Somatosensory Impairment Research Articles

Current Practice of Somatosensory Impairment

Abstract Date Presented 03/21/24 The purpose of this quantitative, cross-sectional survey was to determine occupational and physical therapists' current practice of assessment and intervention related to somatosensory impairment across the United States. Primary Author and Speaker: Demma Franklin Additional Authors and Speakers: Krystal Robinson-Bert, Allison Dickes Contributing Authors: Senna Larson, Rebecca Puleo, Morgan Hissong

Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study.

Pain and somatosensory impairments are commonly reported following stroke. This study investigated the relationship between somatosensory impairments (touch detection, touch discrimination and proprioceptive discrimination) and the reported presence and perception of any bodily pain in stroke survivors. Stroke survivors with somatosensory impairment ( N = 45) completed the Weinstein Enhanced Sensory Test (WEST), Tactile Discrimination Test, and Wrist Position Sense Test for quantification of somatosensation in both hands and the McGill Pain Questionnaire, visual analog scale and the Neuropathic Pain Symptom Inventory (NPSI) for reporting presence and perception of pain. No relationship was observed between somatosensory impairment (affected contralesional hand) of touch detection, discriminative touch or proprioceptive discrimination with the presence or perception of pain. However, a weak to moderate negative relationship between touch detection in the affected hand (WEST) and perception of pain intensity (NPSI) was found, suggesting that stroke survivors with milder somatosensory impairment of touch detection, rather than severe loss, are likely to experience higher pain intensity [rho = -0.35; 95% confidence interval (CI), -0.60 to -0.03; P = 0.03]. Further, a moderate, negative relationship was found specifically with evoked pain (NPSI) and touch detection in the affected hand (rho = -0.43; 95% CI, -0.72 to -0.02; P = 0.03). In summary, our findings indicate a weak to moderate, albeit still uncertain, association, which prevents making a definitive conclusion. Nevertheless, our findings contribute to our understanding of the complexities surrounding the experience of pain in survivors of stroke and provide direction for future studies.

Alterations of tactile and anatomical spatial representations of the hand after stroke

Stroke often causes long-term motor and somatosensory impairments. Motor planning and tactile perception rely on spatial body representations. However, the link between altered spatial body representations, motor deficit and tactile spatial coding remains unclear. This study investigates the relationship between motor deficits and alterations of anatomical (body) and tactile spatial representations of the hand in 20 post-stroke patients with upper limb hemiparesis. Anatomical and tactile spatial representations were assessed from 10 targets (nails and knuckles) respectively cued verbally by their anatomical name or using tactile stimulations. Two distance metrics (hand width and finger length) and two structural measures (relative organization of targets positions and angular deviation of fingers from their physical posture) were computed and compared to clinical assessments, normative data and lesions sites. Over half of the patients had altered anatomical and/or tactile spatial representations. Metrics of tactile and anatomical representations showed common variations, where a wider hand representation was linked to more severe motor deficits. In contrast, alterations in structural measures were not concomitantly observed in tactile and anatomical representations and did not correlate with clinical assessments. Finally, a preliminary analysis showed that specific alterations in tactile structural measures were associated with dorsolateral prefrontal stroke lesions. This study reveals shared and distinct characteristics of anatomical and tactile hand spatial representations, reflecting different mechanisms that can be affected differently after stroke: metrics and location of tactile and anatomical representations were partially shared while the structural measures of tactile and anatomical representations had distinct characteristics.

