Brain Sciences

Research

25 pages, 4414 KiB

Open AccessArticle

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

by Isuru Senadheera, Beverley C. Larssen, Yvonne Y. K. Mak-Yuen, Sarah Steinfort, Leeanne M. Carey and Damminda Alahakoon

Brain Sci. 2023, 13(9), 1253; https://doi.org/10.3390/brainsci13091253 - 28 Aug 2023

Cited by 3 | Viewed by 1534

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

21 pages, 2498 KiB

Open AccessEditor’s ChoiceArticle

Calibration of Impairment Severity to Enable Comparison across Somatosensory Domains

by Thomas A. Matyas, Yvonne Y. K. Mak-Yuen, Tristan P. Boelsen-Robinson and Leeanne M. Carey

Brain Sci. 2023, 13(4), 654; https://doi.org/10.3390/brainsci13040654 - 13 Apr 2023

Cited by 4 | Viewed by 1686

Abstract

Comparison across somatosensory domains, important for clinical and scientific goals, requires prior calibration of impairment severity. Provided test score distributions are comparable across domains, valid comparisons of impairment can be made by reference to score locations in the corresponding distributions (percentile rank or [...] Read more.

Comparison across somatosensory domains, important for clinical and scientific goals, requires prior calibration of impairment severity. Provided test score distributions are comparable across domains, valid comparisons of impairment can be made by reference to score locations in the corresponding distributions (percentile rank or standardized scores). However, this is often not the case. Test score distributions for tactile texture discrimination (n = 174), wrist joint proprioception (n = 112), and haptic object identification (n = 98) obtained from pooled samples of stroke survivors in rehabilitation settings were investigated. The distributions showed substantially different forms, undermining comparative calibration via percentile rank or standardized scores. An alternative approach is to establish comparable locations in the psychophysical score ranges spanning performance from just noticeably impaired to maximally impaired. Several simulation studies and a theoretical analysis were conducted to establish the score distributions expected from completely insensate responders for each domain. Estimates of extreme impairment values suggested by theory, simulation and observed samples were consistent. Using these estimates and previously discovered values for impairment thresholds in each test domain, comparable ranges of impairment from just noticeable to extreme impairment were found. These ranges enable the normalization of the three test scales for comparison in clinical and research settings. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

15 pages, 1459 KiB

Open AccessEditor’s ChoiceArticle

Characterizing Touch Discrimination Impairment from Pooled Stroke Samples Using the Tactile Discrimination Test: Updated Criteria for Interpretation and Brief Test Version for Use in Clinical Practice Settings

by Yvonne Y. K. Mak-Yuen, Thomas A. Matyas and Leeanne M. Carey

Brain Sci. 2023, 13(4), 533; https://doi.org/10.3390/brainsci13040533 - 23 Mar 2023

Cited by 6 | Viewed by 3383

Abstract

Somatosensory loss post-stroke is common, with touch sensation characteristically impaired. Yet, quantitative, standardized measures of touch discrimination available for clinical use are currently limited. We aimed to characterize touch impairment and re-establish the criterion of abnormality of the Tactile Discrimination Test (TDT) using [...] Read more.

Somatosensory loss post-stroke is common, with touch sensation characteristically impaired. Yet, quantitative, standardized measures of touch discrimination available for clinical use are currently limited. We aimed to characterize touch impairment and re-establish the criterion of abnormality of the Tactile Discrimination Test (TDT) using pooled data and to determine the sensitivity and specificity of briefer test versions. Baseline data from stroke survivors (n = 207) and older neurologically healthy controls (n = 100) assessed on the TDT was extracted. Scores were re-analyzed to determine an updated criterion of impairment and the ability of brief test versions to detect impairment. Updated scoring using an area score was used to calculate the TDT percent maximum area (PMA) score. Touch impairment was common for the contralesional hand (83%) but also present in the ipsilesional hand (42%). The criterion of abnormality was established as 73.1 PMA across older adults and genders. High sensitivity and specificity were found for briefer versions of the TDT (25 vs. 50 trials; 12 or 15 vs. 25 trials), with sensitivity ranging between 91.8 and 96.4% and specificity between 72.5 and 95.0%. Conclusion: Updated criterion of abnormality and the high sensitivity and specificity of brief test versions support the use of the TDT in clinical practice settings. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

