Sensory Dysfunction Following Stroke: Incidence, Significance, Examination, and Intervention

Abstract Recent studies have provided evidence of the widespread incidence of sensory dysfunction following stroke. The importance of these findings lies in the association between sensory loss poststroke and poorer outcomes in motor capacity, functional abilities, length of inpatient stay, and quality of life. Since literature suggests that clinicians can use information about clients’ sensory status to predict rehabilitation outcomes and select appropriate interventions, the accuracy of somatosensory assessment is extremely clinically relevant. However, many of the clinical tests that are commonly used to examine sensation have not been found to be valid or reliable. Emerging evidence supports the efficacy of several interventions that target the sensory systems. This article reviews the incidence, significance, examination, and interventions for sensory dysfunction following stroke and summarizes the important characteristics of interventions directed at somatosensation.

[1]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[2]  Fox Jv CUTANEOUS STIMULATION. EFFECTS ON SELECTED TESTS OF PERCEPTION. , 1964 .

[3]  L. Carey,et al.  Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. , 1993, Archives of physical medicine and rehabilitation.

[4]  G. Moretto,et al.  Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation , 2005, Experimental Brain Research.

[5]  N. Korner-Bitensky,et al.  Eliciting information on differential sensation of heat in those with and without poststroke aphasia using a visual analogue scale. , 2006, Stroke.

[6]  Takashi Hanakawa,et al.  Enduring representational plasticity after somatosensory stimulation , 2005, NeuroImage.

[7]  J. H. van der Lee,et al.  Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. , 1999, Stroke.

[8]  Monica A. Perez,et al.  Motor skill training induces changes in the excitability of the leg cortical area in healthy humans , 2004, Experimental Brain Research.

[9]  MassimoPenta,et al.  The ABILHAND Questionnaire as a Measure of Manual Ability in Chronic Stroke Patients , 2001 .

[10]  Leeanne M. Carey,et al.  Impaired Touch Discrimination After Stroke: A Quantiative Test , 1997 .

[11]  Michael C. Ridding,et al.  Influence of Combined Afferent Stimulation and Task-Specific Training Following Stroke: A Pilot Randomized Controlled Trial , 2007, Neurorehabilitation and neural repair.

[12]  R. Chan,et al.  Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients. , 1998, American journal of physical medicine & rehabilitation.

[13]  Pamela W. Duncan,et al.  Similar Motor Recovery of Upper and Lower Extremities After Stroke , 1994, Stroke.

[14]  N. Byl,et al.  The Byl-Cheney-Boczai Sensory Discriminator: reliability, validity, and responsiveness for testing stereognosis. , 2002, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[15]  M. Reding,et al.  Key Neurological Impairments Influence Function-Related Group Outcomes After Stroke , 2002, Stroke.

[16]  W. Byblow,et al.  The effects of repetitive proprioceptive stimulation on corticomotor representation in intact and hemiplegic individuals , 2004, Clinical Neurophysiology.

[17]  D. Basso,et al.  Development of the Hand Active Sensation Test: reliability and validity. , 2006, Archives of physical medicine and rehabilitation.

[18]  P. Halligan,et al.  Somatosensory Assessment after Central Nerve Damage: the Need for Standardized Clinical Measures , 1999 .

[19]  Richard S. J. Frackowiak,et al.  Neural correlates of outcome after stroke: a cross-sectional fMRI study. , 2003, Brain : a journal of neurology.

[20]  The impact of somatosensory function on activity performance and length of hospital stay in geriatric patients with stroke , 2004, Clinical rehabilitation.

[21]  B. Amblard,et al.  Transcutaneous electric nerve stimulation reduces neglect-related postural instability after stroke. , 2001, Archives of physical medicine and rehabilitation.

[22]  Andreas R. Luft,et al.  Lesion location alters brain activation in chronically impaired stroke survivors , 2004, NeuroImage.

[23]  C. Hui-Chan,et al.  Transcutaneous Electrical Nerve Stimulation Combined With Task-Related Training Improves Lower Limb Functions in Subjects With Chronic Stroke , 2007, Stroke.

[24]  E. Anderson,et al.  Parietal lobe syndromes in hemiplegia. , 1970, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[25]  Functional vibratory stimulation on the hand facilitates voluntary movements of a hemiplegic upper limb in a patient with stroke , 2007, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[26]  L. Cohen,et al.  Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. , 2007, Archives of physical medicine and rehabilitation.