Enhancing touch sensibility with sensory electrical stimulation and sensory retraining

A large proportion of stroke survivors suffer from sensory loss, negatively impacting their independence, quality of life, and neurorehabilitation prognosis. Despite the high prevalence of somatosensory impairments, our understanding of somatosensory interventions such as sensory electrical stimulation (SES) in neurorehabilitation is limited. We aimed to study the effectiveness of SES combined with a sensory discrimination task in a well-controlled virtual environment in healthy participants, setting a foundation for its potential application in stroke rehabilitation. We employed electroencephalography (EEG) to gain a better understanding of the underlying neural mechanisms and dynamics associated with sensory training and SES. We conducted a single-session experiment with 26 healthy participants who explored a set of three visually identical virtual textures—haptically rendered by a robotic device and that differed in their spatial period—while physically guided by the robot to identify the odd texture. The experiment consisted of three phases: pre-intervention, intervention, and post-intervention. Half the participants received subthreshold whole-hand SES during the intervention, while the other half received sham stimulation. We evaluated changes in task performance—assessed by the probability of correct responses—before and after intervention and between groups. We also evaluated differences in the exploration behavior, e.g., scanning speed. EEG was employed to examine the effects of the intervention on brain activity, particularly in the alpha frequency band (8–13 Hz) associated with sensory processing. We found that participants in the SES group improved their task performance after intervention and their scanning speed during and after intervention, while the sham group did not improve their task performance. However, the differences in task performance improvements between groups only approached significance. Furthermore, we found that alpha power was sensitive to the effects of SES; participants in the stimulation group exhibited enhanced brain signals associated with improved touch sensitivity likely due to the effects of SES on the central nervous system, while the increase in alpha power for the sham group was less pronounced. Our findings suggest that SES enhances texture discrimination after training and has a positive effect on sensory-related brain areas. Further research involving brain-injured patients is needed to confirm the potential benefit of our solution in neurorehabilitation.

NeuroSense: A non-invasive and configurable somatosensory stimulator with OPENVIBE communication

Understanding the somatosensory system and its abnormalities requires the development of devices that can accurately stimulate the human skin. New methods for assessing the somatosensory system can enhance the diagnosis, treatments, and prognosis for individuals with somatosensory impairments. Therefore, the design of NeuroSense, a tactile stimulator that evokes three types of daily life sensations (touch, air and vibration) is described in this work. The prototype aims to evoke quantitative assessments to evaluate the functionality of the somatosensory system and its abnormal conditions that affect the quality of life. In addition, the device has proven to have varying intensities and onset latencies that produces somatosensory evoked potentials and energy desynchronization on somatosensory cortex.

Does somatosensory discrimination therapy alter sensorimotor upper limb function differently compared to motor therapy in children and adolescents with unilateral cerebral palsy: study protocol for a randomized controlled trial

BackgroundBesides motor impairments, up to 90% of the children and adolescents with unilateral cerebral palsy (uCP) present with somatosensory impairments in the upper limb. As somatosensory information is of utmost importance for coordinated movements and motor learning, somatosensory impairments can further compromise the effective use of the impaired upper limb in daily life activities. Yet, intervention approaches specifically designated to target these somatosensory impairments are insufficiently investigated in children and adolescents with uCP. Therefore, the aim of this randomized controlled trial (RCT) is to compare the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP, who experience somatosensory impairments in the upper limb. We will further explore potential behavioral and neurological predictors of therapy response.MethodsA parallel group, evaluator-blinded, phase-II, single-center RCT will be conducted for which 50 children and adolescents with uCP, aged 7 to 15 years, will be recruited. Participants will be randomized to receive 3 weekly sessions of 45 minutes of either somatosensory discrimination therapy or upper limb motor therapy for a period of 8 weeks. Stratification will be performed based on age, manual ability, and severity of tactile impairment at baseline. Sensorimotor upper limb function will be evaluated at baseline, immediately after the intervention and after 6 months follow-up. The primary outcome measure will be bimanual performance as measured with the Assisting Hand Assessment. Secondary outcomes include a comprehensive test battery to objectify somatosensory function and measures of bimanual coordination, unimanual motor function, and goal attainment. Brain imaging will be performed at baseline to investigate structural brain lesion characteristics and structural connectivity of the white matter tracts.DiscussionThis protocol describes the design of an RCT comparing the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP. The results of this study may aid in the selection of the most effective upper limb therapy, specifically for children and adolescents with tactile impairments.Trial registrationClinicalTrials.gov (NCT06006065). Registered on August 8, 2023.

