 25 participants with ABI to establish concurrent criterion-related validity, internal consistency, and floor/ceiling effects. Criterion validity was assessed against two-point discrimination and tactile-localization tests. Our normative data showed significant differences among the various age groups (p < 0.05), supporting the validity of the Spanish-version assessment. For the ABI sample, we also found further evidence of validity with Spearman’s rho coefficient between the total scores and the two-point discrimination and tactile-localization tests, which showed low and moderate correlations (rho = 0.50–0.75, p < 0.05). Internal consistency was excellent, with a Cronbach’s alpha of 0.91. No ceiling or floor effects were found. We conclude that the stereognosis component of the NSA in its Spanish version is a valid scale that can be used to comprehensively and accurately assess stereognosis capacity in adults with ABI. As a low-cost evaluation, this assessment has great potential to be widely used in clinical practice and research settings.

Sensorimotor tongue evaluation and rehabilitation in patients with sleep-disordered breathing: a novel approach

STUDY OBJECTIVES

To evaluate tone, apraxia and stereognosis dysfunctions in patients with SDB compared with healthy controls, and to monitor the effectiveness of Airway Gym^® as an easy-to-use myofunctional therapy (MT) modality in terms of the tongue's motor and sensory responses, comparing results before and after therapy.

METHODS

This was a prospective, non-randomised pilot study of 25 patients with moderate to severe obstructive sleep apnoea-hypopnoea syndrome (OSAHS), 25 patients with primary snoring (PS) and 20 healthy controls. Qualitative and quantitative instruments-Iowa Oral Performance Instrument (IOPI), lingual apraxia and stereognosis tests were used to assess tongue sensorimotor function.

RESULTS

22 patients with PS, 21 with OSAHS and all 20 controls ended the therapy. In OSAHS, the Epworth Sleepiness Scale score decreased from 16 ± 7.3 to 12 ± 4.5 after therapy (p = 0.53). In PS and OSAHS groups, the IOPI scores increased significantly. These measures did not change significantly in the controls. Lingual apraxia testing showed that controls performed all the manoeuvres, whereas PS 5.6 ± 1.4 and OSAHS 4.5 ± 1.9 (p = 0.14). In the stereognosis test, the mean number of figures recognised was 2.6 ± 2.2 in OSAHS, 3.3±1.2 in PS and 5.7±0.9 in control group (p < 0.05). Patients with OSAHS recognised circles and ovals less often.

CONCLUSION

Using the Airway Gym^® app produced improvements in sensorimotor tongue function in patients with SDB, due to continuous stimulation of the brain based on proprioceptive training required to localise responses when doing the exercises.

Effect of complete dentures on oral stereognostic ability in edentulous patients: A systematic review

Aim:

Oral stereognosis is an important sensation for a human being to percept any type of materials that are introduced in the oral cavity. It is defined as the ability of an individual to recognize objects using only tactile sensation without using vision, audition, balance, somatic function, taste, or smell. The primary purpose of this review was to evaluate the effect of complete dentures on oral stereognostic ability in edentulous subjects.

Settings and Design:

Systematic review based on PRISMA guidelines.

Materials and Methods:

A systematic search of the electronic databases like PubMed and Web of Science was done using keywords – “stereognosis,” “oral stereognosis,” “complete denture,” and “complete edentulism.” In addition to this, a manual search of references mentioned in the articles and gray literature was done. Data extraction and assessment were done by two independent reviewers.

Statistical Analysis Used:

Qualitative analysis.

Results:

The literature search yielded a total of 61 articles. Thirteen duplicate articles were removed and 36 articles were rejected after initial screening of titles and abstracts. A total of 12 articles were selected for full text reading and 5 of them were included for qualitative analysis.

Conclusion:

All the included studies showed complete denture treatment therapy improved stereognostic ability in terms of correct identification of test pieces and time taken to identify the objects. There is also a direct relationship between the adaptability of dentures and stereognostic ability.

Toward an index of oral somatosensory acuity: Comparison of three measures in adults

PURPOSE

Somatosensory targets and feedback are instrumental in ensuring accurate speech production. Individuals differ in their ability to access and respond to somatosensory information, but there is no established standard for measuring somatosensory acuity. The primary objective of this study was to determine which of three measures of somatosensory acuity had the strongest association with change in production accuracy in a vowel learning task, while controlling for the better-studied covariate of auditory acuity.