[27]  Richard D. Zorowitz,et al.  Recovery Patterns of Shoulder Subluxation After Stroke: A Six-Month Follow-Up Study , 2001, Topics in stroke rehabilitation.

[28]  Rüdiger J. Seitz,et al.  Post-lesional cerebral reorganisation: Evidence from functional neuroimaging and transcranial magnetic stimulation , 2006, Journal of Physiology-Paris.

[29]  N. Byl,et al.  Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke , 2003, Neurorehabilitation and neural repair.

[30]  W. Rymer,et al.  Long-lasting reductions of spasticity induced by skin electrical stimulation. , 1996, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[31]  W. Byblow,et al.  Priming the motor system enhances the effects of upper limb therapy in chronic stroke. , 2008, Brain : a journal of neurology.

[32]  C. Gaubert,et al.  Inter-rater reliability of the Nottingham method of stereognosis assessment , 2000, Clinical rehabilitation.

[33]  E. Corte,et al.  Treating sensory impairments in the post-stroke upper limb with intermittent pneumatic compression. Results of a preliminary trial , 2003, Clinical rehabilitation.

[34]  L. Cohen,et al.  Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. , 2006, Archives of physical medicine and rehabilitation.

[35]  C. Sartor-Glittenberg Quantitative measurement of kinesthesia following cerebral vascular accident , 1993 .

[36]  M. Ridding,et al.  Induction of persistent changes in the organisation of the human motor cortex , 2002, Experimental Brain Research.

[37]  K. Stiller,et al.  Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. , 2007, Archives of physical medicine and rehabilitation.

[38]  H. Feys,et al.  Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. , 1998, Stroke.

[39]  Niels Birbaumer,et al.  Influence of somatosensory input on motor function in patients with chronic stroke , 2004, Annals of neurology.

[40]  Isabelle Loubinoux,et al.  Induction of cortical plastic changes in wrist muscles by paired associative stimulation in healthy subjects and post-stroke patients , 2007, Experimental Brain Research.

[41]  T. Fung,et al.  A Preliminary Investigation , 2005 .

[42]  R J Ilmoniemi,et al.  Specific changes in somatosensory evoked magnetic fields during recovery from sensorimotor stroke , 2000, Annals of neurology.

[43]  Richard G Carson,et al.  Phasic modulation of corticomotor excitability during passive movement of the upper limb: effects of movement frequency and muscle specificity , 2001, Brain Research.

[44]  H. Goldman Improvement of double simultaneous stimulation perception in hemiplegic patients. , 1966, Archives of physical medicine and rehabilitation.

[45]  Salvatore Giaquinto,et al.  Enhancement of the somatosensory N140 component during attentional training after stroke , 2003, Clinical Neurophysiology.

[46]  Y. T. Lin,et al.  Predictors of shoulder subluxation in stroke patients. , 1995, Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences.

[47]  W. Garraway,et al.  Proprioception and spatial neglect after stroke. , 1983, Age and ageing.

[48]  G. Schlaug,et al.  Cerebral activation covaries with movement rate , 1996, Neuroreport.

[49]  Å. Seiger,et al.  Prognosis for patients with neglect and anosognosia with special reference to cognitive impairment. , 2003, Journal of rehabilitation medicine.

[50]  H Kalimo,et al.  Low TENS treatment on post-stroke paretic arm: a three-year follow-up , 2000, Clinical rehabilitation.

[51]  J. Liepert,et al.  Modulation of intracortical facilitatory circuits of the human primary motor cortex by digital nerve stimulation , 2006, Clinical Neurophysiology.

[52]  P. Yarnell,et al.  Left "Hemi" ADL Learning and Outcome: Limiting Factors , 1987 .

[53]  Peter Crome,et al.  Hand function and stroke , 2002 .

[54]  L. Hedman,et al.  Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke , 2007, Clinical rehabilitation.

[55]  R. Dykes,et al.  Sensory loss in the hand after sensory stroke: therapeutic rationale. , 1988, Archives of physical medicine and rehabilitation.

