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Sensory Impairment and recovery After Stroke

By Louise Anne Connell

Abstract

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be accurately predicted, suggesting other potentially treatable factors such as cognitive and perceptual ability are involved. Rasch analysis allowed calculation of total scores, but also importantly allowed the scale to be shortened, making the NSA a more useable outcome measure.

Type: Thesis, NonPeerReviewed
Topics: RC Internal medicine
Year: 2007
OAI identifier: oai:etheses.nottingham.ac.uk:247
Provided by Nottingham eTheses

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  1. S A ADAMS, A ASHBURN, R M PICKERING and D TAYLOR. (1997). The scalability of the Rivermead Motor Assessment in acute stroke patients.
  2. S AGLIOTI, A BELTRAMELLO, A BONAZZI and M CORBETTA. (1996). Thumb-pointing in humans after damage to somatic sensory cortex.
  3. C ANDERSON, TAYLOR BV, HANKEY GJ and E A. (1994). Validation of a clinical classification for subtypes of acute cerebral infarction.
  4. K ANDREWS, J C BROCKLEHURST, B RICHARDS and P J LAYCOCK. (1981). The rate and recovery from stroke and its measurement.
  5. J BAMFORD, P SANDERCOCK, M DENNIS, J BURN and C WARLOW. (1991). Classification and natural history of clinical identifiable subtypes of cerebral infarction.
  6. H J M BARNETT, J P MOHR, B M STEIN and F M YATSU. (1986). Stroke: Pathophysiology, Diagnosis and Management,
  7. E P BASTINGS, G RAPISARDA, G PENNISI, MAERTENS DE NOORDHOUT, A LENAERTS, M GOOD, D C and P J DELWAIDE. (1997). Mechanisms of hand motor recovery after stroke: an electrophysiological study of central motor pathways.
  8. S BEASON-HAZEN, D J LYNN, K W RAMMOHAN and R A BORNSTEIN. (1993). Stereognosis and Neuropsychological Function in Multiple Sclerosis.
  9. J A BELL-KROTOSKI. (1990). Sensibility testing: State of the art.
  10. S BENBOW, G SANGSTER and D BARER. (1991). Incontinence after stroke.
  11. R M BERNE and M N LEVY. (2000). Principles of Physiology,
  12. B BISHOP. (1982). Neural plasticity, part 4: Lesion induced reorganisation of the CNS.
  13. S J BLAKEMORE, D M WOLPERT and C D FRITH. (1999). The cerebellum contributes to somatosensory cortical activity during selfproduced tactile stimulation. doi
  14. B BOBATH. (1978). Adult hemiplegia: evaluation and treatment, doi
  15. R W BOHANNON. (2003). Evaluation and treatment of sensory and perceptual impairments following stroke. Topics in Geriatric Rehabilitation,
  16. C BRAUN, U HEINZ, R SCHWEIZER, K WIECH, N BIRBAUMER and H TOPKA. (2001). Dynamic organization of the somatosensory cortex induced by motor activity. doi
  17. A BRODAL. (1973). Self-observations and neuroanatomical considerations after a stroke. doi
  18. T BROTT, H P ADAMS and C P OLINGER. (1989). Measurements of acute cerebral infarction: a clinical examination scale. doi
  19. J BURN, M DENNIS, J BAMFORD, P SANDERCOCK, D WADE and C WARLOW. (1994). Long-term risk of recurrent stroke after a firstever stroke. The Oxfordshire Community Stroke Project [published erratum appears in Stroke doi
  20. N BYL, J RODERICK, O MOHAMED, M HANNY, J KOTLER, A SMITH, M TANG and G ABRAMS. (2003). Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke. doi
  21. D C CAMBIER, E DE CORTE, L A DANNEELS and E E WITVROUW. (2003). Treating sensory impairments in the post-stroke upper limb with intermittent pneumatic compression. Results of a preliminary trial.
  22. L M CAREY. (1993). Tactile and proprioceptive discrimination loss after stroke: Training effects and quantitative measurement.
  23. L M CAREY. (1995). Somatosensory Loss after Stroke. Crit Reviews
  24. L M CAREY, T MATYAS and L E OKE. (1993). Sensory loss in Stroke patients: Effective training of tactile and proprioceptive discrimination.