Reduced menthol sensitivity in a prodromal Parkinson's disease model induced by intranasal rotenone treatment.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor symptoms, and it is associated with several prodromal non-motor symptoms, including an impaired sense of smell, taste and touch. We previously reported that bitter taste impairments occur independently of olfactory impairments in an early-stage PD animal model using short-term intranasal rotenone-treated mice. Cool temperatures also affect bitter taste perception, but it remains unclear whether or not bitter taste impairments result from an altered sensitivity for intraoral cool stimuli. We examined disturbances in the intraoral menthol sensitivity, such as coolness at low concentrations of menthol, using a brief-access test. Once a day, one solution from the 7-concentration series of (-)-menthol (0-2.3 mM) or the bitter taste quinine-HCl (0.3 mM) was randomly presented 20 times for 10 s to water-deprived mice before and 1 week after rotenone treatment. The total number of licks within 20 times was significantly decreased with the presentation of 2.3 mM menthol and quinine-HCl, compared to distilled water in untreated mice, but not in rotenone-treated mice. The correlation between the licks for quinine-HCl and that for menthol was increased after rotenone treatment. In contrast, the 2-bottle choice test for 48 h clarified that menthol sensitivity was increased after rotenone treatment. Furthermore, a thermal place preference test revealed that seeking behavior toward a cold-floored room was increased in the rotenone-treated mice despite the unchanged plantar cutaneous cold sensitivity. These results suggest that taste impairments in this model mice are at least partly due to intraoral somatosensory impairments, accompanied by peripheral/central malfunction.

On the mechanics of monofilaments used in touch sensory perception

The buckling of a slender monofilament is a standard clinical method used to assess touch sensory perception, with specific applications to somatosensory impairment in patients after a stroke, detecting carpal tunnel syndrome, and as a prognosis tool for diabetic peripheral neuropathy. The basis of this approach is the Semmes-Weinstein monofilament, which comprises a calibrated set of thin, polycarbonate rods with different diameters. Application of a monofilament onto the surface of the skin with increasing pressure causes the rod to buckle. That is, at a specific force of pushing down on the far end, the monofilament suddenly bows out sidewards - the buckling load. The ability of a patient to detect increasingly finer monofilament buckling (pressure threshold) is then used to assess sensory deterioration. This paper addresses the underlying mechanics of the buckling process. Despite the accuracy and repeatability problems that have been reported in the literature, and the necessarily subjective aspects of sensory physiology, the mathematical modeling of the monofilament buckling is unambiguous and provides some fundamental insight into the parameters that underlie this approach.

Upper limb sensorimotor recovery in Asian stroke survivors: a study protocol for the development and implementation of a Technology-Assisted dIgitaL biOmaRker (TAILOR) platform.