[56]  M Penta,et al.  The ABILHAND Questionnaire as a Measure of Manual Ability in Chronic Stroke Patients: Rasch-Based Validation and Relationship to Upper Limb Impairment , 2001, Stroke.

[57]  I. Hsueh,et al.  Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients , 2004, Clinical rehabilitation.

[58]  Steven R. Roys,et al.  Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects , 2003, Experimental Brain Research.

[59]  Somatosensory evoked response and recovery from stroke. , 1989, Archives of physical medicine and rehabilitation.

[60]  G Bernardi,et al.  Bilateral hemispheric activation in the early recovery of motor function after stroke. , 1998, Stroke.

[61]  Nadina B. Lincoln,et al.  The unreliability of sensory assessments , 1991 .

[62]  L. Cohen,et al.  Mechanisms underlying recovery of motor function after stroke , 2005, Postgraduate Medical Journal.

[63]  Forster Fm,et al.  Cortical sensory defects causing disability. , 1959 .

[64]  M. Ridding,et al.  Changes in motor cortical excitability induced by paired associative stimulation , 2003, Clinical Neurophysiology.

[65]  J. Fox CUTANEOUS STIMULATION. EFFECTS ON SELECTED TESTS OF PERCEPTION. , 1964, American Journal of Occupational Therapy.

[66]  C. Hong,et al.  Prediction of reflex sympathetic dystrophy in hemiplegic patients by electromyographic study. , 1995, Stroke.

[67]  Nadina B. Lincoln,et al.  Reliability and Revision of the Nottingham Sensory Assessment for Stroke Patients , 1998 .

[68]  C. Ochoa-Sangrador,et al.  Predictive model of functional independence in stroke patients admitted to a rehabilitation programme , 1999, Clinical rehabilitation.

[69]  S. Morioka,et al.  Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial , 2003, Clinical Rehabilitation.

[70]  P. E. Sullivan,et al.  Balance and physical impairments after stroke. , 1999, Archives of physical medicine and rehabilitation.

[71]  K. Hunt,et al.  Dynamic balance training with sensory electrical stimulation in chronic stroke patients , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[72]  L. Cohen,et al.  Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes , 2007, Journal of Neurology.

[73]  G. Vallar,et al.  Modulation of neglect hemianesthesia by transcutaneous electrical stimulation , 1996, Journal of the International Neuropsychological Society.

[74]  Mark L. Freed,et al.  Electrical stimulation for swallowing disorders caused by stroke. , 2001, Respiratory care.

[75]  L. Cohen,et al.  Influence of interhemispheric interactions on motor function in chronic stroke , 2004, Annals of neurology.

[76]  G. Kwakkel,et al.  Predicting disability in stroke--a critical review of the literature. , 1996, Age and ageing.

[77]  A. Carmon Distrubances of tactile sensitivity in patients with unilateral cerebral lesions. , 1971, Cortex; a journal devoted to the study of the nervous system and behavior.

[78]  Lumy Sawaki,et al.  Effects of Somatosensory Stimulation on Use-Dependent Plasticity in Chronic Stroke , 2006, Stroke.

[79]  A. Fugl-Meyer,et al.  Site of brain lesion and functional capacity in rehabilitated hemiplegics. , 1982, Scandinavian journal of rehabilitation medicine.

[80]  M. Levin,et al.  Development and validation of two new sensory tests of the hand for patients with stroke , 2002, Clinical Rehabilitation.

[81]  P A Bandettini,et al.  Relationship between Finger Movement Rate and Functional Magnetic Resonance Signal Change in Human Primary Motor Cortex , 1996, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[82]  Heidi Johansen-Berg,et al.  Attention to touch modulates activity in both primary and secondary somatosensory areas , 2000, NeuroImage.

[83]  R. Nudo Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. , 2003, Journal of rehabilitation medicine.

[84]  A Puce,et al.  Reemergence of activation with poststroke somatosensory recovery: A serial fMRI case study , 2002, Neurology.

[85]  A. Ek Sensory impairments in hemiplegia. , 1971 .

[86]  A. Sanabria,et al.  Randomized controlled trial. , 2005, World journal of surgery.

[87]  I. Wiklund,et al.  Can sensory stimulation improve the functional outcome in stroke patients? , 1993, Neurology.