15 pages, 1430 KiB

Open AccessArticle

Wrist Proprioception in Adults with and without Subacute Stroke

by Brittany M. Young, Rishika Yadav, Shivam Rana, Won-Seok Kim, Camellia Liu, Rajan Batth, Shivani Sakthi, Eden Farahmand, Simon Han, Darshan Patel, Jason Luo, Christina Ramsey, Marc Feldman, Isabel Cardoso-Ferreira, Christina Holl, Tiffany Nguyen, Lorie Brinkman, Michael Su, Tracy Y. Chang and Steven C. Cramer

Brain Sci. 2023, 13(1), 31; https://doi.org/10.3390/brainsci13010031 - 23 Dec 2022

Cited by 4 | Viewed by 2719

Abstract

Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) [...] Read more.

Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

23 pages, 4930 KiB

Open AccessArticle

Beyond the Dorsal Column Medial Lemniscus in Proprioception and Stroke: A White Matter Investigation

by Matthew J. Chilvers, Trevor A. Low and Sean P. Dukelow

Brain Sci. 2022, 12(12), 1651; https://doi.org/10.3390/brainsci12121651 - 2 Dec 2022

Cited by 1 | Viewed by 3048

Abstract

Proprioceptive deficits are common following stroke, yet the white matter involved in proprioception is poorly understood. Evidence suggests that multiple cortical regions are involved in proprioception, each connected by major white matter tracts, namely: Superior Longitudinal Fasciculus (branches I, II and III), Arcuate [...] Read more.

Proprioceptive deficits are common following stroke, yet the white matter involved in proprioception is poorly understood. Evidence suggests that multiple cortical regions are involved in proprioception, each connected by major white matter tracts, namely: Superior Longitudinal Fasciculus (branches I, II and III), Arcuate Fasciculus and Middle Longitudinal Fasciculus (SLF I, SLF II, SLF III, AF and MdLF respectively). However, direct evidence on the involvement of these tracts in proprioception is lacking. Diffusion imaging was used to investigate the proprioceptive role of the SLF I, SLF II, SLF III, AF and MdLF in 26 participants with stroke, and seven control participants without stroke. Proprioception was assessed using a robotic Arm Position Matching (APM) task, performed in a Kinarm Exoskeleton robotic device. Lesions impacting each tract resulted in worse APM task performance. Lower Fractional Anisotropy (FA) was also associated with poorer APM task performance for the SLF II, III, AF and MdLF. Finally, connectivity data surrounding the cortical regions connected by each tract accurately predicted APM task impairments post-stroke. This study highlights the importance of major cortico–cortical white matter tracts, particularly the SLF III and AF, for accurate proprioception after stroke. It advances our understanding of the white matter tracts responsible for proprioception. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

17 pages, 1971 KiB

Open AccessArticle

Kinematic Studies of the Go/No-Go Task as a Dynamic Sensorimotor Inhibition Task for Assessment of Motor and Executive Function in Stroke Patients: An Exploratory Study in a Neurotypical Sample

by Gemma Lamp, Rosa Maria Sola Molina, Laila Hugrass, Russell Beaton, David Crewther and Sheila Gillard Crewther

Brain Sci. 2022, 12(11), 1581; https://doi.org/10.3390/brainsci12111581 - 19 Nov 2022

Viewed by 1963

Abstract

Inhibition of reaching and grasping actions as an element of cognitive control and executive function is a vital component of sensorimotor behaviour that is often impaired in patients who have lost sensorimotor function following a stroke. To date, there are few kinematic studies [...] Read more.