Stroke is a leading cause of lifelong disability worldwide, partially driven by a reduced ability to use the upper limb in daily life causing increased dependence on caregivers. However, post-stroke functional impairments have only been investigated using limited clinical scores, during short-term longitudinal studies in relatively small patient cohorts. With the addition of technology-based assessments, we propose to complement clinical assessments with more sensitive and objective measures that could more holistically inform on upper limb impairment recovery after stroke, its impact on upper limb use in daily life, and on overall quality of life. This paper describes a pragmatic, longitudinal, observational study protocol aiming to gather a uniquely rich multimodal database to comprehensively describe the time course of upper limb recovery in a representative cohort of 400 Asian adults after stroke. Particularly, we will characterize the longitudinal relationship between upper limb recovery, common post-stroke impairments, functional independence and quality of life. Participants with stroke will be tested at up to eight time points, from within a month to 3 years post-stroke, to capture the influence of transitioning from hospital to community settings. We will perform a battery of established clinical assessments to describe the factors most likely to influence upper limb recovery. Further, we will gather digital health biomarkers from robotic or wearable sensing technology-assisted assessments to sensitively characterize motor and somatosensory impairments and upper limb use in daily life. We will also use both quantitative and qualitative measures to understand health-related quality of life. Lastly, we will describe neurophysiological motor status using transcranial magnetic stimulation. Descriptive analyses will be first performed to understand post-stroke upper limb impairments and recovery at various time points. The relationships between digital biomarkers and various domains will be explored to inform key aspects of upper limb recovery and its dynamics using correlation matrices. Multiple statistical models will be constructed to characterize the time course of upper limb recovery post-stroke. Subgroups of stroke survivors exhibiting distinct recovery profiles will be identified. This is the first study complementing clinical assessments with technology-assisted digital biomarkers to investigate upper limb sensorimotor recovery in Asian stroke survivors. Overall, this study will yield a multimodal data set that longitudinally characterizes post-stroke upper limb recovery in functional impairments, daily-life upper limb use, and health-related quality of life in a large cohort of Asian stroke survivors. This data set generates valuable information on post-stroke upper limb recovery and potentially allows researchers to identify different recovery profiles of subgroups of Asian stroke survivors. This enables the comparisons between the characteristics and recovery profiles of stroke survivors in different regions. Thus, this study lays out the basis to identify early predictors for upper limb recovery, inform clinical decision-making in Asian stroke survivors and establish tailored therapy programs. ClinicalTrials.gov, identifier: NCT05322837.

Visual motion detection thresholds can be reliably measured during walking and standing.

In upright standing and walking, the motion of the body relative to the environment is estimated from a combination of visual, vestibular, and somatosensory cues. Associations between vestibular or somatosensory impairments and balance problems are well established, but less is known whether visual motion detection thresholds affect upright balance control. Typically, visual motion threshold values are measured while sitting, with the head fixated to eliminate self-motion. In this study we investigated whether visual motion detection thresholds: (1) can be reliably measured during standing and walking in the presence of natural self-motion; and (2) differ during standing and walking. Twenty-nine subjects stood on and walked on a self-paced, instrumented treadmill inside a virtual visual environment projected on a large dome. Participants performed a two-alternative forced choice experiment in which they discriminated between a counterclockwise ("left") and clockwise ("right") rotation of a visual scene. A 6-down 1-up adaptive staircase algorithm was implemented to change the amplitude of the rotation. A psychometric fit to the participants' binary responses provided an estimate for the detection threshold. We found strong correlations between the repeated measurements in both the walking (R = 0.84, p < 0.001) and the standing condition (R = 0.73, p < 0.001) as well as good agreement between the repeated measures with Bland-Altman plots. Average thresholds during walking (mean = 1.04°, SD = 0.43°) were significantly higher than during standing (mean = 0.73°, SD = 0.47°). Visual motion detection thresholds can be reliably measured during both walking and standing, and thresholds are higher during walking.

Falling Out of Postural Instability: Evaluating the Contribution of Somatosensation to Standing Balance in Parkinson's Disease

People with PD (PwPD) experience a variety of motor symptoms, including postural instability, impaired gait, tremors, and falls. Falls among PwPD are especially debilitating, as they can result in fracture risk, increased progression of the disease, and even death. Previous research has demonstrated that the somatosensory system, consisting of tactile sensation (which is responsible for feelings of touch and pressure) and proprioceptive feedback (which is important in joint position sense), is crucial for reactive balance control. The primary goal of this project was to determine the unique contributions of the tactile and proprioceptive systems to standing balance control in PD. Participants at the Gait and Balance Disorders Lab at Arizona State University were asked to maintain their balance while experiencing 3 sensory vibration conditions from vibrotactile transducers 1) a control condition with no vibration, 2) vibration underneath the feet to disturb tactile sensation, and 3) vibration on top of their feet (dorsiflexor tendon) to manipulate proprioception. Another goal was to identify predictors of somatosensory impairment during standing balance (i.e., participants affected most by sensory vibration) by associating clinical characteristics with change scores in balance outcomes from the no vibration-control condition to the tactile and proprioceptive stimulation conditions. The results of this study indicate that vibrotactile stimulation had minimal impacts on standing balance responses. This study also found few predictors of somatosensory impairments. Further research is needed to enhance clinical efficiency in designing treatments that have the most impact on improving balance control and preventing falls.