  25. L M CAREY, L E OKE and T MATYAS. (1997). Impaired Touch Discrimination After Stroke: A Quantitative Test.
  26. J H CARR and R B SHEPHERD. (1982). A motor relearning programme for stroke,
  27. J-C CHEN, L CC and S FZ. (2005). Facilitation of sensory and motor recovery by thermal intervention for the hemiplegic upper limb in acute stroke patients: a single-blind randomized clinical trial.
  28. D X CIFU and T R LORISH. (1994). Stroke Rehabilitation. 5. Stroke Outcome.
  29. CLINICAL EFFECTIVENESS and EVALUATION UNIT. (2000). Measuring Clinical Outcome in Stroke: Acute Care.
  30. J COHEN. (1960). A coefficient of agreement for nominal scales.
  31. J COHEN. (1969). Statistical power analysis for the behavioral sciences.,
  32. F M COLLEN, D T WADE and C M BRADSHAW. (1990). Mobility after stroke: reliability of measures of impairment and disability.
  33. C COLLIN, D T WADE, G F ROBB and C F BRADSHAW. (1988). The Barthel ADL Index: a reliability study.
  34. S COREN, C PORAC and L M WARD. (1979). Sensation and Perception,
  35. S COREN, C PORAC and L M WARD. (1979). Sensation and Perception,
  36. S CORKIN, B MILNER and T RASMUSSEN. (1970). Somatosensory thresholds: contrasting effects of post-central gyrus and posterior parietal lobe excisions.
  37. S C CRAMER and E P BASTINGS. (2000). Mapping clinically relevant plasticity after stroke.
  38. N K DAMIANO, W R STAINES, S E BLACK and W E MCILROY. (2001). Relationship between sensorimotor tasks and the stages of recovery of hand function following stroke.
  39. R M DANNENBAUM and R W DYKES. (1988). Sensory loss in the hand after stroke: Therapeutic Rationale.
  40. R M DANNENBAUM and L A JONES. (1993). The assessment and treatment of patients who have sensory loss following cortical lesions. [Review] [81 refs].
  41. R M DANNENBAUM, S M MICHAELSEN, J DESROSIERS and M F LEVIN. (2002). Development and validation of two new sensory tests of the hand for patients with stroke.
  42. P M DAVIES. (1985). Steps to Follow: A Guide to the treatment and Rehabilitation of Adult Hemiplegia,
  43. R DE HAAN, J HORN, M LIMBURG, J VAN DER MEULEN and B P. (1993). A comparison of five stroke scales with measures of disability, handicap, and quality of life.
  44. H FEYS. (2006). Stroke rehabilitation in Europe: what do physiotherapists and occupational therapists actually do?
  45. A L DELLON. (1991). Sensibility Testing,
  46. (1996). Burdens of disease.
  47. L H DESOUZA. (1983). The effects of sensation and motivation on regaining movement control following stroke.
  48. J DESROSIERS, D BOURBONNAIS, G BRAVO, P-M ROY and M GUAY. (1996). Performance of the `Unaffected' Upper Extremity of Elderly Stroke Patients.
  49. E DIEBERT, M KRAUT, S KREMEN and J J HART. (1999). Neural Pathways in tactile object recognition.
  50. M DUBIN. (2002). How the brain works,
  51. R DUBNER and K REN. (1999). Endogenous mechanisms of sensory modulation.
  52. H M FEYS, W J DE WEERDT, B E SELZ, COX STECK, G A, R SPICHIGER, L E VEREECK, K D PUTMAN and G A VAN HOYDONCK. (1998). Effect of a Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke : A SingleBlind, Randomized, Controlled Multicenter Trial.
  53. S FINGER and C R ALMLI. (1985). Brain damage and neuroplasticity: mechanisms of recovery or development?
  54. A FUGL-MEYER, L JAASKO, I LEYMAN, S OLSSON and S STEGLIND. (1975). The post-stroke hemiplegic patient: a method for evaluation of physical performance.
  55. K FULLERTON, G MACKENZIE and S R. (1988). Prognostic indices in stroke.
  56. C S GAUBERT and S P MOCKETT. (2000). Inter-rater reliability of the Nottingham method of stereognosis assessment.
  57. J R F GLADMAN, N B LINCOLN and D H BARER. (1993). Use of the Extended ADL scale with stroke patients.
  58. P GOMPERTZ, P POUND and S EBRAHIM. (1993). The reliability of stroke outcome measures.
  59. J GORDON. (1990). Disorders of motor control.
  60. J B GREEN. (2003). Brain reorganisation after stroke.
  61. K GRIMMER, S BIALOCERKOWSKI, S KUMAR and S MILANESE. (2004). Implementing evidence in clinical practice: the "therapies" dilemma.