[88]  B. Dobkin Do electrically stimulated sensory inputs and movements lead to long-term plasticity and rehabilitation gains? , 2003, Current opinion in neurology.

[89]  W. Backes,et al.  Somatosensory cortex responses to median nerve stimulation: fMRI effects of current amplitude and selective attention , 2000, Clinical Neurophysiology.

[90]  Hubert R. Dinse,et al.  Associative pairing of tactile stimulation induces somatosensory cortical reorganization in rats and humans , 1996, Neuroreport.

[91]  J. Liepert,et al.  Modulation of intracortical facilitatory circuits of the human primary motor cortex by digital nerve stimulation , 2006, Experimental Brain Research.

[92]  A. Geurts,et al.  Long-Term Effects of 6-Week Whole-Body Vibration on Balance Recovery and Activities of Daily Living in the Postacute Phase of Stroke: A Randomized, Controlled Trial , 2006, Stroke.

[93]  J. Rothwell,et al.  Driving Plasticity in Human Adult Motor Cortex Is Associated with Improved Motor Function after Brain Injury , 2002, Neuron.

[94]  Thomas A Matyas,et al.  Evaluation of impaired fingertip texture discrimination and wrist position sense in patients affected by stroke: comparison of clinical and new quantitative measures. , 2002, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[95]  S. Studenski,et al.  The relation between impairments and functional outcomes poststroke. , 2000, Archives of physical medicine and rehabilitation.

[96]  Sarah F Tyson,et al.  Sensory Loss in Hospital-Admitted People With Stroke: Characteristics, Associated Factors, and Relationship With Function , 2008, Neurorehabilitation and neural repair.

[97]  N. Tebble,et al.  The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain , 2003, Clinical rehabilitation.

[98]  M. Viitanen,et al.  Can the site of brain lesion predict improved motor function after Low-TENS treatment on the post-stroke paretic arm? , 2001, Clinical rehabilitation.

[99]  K. Kawahira,et al.  Short-term effects of thermotherapy for spasticity on tibial nerve F-waves in post-stroke patients , 2006, International journal of biometeorology.

[100]  N Forss,et al.  Effects of stimulus intensity on signals from human somatosensory cortices , 1998, Neuroreport.

[101]  F Chollet,et al.  Neural Substrate for the Effects of Passive Training on Sensorimotor Cortical Representation: A Study with Functional Magnetic Resonance Imaging in Healthy Subjects , 2000, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[102]  A. Eliasson,et al.  Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia , 2002, Developmental medicine and child neurology.

[103]  V Pizzella,et al.  On the reorganization of sensory hand areas after mono-hemispheric lesion: a functional (MEG)/anatomical (MRI) integrative study , 1998, Brain Research.

[104]  H. Stam,et al.  Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. , 2007, Archives of physical medicine and rehabilitation.

[105]  E. Vandenbussche,et al.  Upper Limb Exteroceptive Somatosensory and Proprioceptive Sensory Afferent Modulation of Hemispatial Neglect , 2003, Journal of clinical and experimental neuropsychology.

[106]  N. Soroker,et al.  Anosognosia for Hemiplegia in Stroke Rehabilitation , 2001, Neurorehabilitation and neural repair.

[107]  Richard B. Stein,et al.  Electrical stimulation of the human common peroneal nerve elicits lasting facilitation of cortical motor-evoked potentials , 2003, Experimental Brain Research.

[108]  G. McClatchie SURVEY OF THE REHABILITATION OUTCOME OF STROKES , 1980, The Medical journal of Australia.

[109]  Gary F Egan,et al.  Motor Impairment and Recovery in the Upper Limb After Stroke: Behavioral and Neuroanatomical Correlates , 2005, Stroke.

[110]  M. Hallett,et al.  Contribution of the ipsilateral motor cortex to recovery after chronic stroke , 2003, Annals of neurology.

[111]  M. Jüptner,et al.  Reorganization of sensory and motor systems in hemiplegic stroke patients. A positron emission tomography study. , 1999, Stroke.

[112]  Jon Driver,et al.  Active Tool Use with the Contralesional Hand Can Reduce Cross-modal Extinction of Touch on that Hand , 2002, Neurocase.

[113]  F. E. Lightbody,et al.  Long-term follow-up of the poststroke patient. , 1972, Archives of physical medicine and rehabilitation.