METHOD

Three somatosensory tasks were administered to 20 female college students: an oral stereognosis task, a bite block task with auditory masking, and a novel phonetic awareness task. Individual scores from the tasks were compared to their performance on a speech learning task in which participants were trained to produce novel Mandarin vowels with visual biofeedback.

RESULTS

Of the three tasks, only bite block adaptation with auditory masking was significantly associated with performance in the speech learning task. Participants with weaker somatosensory acuity tended to demonstrate larger increases in production accuracy over the course of training.

CONCLUSIONS

The bite block adaptation task measures proprioceptive awareness rather than tactile acuity and assesses somatosensory knowledge implicitly, with limited metalinguistic demands. This small-scale study provides preliminary evidence that these characteristics may be desirable for the assessment of oral somatosensory acuity, at least in the context of vowel learning tasks. Well-normed somatosensory measures could be of clinical utility by informing diagnosis/prognosis and treatment planning.

Somatosensory discrimination impairment in children with hemiplegic cerebral palsy as measured by the sense_assess© kids

INTRODUCTION

To characterise somatosensory discrimination impairment of the upper-limb across domains of tactile discrimination, limb position sense and haptic object recognition using the sense_assess© kids and examine associations with upper-limb motor performance in children with hemiplegic cerebral palsy (CP).

METHODS

The sense_assess© kids was administered at one timepoint to 28 children, aged 6-15.5 years (M = 10.1, SD = 2.4), with hemiplegic CP (right hemiplegia n = 15) and Manual Ability Classification System Levels I (n = 11) and II (n = 17). Unimanual motor performance was quantified using the Box and Block Test.

RESULTS

Tactile discrimination was impaired in 18, limb position sense in 20, and haptic object recognition was impaired in 21 of 28 children. Over 80% (23/28) of children had impaired somatosensory discrimination in one or more domains. Low to moderate correlations were observed between each measure of somatosensory discrimination and motor performance. Manual ability classification was associated with limb position sense and haptic object recognition. A moderate inverse correlation (r = -.57, p < .01) exists between the number of somatosensory domains impaired and motor performance.

CONCLUSION

The frequency of somatosensory impairment in the upper limb of children in our sample was high and associated with manual ability, suggesting a need for routine assessment of somatosensation in this population.

Comparative study of evaluation of the oral stereognostic ability between diabetic and nondiabetic complete denture wearers with and without denture

BACKGROUND

The diabetic subjects would have impaired oral stereognostic ability (OSA) compared with normal subjects due to diabetic neuropathy and microcirculatory disturbances. This study was conducted to compare the OSA between diabetic and nondiabetic complete denture wearers with and without denture.

MATERIALS AND METHODS

In this in vivo study the present comparative study comprised of seventy edentulous subjects (36 males and 34 females), aged from 35 to 84 rehabilitated with complete dentures (among them 35 were diabetic and 35 subjects were nondiabetic complete denture wearer). The OSA tests were conducted using acrylic test samples of 12 shaped forms, which were placed in patient's mouth for a given period of time for identification and scored according to three-point scale as OSA score and the identification time was also recorded. The data obtained were analyzed using Chi-square test, t-test, and Pearson's correlation coefficient (P < 0.05).

RESULTS

In this study, diabetic complete denture wearers got the mean OSA score of 12.43 ± 3.93 without dentures, which was lower than nondiabetic complete denture wearer group (14.82 ± 4.44). There was a significant difference (P = 0.020*) in the identification of test pieces.

CONCLUSION

Within limitations of this study, diabetic complete denture wearers showed decreased OSA than nondiabetic subjects, particularly it was significant while not wearing dentures. Oral stereognosis may be used as one of the clinical aids in predicting patient's performance to a prosthesis. Based on their response, we can educate the patient about the prognosis.

The Effect of Treatment on Stereognosis in Children With Hemiplegic Cerebral Palsy

PURPOSE

To determine if rehabilitation alone or combined with surgery or botulinum toxin injection improved stereognosis in children with hemiplegic cerebral palsy.

METHODS

Inclusion criteria were children with spastic hemiplegic cerebral palsy who had stereognosis testing 2 separate times with documentation of intervening treatment. Sixty-three children were included, 30 girls and 33 boys at an average age of 9.1 years (range, 4.4-16.0 years). Twelve standardized objects were used for manual identification. Baseline and postintervention stereognosis results were recorded for the hemiplegic and the dominant limb of each patient. The patients were separated into 3 groups based on intervening treatment: surgery with rehabilitation (27 patients), botulinum toxin injection with rehabilitation (19 subjects), and rehabilitation alone (7 subjects). Results were also analyzed by patient age group.