  62. A L GYLLENSTEN, G GARD, E SALFORD and C EKDAHL. (1999). Interaction between patient and physiotherapist: a qualitative study reflecting the physiotherapist's perspective.
  63. K Y HAALAND and H D DELANEY. (1981). Motor deficits after left or right hemisphere damage due to stroke or tumor.
  64. M HALLETT. (2001). Plasticity of the human motor cortex and recovery from stroke.
  65. P W HALLIGAN, M HUNT, J C MARSHALL and D T WADE. (1995). Sensory detection without localization.
  66. P W HALLIGAN, B WILSON and J COCKBURN. (1990). A short screening test for visual neglect in stroke patients.
  67. Y HAMADA, H KADO and R SUZUKI. (2001). The temporal profile of interactions between sensory information from both hand in the second somatosensory cortex.
  68. H HAMALAINEN, J HILTUNEN and I TITIEVSKAJA. (2002). Activation of somatosensory cortical areas varies with attentional state: an fMRI study.
  69. H C HANGER and R SAINSBURY. (1996). Sensory Abnormalities After Stroke.
  70. J A HARRIS, T THEIN and C W G CLIFFORD. (2004). Dissociating Detection from Localization of Tactile Stimuli.
  71. J P HELD. (1975). The Natural History of Stroke.
  72. S S HSIAO, J LANE and P FITZGERALD. (2002). Representation of orientation in the somatosensory system.
  73. S S HSIAO, D M O'SHAUGHNESSY and K O JOHNSON. (1993). Effects of selective attention of spatial form processing in monkey primary and secondary somatosensory cortex.
  74. A J HUDSPETH and N K LOGOTHETIS. (2000). Sensory systems.
  75. W JIANG, F TREMBLAY and C E CHAPMAN. (1997). Neuronal encoding of texture changes in primary and the secondary somatosensory cortical areas of monkeys during passive texture discrimination.
  76. B B JOHANSSON. (2000). Brain plasticity and stroke rehabilitation: The Willis lecure.
  77. R D JONES, I M DONALDSON and P J PARKIN. (1989). Impairment and recovery of ipsilateral sensory-motor function following unilateral cerebral infarction.
  78. H S JORGENSEN, H NAKAYAMA, H O RAASCHOU and T S OLSEN. (1995). Recovery of walking function in stroke patients: the Copenhagen Stroke Study.
  79. H S JORGENSEN, H NAKAYAMA, H O RAASCHOU, J VIV-LARSEN, M STOIER and T S OLSEN. (1995). Outcome and time course of recovery in stroke. Part II: time course of recovery. The Copenhagen Stroke Study.
  80. H S JORGENSEN, H NAKAYAMA, H O RAASCHOU, J VIVELARSEN, M STOIER and T S OLSEN. (1995). Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study.
  81. H S JORGENSEN, J REITH, H NAKAYAMA, L P KAMMERSGAARD, H O RAASCHOU and T S OLSEN. (1999). What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke Study.
  82. L JULKUNEN, O TENOVUO, S JAASKELAINEN and H HAMALAINEN. (2005). Recovery of somatosensory deficits in acute stroke.
  83. J H KAAS and C E COLLINS. (2001). The organization of sensory cortex.
  84. R KANG, D HERMAN, M MACGILLIS and P ZARZECKI. (1985). Convergence of sensory inputs in somatosensory cortex: Interactions from seperate afferent sources.
  85. F S KAPLAN, J E NIXON, M REITZ, L RINDFLEISH and J TUCKER. (1985). Age-related changes in propreioception and sensation of joint choice.
  86. D R KENSHALO. (1986). Somesthetic sensitivity in young and elderly humans.
  87. Z KHAN, J HERTANU and YANG WC. (1981). Predictive correlation of urodynamic dysfunction and brain injury after cerebrovascular accident.
  88. G KIDD, N LAWES and I MUSA. (1992). Understanding neuromuscular plasticity, a basis for clinical rehabilitation,
  89. J S KIM and S CHOI-KWON. (1996). Discriminative Sensory Dysfunction After Unilateral Stroke.
  90. R L KLATZKY and S J LEDERMAN. (1995). Identifying objects from a haptic glance.
  91. R L KLATZKY, S J LEDERMAN and V A METZGER. (1985). Identifying objects by touch: An "expert system".
  92. A KUFFOFSKY, I WADELL and B Y NILSSON. (1982). The Relationship Between Sensory Impairment and Motor Recovery in Patients with Hemiplegia.