[114]  G S Sorock,et al.  Peripheral neuromuscular dysfunction and falls in an elderly cohort. , 1992, American journal of epidemiology.

[115]  D. Gottlieb,et al.  Classification of Stroke Rehabilitation Patients with a Simple Impairment Scale , 1997 .

[116]  S. G. Nelson,et al.  Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. , 1983, Physical therapy.

[117]  Yannan Fang,et al.  A study on additional early physiotherapy after stroke and factors affecting functional recovery , 2003, Clinical rehabilitation.

[118]  Gary F. Egan,et al.  Evolution of Brain Activation with Good and Poor Motor Recovery after Stroke , 2006, Neurorehabilitation and neural repair.

[119]  L. Cohen,et al.  Role of voluntary drive in encoding an elementary motor memory. , 2005, Journal of neurophysiology.

[120]  R. Nudo,et al.  Role of adaptive plasticity in recovery of function after damage to motor cortex , 2001, Muscle & nerve.

[121]  Veronica Murray,et al.  Determinants of Mobility and Self-care in Older People With Stroke: Importance of Somatosensory and Perceptual Functions , 2007, Physical Therapy.

[122]  J. M. Hunter,et al.  Rehabilitation of the hand : surgery and therapy , 1995 .

[123]  La Joie Wj,et al.  Somatosensory evoked potentials: their predictive value in right hemiplegia. , 1982 .

[124]  Leeanne M. Carey,et al.  Somatosensory Loss after Stroke , 1995 .

[125]  S. Tyson Use of transcutaneous nerve stimulation to treat sensory loss after stroke. , 2003, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[126]  P. Preux,et al.  Clinical Factors in the Prognosis of Complex Regional Pain Syndrome Type I After Stroke: A Prospective Study , 2002, American journal of physical medicine & rehabilitation.

[127]  A. Prevo,et al.  Poststroke hand swelling and oedema: prevalence and relationship with impairment and disability , 2005, Clinical rehabilitation.

[128]  D. Levine,et al.  The pathogenesis of anosognosia for hemiplegia , 1991, Neurology.

[129]  P. Halligan,et al.  Current practice and clinical relevance of somatosensory assessment after stroke , 1999, Clinical rehabilitation.

[130]  R. Tallis,et al.  Device for quantifying tactile neglect in stroke patients. , 1991, Journal of biomedical engineering.

[131]  H. Johansson,et al.  Comparison of brain activity during different types of proprioceptive inputs: a positron emission tomography study , 2002, Experimental Brain Research.

[132]  L. Cohen,et al.  Induction of plasticity in the human motor cortex by paired associative stimulation. , 2000, Brain : a journal of neurology.

[133]  A. Térent,et al.  Characteristics of the National Institute of Health Stroke Scale: Results from a Population-Based Stroke Cohort at Baseline and after One Year , 2003, Cerebrovascular Diseases.

[134]  C. Gowland,et al.  Recovery of motor function following stroke: Profile and predictors , 1982 .

[135]  E. Moberg,et al.  Two-point discrimination test. A valuable part of hand surgical rehabilitation, e.g. in tetraplegia. , 1989, Scandinavian journal of rehabilitation medicine.

[136]  M. Engardt,et al.  Assessment of the perceptual threshold of touch (PTT) with high-frequency transcutaneous electric nerve stimulation (Hf/TENS) in elderly patients with stroke: a reliability study , 2003, Clinical rehabilitation.

[137]  J. Melvin,et al.  Somatosensory evoked potentials: their predictive value in right hemiplegia. , 1982, Archives of physical medicine and rehabilitation.

[138]  I. Tarkka,et al.  Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke , 2002, Clinical rehabilitation.

[139]  Nicola Smania,et al.  Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. , 2003, Archives of physical medicine and rehabilitation.

[140]  S. Carmichael,et al.  Plasticity of Cortical Projections after Stroke , 2003, The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry.

[141]  K. Uğurbil,et al.  Analysis of fMRI and finger tracking training in subjects with chronic stroke. , 2002, Brain : a journal of neurology.

[142]  J. Nielsen,et al.  Changes in intracortical excitability induced by stimulation of wrist afferents in man , 2001, The Journal of physiology.