Inhibition of reaching and grasping actions as an element of cognitive control and executive function is a vital component of sensorimotor behaviour that is often impaired in patients who have lost sensorimotor function following a stroke. To date, there are few kinematic studies detailing the fine spatial and temporal upper limb movements associated with the millisecond temporal trajectory of correct and incorrect responses to visually driven Go/No-Go reaching and grasping tasks. Therefore, we aimed to refine the behavioural measurement of correct and incorrect inhibitory motor responses in a Go/No-Go task for future quantification and personalized rehabilitation in older populations and those with acquired motor disorders, such as stroke. An exploratory study mapping the kinematic profiles of hand movements in neurotypical participants utilizing such a task was conducted using high-speed biological motion capture cameras, revealing both within and between subject differences in a sample of healthy participants. These kinematic profiles and differences are discussed in the context of better assessment of sensorimotor function impairment in stroke survivors. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

15 pages, 858 KiB

Open AccessArticle

“My Hand Is Different”: Altered Body Perception in Stroke Survivors with Chronic Pain

by Brendon S. Haslam, David S. Butler, G. Lorimer Moseley, Anthony S. Kim and Leeanne M. Carey

Brain Sci. 2022, 12(10), 1331; https://doi.org/10.3390/brainsci12101331 - 30 Sep 2022

Cited by 4 | Viewed by 9234

Abstract

Background: Chronic pain and body perception disturbance are common following stroke. It is possible that an interaction exists between pain and body perception disturbance, and that a change in one may influence the other. We therefore investigated the presence of body perception disturbance [...] Read more.

Background: Chronic pain and body perception disturbance are common following stroke. It is possible that an interaction exists between pain and body perception disturbance, and that a change in one may influence the other. We therefore investigated the presence of body perception disturbance in individuals with stroke, aiming to determine if a perceived change in hand size contralateral to the stroke lesion is more common in those with chronic pain than in those without. Methods: Stroke survivors (N = 523) completed an online survey that included: stroke details, pain features, and any difference in perceived hand size post-stroke. Results: Individuals with stroke who experienced chronic pain were almost three times as likely as those without chronic pain to perceive their hand as now being a different size (OR = 2.895; 95%CI 1.844, 4.547). Further, those with chronic pain whose pain included the hand were almost twice as likely to perceive altered hand size than those whose pain did not include the hand (OR = 1.862; 95%CI 1.170, 2.962). This was not influenced by hemisphere of lesion (p = 0.190). Conclusions: The results point to a new characteristic of chronic pain in stroke, raising the possibility of body perception disturbance being a rehabilitation target to improve function and pain-related outcomes for stroke survivors. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

20 pages, 1015 KiB

Open AccessArticle

Effectiveness of Somatosensory Stimulation for the Lower Limb and Foot to Improve Balance and Gait after Stroke: A Systematic Review

by Alison M. Aries, Poppy Downing, Julius Sim and Susan M. Hunter

Brain Sci. 2022, 12(8), 1102; https://doi.org/10.3390/brainsci12081102 - 19 Aug 2022

Cited by 6 | Viewed by 3736

Abstract

This systematic review’s purpose was to evaluate the effectiveness of lower-limb and foot somatosensory stimulation to improve balance and gait post-stroke. PRISMA reporting guidelines were followed. Included studies: randomized controlled trials (RCTs), published in English with ethical approval statement. Studies of conditions other [...] Read more.

This systematic review’s purpose was to evaluate the effectiveness of lower-limb and foot somatosensory stimulation to improve balance and gait post-stroke. PRISMA reporting guidelines were followed. Included studies: randomized controlled trials (RCTs), published in English with ethical approval statement. Studies of conditions other than stroke, functional electrical stimulation, and interventions eliciting muscle contraction, were excluded. AgeLine, AMED, CINAHL PLUS, EMBASE, EMCARE MEDLINE, PEDro, PsycARTICLES, PsycINFO, SPORTDiscus, Web of Science and Cochrane central register of controlled trials were searched from 1 January 2002 to 31 March 2022. Two authors independently screened results, extracted data and assessed study quality using Cochrane Risk of Bias 2 tool; 16 RCTs (n = 638) were included. Four studies showed a medium or large standardized between-group effect size (Cohen’s d) in favor of somatosensory stimulation, in relation to: customized insoles (d = 0.527), taping (d = 0.687), and electrical stimulation (two studies: d = 0.690 and d = 1.984). Although limited by study quality and heterogeneity of interventions and outcomes, with only one study’s results statistically significant, several interventions showed potential for benefit, exceeding the minimally important difference for gait speed. Further research with larger trials is required. This unfunded systematic review was registered with PROSPERO (number CRD42022321199). Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