  93. G KWAKKEL, R C WAGENAAR, B J KOLLEN and G J LANKHORST. (1996). Predicting disability in stroke--a critical review of the literature.
  94. R H LAMOTTE and V B MOUNTCASTLE. (1979). Disorders in somethesis following lesions of a parietal lobe.
  95. J R LANDIS. (1977). The measurement of observer agreement for catergorical data.
  96. LANGTON HEWER and R. (1990). Rehabilitation after stroke.
  97. S J LEDERMAN and R L KLATZKY. (1987). Hand Movements: A Window into Haptic Object Recognition.
  98. S J LEDERMAN and R L KLATZKY. (1990). Haptic classification of common objects: knowledge-driven exploration.
  99. S J LEDERMAN and R L KLATZKY. (1993). Extracting object properties through haptic exploration.
  100. J LIEPERT, W H R MILTNER, H BAUDER, M SOMMER, C DETTMERS, E TAUB and C WEILLER. (1998). Motor cortex plasticity during constrain induced therapy in stroke patients.
  101. J LIN, I HSUEH, C SHEU and C HSIEH. (2004). Psychometric properties of the sensory scale of the Fugyl-Meyer Assessment in stroke patients.
  102. N B LINCOLN, J L CROW, J M JACKSON, G R WATERS, S A ADAMS and P HODGSON. (1991). The unreliability of sensory assessment.
  103. N B LINCOLN and J R F GLADMAN. (1992). The Extended Activities of Daily Living Scale: a further validation.
  104. N B LINCOLN, J M JACKSON and S A ADAMS. (1998). Reliability and Revision of the Nottingham Sensory Assessment for Stroke Patients.
  105. N B LINCOLN and D LEADBITTER. (1979). Assessment of motor function in stroke patients.
  106. A LINDGREN, B NORVVING, O RUDLING and E A. (1994). Comparison of clinical and neuroradiological findings in first-ever stroke: a population based study.
  107. R B LIVINGSTON. (1978). Sensory Processing, Perception, and Behaviour,
  108. J M LOOMIS and S J LEDERMAN. (1986). Tactual Perception. IN
  109. P D LYDEN, T BROTT, B TILLEY, K M WELCH, E J MASCHA, S R LEVINE, E C HALEY, J GROTTA and J MARLER. (1994). Improved reliability of the NIH Stroke Scale using video training.
  110. P D LYDEN, MEI LU, C JACKSON, J M, J MARLER, R KOTHARI, T BROTT and J ZIVIN. (1999). Underlying structure of the National Institutes of Health Stroke Scale: Results of a factor analysis.
  111. F I MAHONEY and D W BARTHEL. (1965). Functional Evaluation: The Barthel Index.
  112. G N MASTERS. (1982). A Rasch Model for partial credit scoring.
  113. J B MATTINGLEY, J DRIVER, N BESCHIN and I H ROBERTSON. (1997). Attentional competition between modalities: extinction between touch and vision after right hemisphere damage.
  114. F MAUGUIERE and J E DESMEDT. (1991). Focal capsular vascular lesions can selectively deafferent the prerolandic or the parietal cortex: Somatosensory evoked potentials evidence.
  115. F MAUGUIERE and J ISNARD. (1995). Astereognosis and Dysfunction of the Primary Somatosensory (Si) Area - Somatosensory-Evoked Potentials (Sep) Data in Patients with Impaired Tactile Object Recognition.
  116. N MAYO, B COLE, J DOWLER, C GOWLAND and E FINCH. (1994). Use of outcome measures in physiotherapy: survey of current practice.
  117. D I MCCLOSKEY. (1978). Kinesthetic sensibility.
  118. I MCDOWELL and C NEWELL. (1996). Measuring Health - a Guide to Rating Scales and Questionnaires,
  119. G E MEAD, S C LEWIS, J M WARDLAW, M S DENNIS and C P WARL. (2000). How well does the Oxfordshire Community Stroke Project classification predict the site and size of the infarct on brain imaging?