[143]  Richard S. J. Frackowiak,et al.  Neural correlates of motor recovery after stroke: a longitudinal fMRI study. , 2003, Brain : a journal of neurology.

[144]  L. Jones,et al.  The assessment and treatment of patients who have sensory loss following cortical lesions. , 1993, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[145]  S. Hillier,et al.  A pilot study of sensory retraining for the hemiparetic foot post-stroke , 2006, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[146]  J. Rothwell,et al.  Spatial attention affects sensorimotor reorganisation in human motor cortex , 2006, Experimental Brain Research.

[147]  J S Kim,et al.  Discriminative sensory dysfunction after unilateral stroke. , 1996, Stroke.

[148]  A. Geurts,et al.  Motor recovery after stroke: a systematic review of the literature. , 2002, Archives of physical medicine and rehabilitation.

[149]  P. Manganotti,et al.  Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke , 2002, Clinical Neurophysiology.

[150]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[151]  Derick T Wade,et al.  Somatosensory recovery: A longitudinal study of the first 6 months after unilateral stroke , 2007, Disability and rehabilitation.

[152]  M. Reding,et al.  Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach. , 1988, Stroke.

[153]  T. S. Miles,et al.  Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects , 2000, Experimental Brain Research.

[154]  H. Freund,et al.  The role of diaschisis in stroke recovery. , 1999, Stroke.

[155]  R. Dykes,et al.  Evaluating sustained touch-pressure in severe sensory deficits: meeting an unanswered need. , 1990, Archives of physical medicine and rehabilitation.

[156]  F. Tomasello,et al.  Assessment of inter‐observer differences in the Italian multicenter study on reversible cerebral ischemia. , 1982, Stroke.

[157]  H. Holmgren,et al.  Central post-stroke pain — somatosensory evoked potentials in relation to location of the lesion and sensory signs , 1990, Pain.

[158]  J. Liepert,et al.  Motor cortex disinhibition of the unaffected hemisphere after acute stroke , 2000, Muscle & nerve.

[159]  T. Miles Reorganization of the human motor cortex by sensory signals: A selective review , 2005, Clinical and experimental pharmacology & physiology.

[160]  F. Chollet,et al.  Neural Correlates of Proprioceptive Integration in the Contralesional Hemisphere of Very Impaired Patients Shortly After a Subcortical Stroke: An fMRI Study , 2008, Neurorehabilitation and neural repair.

[161]  M. Ridding,et al.  Time course of induction of increased human motor cortex excitability by nerve stimulation , 2002, Neuroreport.

[162]  M Robinson,et al.  Factors Influencing Stroke Rehabilitation , 1971, Stroke.

[163]  E. Anderson Sensory impairments in hemiplegia. , 1971, Archives of physical medicine and rehabilitation.

[164]  P. Bach-y-Rita,et al.  Reconsidering the motor recovery plateau in stroke rehabilitation. , 2004, Archives of physical medicine and rehabilitation.

[165]  Jia-Ching Chen,et al.  Facilitation of Sensory and Motor Recovery by Thermal Intervention for the Hemiplegic Upper Limb in Acute Stroke Patients: A Single-Blind Randomized Clinical Trial , 2005, Stroke.

[166]  P. Di Benedetto,et al.  Shoulder-hand syndrome after stroke. A complex regional pain syndrome. , 2005, Europa medicophysica.

[167]  Richard W. Bohannon Consistency of cortical sensory impairment. , 1996, Stroke.

[168]  R. Beaglehole,et al.  Recovery of motor function after stroke. , 1988, Stroke.

[169]  L. Hedman,et al.  A home program of sensory and neuromuscular electrical stimulation with upper-limb task practice in a patient 5 years after a stroke. , 2004, Physical therapy.

[170]  Timothy S Miles,et al.  Changes in corticomotor representations induced by prolonged peripheral nerve stimulation in humans , 2001, Clinical Neurophysiology.

[171]  L. Carey,et al.  Impaired limb position sense after stroke: a quantitative test for clinical use. , 1996, Archives of physical medicine and rehabilitation.

[172]  Post-apoplectic reorganization of cortical areas processing passive movement and tactile stimulation – a neuromagnetic case study , 2002, Neuroreport.

[173]  P. Brennan,et al.  Predictors of mortality and disability in stroke. , 1983, Journal of Epidemiology and Community Health.

[174]  Lumy Sawaki,et al.  Modulation of human corticomotor excitability by somatosensory input , 2002, The Journal of physiology.

[175]  M. Zwarts,et al.  Analysis of Recovery Processes After Stroke by Means of Transcranial Magnetic Stimulation , 2003, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[176]  H Asanuma,et al.  Experiments on functional role of peripheral input to motor cortex during voluntary movements in the monkey. , 1984, Journal of neurophysiology.

[177]  B. Johansson,et al.  Sensory Stimulation Promotes Normalization of Postural Control After Stroke , 1994, Stroke.

[178]  J. L. Taylor,et al.  Mechanisms of motor‐evoked potential facilitation following prolonged dual peripheral and central stimulation in humans , 2001, The Journal of physiology.

[179]  D. Webster,et al.  Prognostic Value of Sensory Defect in Rehabilitation of Hemiplegics , 1955, Neurology.

[180]  W De Weerdt,et al.  Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examination. , 2000, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[181]  H. Hummelsheim,et al.  Differential effect of repetitive hand movements upon intracortical excitability in cortical and subcortical strokes , 2006, Clinical Neurophysiology.

[182]  M. Viitanen,et al.  Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. , 1998, Scandinavian journal of rehabilitation medicine.

[183]  M. Hallett,et al.  Relevance of stimulus duration for activation of motor and sensory fibers: implications for the study of H-reflexes and magnetic stimulation. , 1988, Electroencephalography and clinical neurophysiology.

[184]  M. Jeannerod,et al.  The control of hand movements in a case of hemianaesthesia following a parietal lesion. , 1984, Brain : a journal of neurology.

[185]  D. Wade,et al.  The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. , 1991, International disability studies.

[186]  E. Taylor,et al.  Sensory retraining of the hemiplegic hand. , 1962, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[187]  John C Rothwell,et al.  Differential effect of muscle vibration on intracortical inhibitory circuits in humans , 2003, The Journal of physiology.

[188]  H. Asanuma,et al.  Projection from the sensory to the motor cortex is important in learning motor skills in the monkey. , 1993, Journal of neurophysiology.

[189]  Stephanie Studenski,et al.  Falls in community-dwelling stroke survivors: an accumulated impairments model. , 2002, Journal of rehabilitation research and development.

[190]  C. Braun,et al.  Motor learning elicited by voluntary drive. , 2003, Brain : a journal of neurology.

[191]  Amra Hodzic,et al.  Improvement and Decline in Tactile Discrimination Behavior after Cortical Plasticity Induced by Passive Tactile Coactivation , 2004, The Journal of Neuroscience.

[192]  M. Levin,et al.  Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. , 1992, Electroencephalography and clinical neurophysiology.

[193]  Thomas A Matyas,et al.  Training of Somatosensory Discrimination After Stroke: Facilitation of Stimulus Generalization , 2005, American journal of physical medicine & rehabilitation.

[194]  B. Nilsson,et al.  The relationship between sensory impairment and motor recovery in patients with hemiplegia. , 1985, Scandinavian journal of rehabilitation medicine.

[195]  M Yekutiel,et al.  A controlled trial of the retraining of the sensory function of the hand in stroke patients. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[196]  Clare L. Park,et al.  A Pilot Exploratory Study of Oral Electrical Stimulation on Swallow Function following Stroke: An Innovative Technique , 1997, Dysphagia.

[197]  H. Hummelsheim,et al.  Motor-evoked potentials are facilitated during perceptual identification of hand position in healthy subjects and stroke patients , 2003, Clinical Rehabilitation.

[198]  Pamela W Duncan,et al.  Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. , 2005, Stroke.

[199]  R. Tallis,et al.  Balance disability after stroke. , 2006, Physical therapy.

[200]  Catherine Simpson Ba Mcsp Sensory Re-education of the Hand after Stroke , 2001 .

[201]  Derick T Wade,et al.  The Rivermead Assessment of Somatosensory Performance (RASP): standardization and reliability data , 2002, Clinical rehabilitation.

[202]  L. Cohen,et al.  Increase in hand muscle strength of stroke patients after somatosensory stimulation , 2002, Annals of neurology.