14 pages, 1104 KiB

Open AccessArticle

Development and Validation of a Novel Robot-Based Assessment of Upper Limb Sensory Processing in Chronic Stroke

by Leen Saenen, Jean-Jacques Orban de Xivry and Geert Verheyden

Brain Sci. 2022, 12(8), 1005; https://doi.org/10.3390/brainsci12081005 - 29 Jul 2022

Cited by 6 | Viewed by 2152

Abstract

Upper limb sensory processing deficits are common in the chronic phase after stroke and are associated with decreased functional performance. Yet, current clinical assessments show suboptimal psychometric properties. Our aim was to develop and validate a novel robot-based assessment of sensory processing. We [...] Read more.

Upper limb sensory processing deficits are common in the chronic phase after stroke and are associated with decreased functional performance. Yet, current clinical assessments show suboptimal psychometric properties. Our aim was to develop and validate a novel robot-based assessment of sensory processing. We assessed 60 healthy participants and 20 participants with chronic stroke using existing clinical and robot-based assessments of sensorimotor function. In addition, sensory processing was evaluated with a new evaluation protocol, using a bimanual planar robot, through passive or active exploration, reproduction and identification of 15 geometrical shapes. The discriminative validity of this novel assessment was evaluated by comparing the performance between healthy participants and participants with stroke, and the convergent validity was evaluated by calculating the correlation coefficients with existing assessments for people with stroke. The results showed that participants with stroke showed a significantly worse sensory processing ability than healthy participants (passive condition: p = 0.028, Hedges’ g = 0.58; active condition: p = 0.012, Hedges’ g = 0.73), as shown by the less accurate reproduction and identification of shapes. The novel assessment showed moderate to high correlations with the tactile discrimination test: a sensitive clinical assessment of sensory processing (r = 0.52–0.71). We conclude that the novel robot-based sensory processing assessment shows good discriminant and convergent validity for use in participants with chronic stroke. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

14 pages, 972 KiB

Open AccessArticle

Predicting Post-Stroke Somatosensory Function from Resting-State Functional Connectivity: A Feasibility Study

by Xiaoyun Liang, Chia-Lin Koh, Chun-Hung Yeh, Peter Goodin, Gemma Lamp, Alan Connelly and Leeanne M. Carey

Brain Sci. 2021, 11(11), 1388; https://doi.org/10.3390/brainsci11111388 - 22 Oct 2021

Cited by 6 | Viewed by 2292

Abstract

Accumulating evidence shows that brain functional deficits may be impacted by damage to remote brain regions. Recent advances in neuroimaging suggest that stroke impairment can be better predicted based on disruption to brain networks rather than from lesion locations or volumes only. Our [...] Read more.

Accumulating evidence shows that brain functional deficits may be impacted by damage to remote brain regions. Recent advances in neuroimaging suggest that stroke impairment can be better predicted based on disruption to brain networks rather than from lesion locations or volumes only. Our aim was to explore the feasibility of predicting post-stroke somatosensory function from brain functional connectivity through the application of machine learning techniques. Somatosensory impairment was measured using the Tactile Discrimination Test. Functional connectivity was employed to model the global brain function. Behavioral measures and MRI were collected at the same timepoint. Two machine learning models (linear regression and support vector regression) were chosen to predict somatosensory impairment from disrupted networks. Along with two feature pools (i.e., low-order and high-order functional connectivity, or low-order functional connectivity only) engineered, four predictive models were built and evaluated in the present study. Forty-three chronic stroke survivors participated this study. Results showed that the regression model employing both low-order and high-order functional connectivity can predict outcomes based on correlation coefficient of r = 0.54 (p = 0.0002). A machine learning predictive approach, involving high- and low-order modelling, is feasible for the prediction of residual somatosensory function in stroke patients using functional brain networks. Full article

(This article belongs to the Special Issue Neuroscience and Touch after Stroke)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Neuroscience and Touch after Stroke

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (10 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI