Is Recovery of Somatosensory Impairment Conditional for Upper-Limb Motor Recovery Early After Stroke?

Abstract

Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recovery influences motor recovery. Methods. Motor (Fugl-Meyer upper-extremity [FM-UE]) and somatosensory impairments (Erasmus modification of the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks and at 5, 12, and 26 weeks after a first-ever ischemic stroke. The longitudinal association between FM-UE and EmNSA-UE was examined in patients with motor and somatosensory impairments (FM-UE ≤ 60 and EmNSA-UE ≤ 37) at baseline. Results. A total of 94 patients were included in the longitudinal analysis. EmNSA-UE increased significantly up to 12 weeks poststroke. The longitudinal association between motor and somatosensory impairment disappeared when correcting for progress of time and was not significantly different for patients with severe baseline somatosensory impairment. Patients with a FM-UE score ≥18 at 26 weeks (n = 55) showed a significant positive association between motor and somatosensory impairments, irrespective of progress of time. Conclusions. Progress of time, as a reflection of spontaneous neurobiological recovery, is an important factor that drives recovery of upper-limb motor as well as somatosensory impairments in the first 12 weeks poststroke. Severe somatosensory impairment at baseline does not directly compromise motor recovery. The study rather suggests that spontaneous recovery of somatosensory impairment is a prerequisite for full motor recovery of the upper paretic limb.

Keywords: motor activity; recovery of function; somatosensory disorders; stroke; upper extremity.

Figure 1.

Flowchart of the included patients with a stroke. Abbreviations: EmNSA-UE, Erasmus modification of the Nottingham Sensory Assessment of the Upper Extremity; FM-UE, Fugl-Meyer Motor Assessment of the Upper Extremity.

Figure 2.

Time course of FM-UE and EmNSA-UE over the first 26 weeks poststroke.^a Abbreviations: B, baseline assessment within 3 weeks post-stroke; EmNSA-UE, Erasmus modification of the Nottingham Sensory Assessment of the Upper Extremity; FM-UE, Fugl-Meyer Motor Assessment of the Upper Extremity; W, week of measurement. ^aA FM-UE score <18 points was considered a low baseline score and >18 points, a high baseline score. An EmNSA-UE score <9 points was considered a low baseline score and >9 points, a high baseline score.

Figure 3.

Percentage of motor and somatosensory recovery between baseline (within 3 weeks poststroke) and 26 weeks poststroke.^{a a}Abbreviations: EmNSA-UE, Erasmus modification of the Nottingham Sensory Assessment of the Upper Extremity; FM-UE, Fugl-Meyer Motor Assessment of the Upper Extremity. Motor and somatosensory recovery of 94 patients expressed as a percentage of the maximum possible improvement: EmNSA-UE recovery = (EmNSA-UE 26 weeks/[40 − EmNSA-UE baseline]) × 100%; FM-UE recovery = (FM-UE 26 weeks/[66 − FM-UE baseline]) × 100%. The black dashed line represents the same percentage recovery of both modalities. When patients show relatively more somatosensory than motor recovery, their value (blue diamond) is below the dashed line; n = 78. When patients show relatively more motor than somatosensory recovery, their value (green dot) is above the dashed line; n = 13. Three patients showed 100% recovery of both modalities (gray square at the top corner).