RESULTS

Baseline testing of the hemiplegic limb revealed that 27 patients (43%) exhibited severe stereognosis impairment (0-4 objects identified correctly), 18 (28%) were moderately impaired (5-8 objects), 13 (21%) were mildly impaired (9-11 objects), and 5 (8%) had intact stereognosis (12 objects). There was no statistically significant difference in change in stereognosis scores postintervention among the 3 different treatment groups or between patients who had surgery and those who did not have surgery. There was no statistically significant difference in stereognosis function or postintervention change based on patient age at time of testing.

CONCLUSIONS

In this study, 92% of children with spastic hemiplegic cerebral palsy had stereognosis impairment with a wide spectrum of severity. After operative or nonoperative treatment interventions, stereognosis as a secondary outcome measure was not changed.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic III.

Management of the spastic wrist and hand in cerebral palsy

Research from the last 5 years on the pathophysiology and treatment of upper extremity sequelae of cerebral palsy (CP) is presented. The development of new treatments of CP-affected limbs, utilizing the brain's inherent neuroplasticity, remains an area of promising and active research. Functional magnetic resonance imaging scans have evaluated the role of neuroplasticity in adapting to the initial central nervous system insult. Children with CP appear to have greater recruitment of the ipsilateral brain for motor and sensory functions of the affected upper limb. Studies have also shown that constraint-induced movement therapy results in localized increase in gray matter volume of the sensorimotor cortex contralateral to the affected arm targeted during rehabilitation. Recent therapy interventions have emphasized the role of home therapy programs, the transient effects of splinting, and the promise of constraint-induced movement therapy and bimanual hand training. The use of motion laboratory analysis to characterize the movement pattern disturbances in children with CP continues to expand. Classification systems for CP upper limb continue to expand and improve their reliability, including use of the House Classification, the Manual Ability Classification System, and the Shriner's Hospital Upper Extremity Evaluation. Surgical outcomes have greater patients' satisfaction when they address functional limitations, also in addition to aesthetics, which may improve patients' self-esteem. Surgical techniques for elbow, wrist, fingers, and thumb continue to be refined. Research into each of these areas continues to expand our understanding of the nervous system insults that cause CP, how they may be modified, and how hand surgeons can continue to serve patients by improving their upper limb function and aesthetics.

Age and strength influences on lingual tactile acuity

Sensory function during the oral processing of liquids is thought to play a key role in informing the tailoring of swallowing motor behaviours to the flow characteristics of the bolus. In addition to taste receptors, the mouth and tongue house trigeminal nerve receptors that support the sensory detection of bolus size, shape (stereognosis), mass, temperature and movement. Recent studies suggest that healthy adults lose tongue strength with advancing age. However, little is known about changes in the sensory function of the tongue attributable to age, or associated with reductions in strength. In this study, we explored lingual tactile acuity in healthy young and older adults, and measured the relationship between tactile acuity and measures of tongue strength. The results showed an age-related reduction in lingual tactile acuity that was not explained by variations in tongue strength.

PRACTICAL APPLICATIONS

Sensory motor interactions are a topic of interest in understanding the processing activities that take place in the mouth during eating and swallowing. In this paper, we explore a test of sensory acuity in the mouth, in which the tongue is used to "read" embossed letters on Teflon strips. Our questions were to determine whether sensory acuity for this task declines with age, or with age-related reductions in tongue strength. We determined that older people perform this task with less accuracy, suggesting some changes in oral sensory function with age. However, these changes were not related to tongue strength. The findings suggest that strength does not play a major role in the kind of sensory discrimination task tested in this study.

Motor and tactile-perceptual skill differences between individuals with high-functioning autism and typically developing individuals ages 5-21

We examined motor and tactile-perceptual skills in individuals with high-functioning autism (IHFA) and matched typically developing individuals (TDI) ages 5-21 years. Grip strength, motor speed and coordination were impaired in IHFA compared to matched TDI, and the differences between groups varied with age. Although tactile-perceptual skills of IHFA were impaired compared to TDI on several measures, impairments were significant only for stereognosis. Motor and tactile-perceptual skills should be assessed in children with IHFA and intervention should begin early because these skills are essential to school performance. Impairments in coordination and stereognosis suggest a broad though selective under-development of the circuitry for higher order abilities regardless of domain that is important in the search for the underlying disturbances in neurological development.