Profiling Somatosensory Impairment after Stroke: Characterizing Common "Fingerprints" of Impairment Using Unsupervised Machine Learning-Based Cluster Analysis of Quantitative Measures of the Upper Limb.

Altered somatosensory function is common among stroke survivors, yet is often poorly characterized. Methods of profiling somatosensation that illustrate the variability in impairment within and across different modalities remain limited. We aimed to characterize post-stroke somatosensation profiles ("fingerprints") of the upper limb using an unsupervised machine learning cluster analysis to capture hidden relationships between measures of touch, proprioception, and haptic object recognition. Raw data were pooled from six studies where multiple quantitative measures of upper limb somatosensation were collected from stroke survivors (n = 207) using the Tactile Discrimination Test (TDT), Wrist Position Sense Test (WPST) and functional Tactile Object Recognition Test (fTORT) on the contralesional and ipsilesional upper limbs. The Growing Self Organizing Map (GSOM) unsupervised machine learning algorithm was used to generate a topology-preserving two-dimensional mapping of the pooled data and then separate it into clusters. Signature profiles of somatosensory impairment across two modalities (TDT and WPST; n = 203) and three modalities (TDT, WPST, and fTORT; n = 141) were characterized for both hands. Distinct impairment subgroups were identified. The influence of background and clinical variables was also modelled. The study provided evidence of the utility of unsupervised cluster analysis that can profile stroke survivor signatures of somatosensory impairment, which may inform improved diagnosis and characterization of impairment patterns.

Effect of a Sensorimotor Exercise Regime for Upper Limb Deficits in the In-Hospital Phase After a Supratentorial Stroke (SMULS)—Protocol for a Randomized Controlled Trial

Background Somatosensory impairments in the upper limb are a common occurrence in &gt;50% of post-stroke individuals. The effects of a combined sensorimotor therapy program on improving functional outcomes have not been studied extensively especially in the acute and subacute phase post-stroke. Methods Through a randomized controlled trial of PROBE design, participants, selected on a pre-set selection criteria will either receive the a structured regime of sensorimotor therapy in addition to routine care or only routine care for over 14 days or until discharge. Outcomes will be analyzed on the “Action Research Arm test” and “Erasmus modified Nottingham Sensory Assessment” scale at discharge and then at the third and sixth months. Results and Conclusion The proposed study will allow development and implementation of sensory rehabilitation components to the existing stroke rehabilitation protocols. Initiating intervention within the acute and subacute phase post-stroke in suitable patients will allow early intervention for sensorimotor impairments subsequently leading to improved upper limb outcomes.

Assessment of sensory impairment of the upper limb post-stroke by occupational therapists within the acute setting: A mixed methods study exploring current clinical practice

Introduction: Sensory impairment of the upper limb is common after stroke and negatively impacts a stroke survivor’s recovery. The acute phase is a critical time for the identification of post-stroke somatosensory impairments and occupational therapists have a key role in the acute stroke setting. Sensory assessment and treatment practices of occupational therapists working in acute stroke settings are largely unknown. This study aims to describe current clinical practice and identify the barriers and enablers for the assessment of sensory impairment in patients post stroke within acute stroke units. Method: A mixed-methods approach was utilised, with an Australian national cross-sectional online survey of occupational therapists ( n = 85) and state-based focus groups ( n = 2). Descriptive analyses and thematic analysis were conducted. Findings: The majority of clinicians (78%) use non-standardised measures to assess for somatosensory impairment. Three qualitative themes were identified: acute setting contextual factors, individual patient characteristics and priorities, and clinician knowledge and perceived benefits. Conclusion: Occupational therapists working within acute stroke units are aware of the importance of assessing sensory impairment of the upper limb post stroke. However, the majority use non-standardised approaches and called for a standardised quick-to-administer tool kit that is readily available in acute stroke units.

