Somatosensory impairments and upper limb function following stroke: Extending the framework guiding neurological physiotherapy

Abstract

Disturbances in the somatosensory system are common following stroke but are often neglected during the rehabilitation of upper limb function. Physical therapists’ theoretical understanding of the body, including somatosensory capacities, is important for clinical decision making. In this article, we introduce theoretical notions based on phenomenology of the body to provide subjectivity status to the body and argue for the application of this understanding to improve clinical practice. Subjectivity status to the body implies a conception of the body as the centre of experience and expression simultaneously with it being a biological mechanism. Somatosensory modalities are considered as integral aspects of the experiencing and expressing body (the embodied self) and therefore need to be studied as integrated rather than isolated neurophysiological events. These body functions support intentionality, ownership and the sense of being in control of one's own movement to enable interaction with the surroundings and other people. Disturbances of the somatosensory system affect vital aspects of the embodied self, and training in these capacities may strengthen the experiencing and expressing body. We apply this framework to clinical examples and discuss the implications of a deeper understanding of somatosensory disturbances following stroke; we also discuss the potential of this framework to influence clinical decision making to further develop neurological physiotherapy.