Altered Dynamic Resting State Functional Connectivity Associated With Somatosensory Impairments in the Upper Limb in the Early Sub-Acute Phase Post-Stroke

Background. Altered dynamic functional connectivity has been associated with motor impairments in the acute phase post-stroke. Its association with somatosensory impairments in the early sub-acute phase remains unexplored. Objective. To investigate altered dynamic functional connectivity associated with somatosensory impairments in the early sub-acute phase post-stroke. Methods. We collected resting state magnetic resonance imaging and clinical somatosensory function of the upper limb of 20 subacute stroke patients and 16 healthy controls (HC). A sliding-window approach was used to identify 3 connectivity states based on the estimated dynamic functional connectivity of sensorimotor related networks. Network components were subdivided into 3 domains: cortical and subcortical sensorimotor, as well as cognitive control network. Between-group differences were investigated using independent t-tests and Mann–Whitney-U tests. Analyzes were performed with correction for age, head motion and time post-stroke and corrected for multiple comparisons. Results. Stroke patients spent significantly less time in a weakly connected network state (state 3; dwell time: pstate3 = 0.003, meanstroke = 53.02, SDstroke = 53.13; meanHC = 118.92, SDHC = 72.84), and stayed shorter but more time intervals in a highly connected intra-domain network state (state 1; fraction time: pstate 1 < 0.001, meanstroke = 0.46, SDstroke = 0.26; meanHC = 0.26, SDHC = 0.21) compared to HC. After 8 weeks of therapy, improvements in wrist proprioception were moderately associated with decreases in dwell and fraction times toward a more normalized pattern. Conclusion. Changes in temporal properties of large-scale network interactions are present in the early rehabilitation phase post-stroke and could indicate enhanced neural plasticity. These findings could augment the understanding of cerebral reorganization after loss of neural tissue specialized in somatosensory functions.

Feasibility of a Home-Based Mirror Therapy Program in Children with Unilateral Spastic Cerebral Palsy.

Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children's bimanual performance and quality of life. Intensive home-based therapies have been developed and have demonstrated their feasibility for children with US CP and their parents, especially when therapies are designed with the proper coaching of families. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy suitable for children with US CP. The aim of this study is to analyze the feasibility of a five-week home-based program of MT for children with US CP that includes coaching by the therapist. Six children aged 8-12 years old performed the therapy for five days per week, 30 min per day. A minimum of 80% of compliance was required. The feasibility included compliance evaluations, total dosage, perceived difficulty of the exercises, and losses of follow-ups. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2.37 to 4.51 out of 10. In conclusion, a home-based program of Mirror Therapy is a safe, cost-efficient, and feasible therapy for children with US CP when the therapist is involved as a coach during the entire program.

Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians

ABSTRACT Background and Purpose Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery. Objectives Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice. Methods An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice. Results Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001). Discussion Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice. Conclusions Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.

Proprioception assessment in stroke rehabilitation: A survey of Australian physiotherapists and occupational therapists

BACKGROUND: Proprioception is the awareness of the position, movement, and muscular force generated by the body and its musculoskeletal parts, and is an important somatosensory impairment to assess in people with stroke. We know that rehabilitation clinicians self-report to assess proprioception in approximately two-thirds of people with stroke. What we do not know is what type of assessments are used, or the true frequency of their use in clinical practice. This study aimed to provide a preliminary description of the type and frequency of proprioception assessment used by clinicians working in stroke rehabilitation in Australia, and their knowledge about proprioception impairment. METHODS: We surveyed Australian physiotherapists and occupational therapists who were involved in the rehabilitation of people with stroke. The online cross-sectional survey ran from March to October 2020. While they were blind to the aims of the study, respondents answered questions about clinical decision-making in a case study of a person with stroke and proprioception impairment. Then, they were asked questions about proprioception. RESULTS: There was a total of 165 survey responses, of which 58 contained complete datasets suitable for analysis. Only 55% (n = 32) of respondents selected an assessment of proprioception for the person described in the case study. The majority of respondents defined proprioception to be the sense of joint / limb (n = 38, 65.5%) or body (n = 27, 46.6%) position and used ‘eyeball’ judgements of limb matching accuracy (56%, n = 33) as an assessment. CONCLUSIONS: These preliminary data suggest that proprioception is likely under-assessed in stroke rehabilitation and that clinicians understand proprioception to be the sense of joint position and movement, but lack awareness of other proprioceptive senses, such as the sense of muscle force. These factors may reduce the ability of clinicians to rehabilitate proprioception impairment in people with stroke.

Are 5HT7 Receptors Possible Target for Multiple Sclerosis?

Multiple sclerosis (MS) is a neurological condition with a complicated autoimmune component that mainly affects women in their forties and fifties. The disorder appears in several forms, ranging from episodic somatosensory impairment to progressive and irreversible central nervous system (CNS) injury. The fundamental cause of this disorder is lack of serotonin (5HT), a neurotransmitter with numerous immune effects. Decreased 5-HT levels or synthesis have also been related to increased proinflammatory cytokines in the CNS. Among several other proinflammatory cytokines, two prototypic pro-inflammatory cytokines, interleukin-1 (IL-1β) and tumor necrosis factor (TNF-α) have been identified as primary effectors of neuroinflammation's functional effects on neurodegeneration.TNF-α is a pleiotropic cytokine that regulates homeostasis, immunity, and inflammation and IL-1β is also a cytokine with neuroimmunological and neurophysiological functions. MS patients are usually on drugs that change the serotonergic system, because of increased clinical comorbidities and proven serotonin deficits. Several studies have shown that higher 5-HT levels have anti-inflammatory and immune-modulating properties, which could help to delay the progression of the disease.

Managing Somatosensory Impairments in Stroke: Current Clinical Practice and The Use of Technology

<h3>Research Objectives</h3> To identify current clinical practices and perspectives of physiotherapists and occupational therapists on the management of somatosensory impairment post-stroke, and the use of technology to objectively assess patient performance and deliver interventions. <h3>Design</h3> Questionnaire-based cross-sectional study. <h3>Setting</h3> Acute hospitals, community hospitals, and day-rehabilitation centres. <h3>Participants</h3> Licensed physiotherapists and occupational therapists (N = 132) with at least 1 year of clinical experience and were actively involved in stroke care within Singapore. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Perceptions, attitudes, and experiences measured by multiple-choice and 5-point Likert-scale questions, which included types of intervention, clinical assessment, and rehabilitation technology typically used in their daily practice. <h3>Results</h3> Most therapists (64.4%) spent no more than half of their clinical practice time per week on somatosensory interventions. Functional or task-specific training was primarily and regularly applied as an intervention for improving somatosensory functions post-stroke. Less than half (43.2%) reported using standardised assessments, with the sensory subscale of the Fugl-Meyer Assessment being the most frequently used, followed by the Nottingham Sensory Assessment. In comparison, the vast majority (97.7%) reported using non-standardised forms of assessment. While most therapists (86.2%) used technology to deliver interventions, technology adoption in clinical assessment was relatively scarce (30.3%). They believed that robotic technology combined with conventional therapy has the potential to optimise stroke rehabilitation, particularly for retraining proprioception. Price (89.4%), ease of use (73.5%), and lack of available space (68.9%) were identified as the major barriers to technology integration in clinical practice. <h3>Conclusions</h3> Somatosensory-specific interventions and standardised assessments were rarely implemented in clinical practice. Technology was more widely used for intervention, compared to assessment. These findings help inform policymakers to provide more standardised clinical guidelines related to the management of somatosensory impairments, and for relevant stakeholders to consider barriers to integrating technology in stroke rehabilitation. <h3>Author(s) Disclosures</h3> No competing interests.