  120. M MEISTER and G LAURENT. (2001). Sensory systems: Editorial overview.
  121. M MESULAM. (1998). From sensation to cognition.
  122. E MOBERG. (1991). The unsolved problem: How to test the functional value of hand sensibility.
  123. C E G MOORE and W SCHADY. (2000). Investigation of the functional correlates of reorginazition within the human somatosensory cortex.
  124. I MUSA. (1986). The role of afferent input in the reduction of spasticity: an hypothesis.
  125. H NAKAYAMA, H JORGENSEN, R HO and T S OLSEN. (1994). Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study.
  126. H NAKAYAMA, J├śRGENSEN HS, PEDERSEN PM, RAASCHOU HO and O TS. (1997). Prevalence and risk factors of incontinence after stroke: the Copenhagen stroke study.
  127. J NETZ, T LAMMERS and V HOMBERG. (1997). Reorganisation of motor output in the non-affected hemisphere after stroke.
  128. F M NOURI and N B LINCOLN. (1987). An extended activities of daily living scale for stroke patients.
  129. R J NUDO and K M FRIEL. (1999). Cortical plasticity after stroke: Implications for rehabilitation.
  130. R J NUDO, K M FRIEL and S W DELIA. (2000). Role of sensory deficits in motor impairments after injury to primary motor cortex.
  131. R J NUDO, E J PLAUTZ and G W MILLIKEN. (1997). Adaptive Plasticity in Primate Motor Cortex as a Consequence of Behavioral Experience and Neuronal Injury. Seminars in
  132. S B O`SULLIVAN and T J SCHMITZ. (1988). Physical Rehabilitation: Assessment and Treatment, F A Davis Co.
  133. J OSBORNE and E WATERS. (2002). Four Assumptions Of Multiple Regression That Researchers Should Always Test.
  134. W OSLER. (1982). The Principles and Practice of Medicine,
  135. A T PATEL, P W DUNCAN, S M LAI and S STUDENSKI. (2000). The relation between impairments and functional outcomes poststroke.
  136. P M PEDERSEN, H S JORGENSEN, H NAKAYAMA, H O RAASCHOU and T S OLSEN. (1998). Impaired orientation in acute stroke: frequency, determinants, and time-course of recovery. The Copenhagen Stroke Study. Cerebrovasc Dis,
  137. Y PEREON, P AUBERTIN and P GUIHENEUC. (1995). Prognostic significance of electrophysiological investigations in stroke patients: somatosensory and motor evoked potentials and sympathetic skin responses.
  138. J PITT-BROOKE, H REID, J LOCKWOOD and K KERR. (1998). Rehabilitation of Movement: Theoretical Basis of Clinical Practice,
  139. V M POMEROY and R C TALLIS. (2002). Restoring movement and functional ability poststroke: now and the future.
  140. R J PRESCOTT, W M GARRAWAY and A J AKHTAR. (1982). Predicting functional outcome following stroke using a standard clinical examination.
  141. J RANKIN. (1957). Cerebral vascular accidents in patients over the age of 60.
  142. B RAPP, S K HENDEL and J MEDINA. (2002). Remodeling of somotasensory hand representations following cerebral lesions in humans.
  143. G RASCH. (1960). Probabilistic models for some intelligence and achievement tests,
  144. M J RIDDOCH, G W HUMPHREYS and A BATEMAN. (1995). Stroke: Issues in Recovery and Rehabilitation.
  145. B C ROBINSON. (1983). Validation of a Caregiver Strain Index.
  146. E ROLAND. (1976). Astereognosis: Tactile Discrimination After Localized Hemispheris Lesions in Man.
  147. P E ROLAND. (1976). Astereognosis: Tactile Discrimination After Localized Hemispheric Lesions in Man.
  148. P E ROLAND. (1984). Cortical areas in man participating in somatosensory discrimination of microgeometric surface deviations and macrogeometric object differences.
  149. P E ROLAND. (1987). Somatosensory detection in patients with circumscribed lesions of the brain.
  150. P E ROLAND. (1987). Somatosensory detection of microgeometry, macrogeometry and kinesthesia after localized lesions of the cerebral hemispheres in man.
  151. R ROMO, A HERNANDEZ, E SALINAS, C D BRODY, A ZAINOS, L LEMUS, V DE LAFUENTE and R LUNA. (2002). From sensation to action.
  152. P M ROSSINI and F PAURI. (2000). Neuromagnetic integrated methods tracking human brain mechanisms of sensorimotor areas 'plastic' reorganisation.
  153. C RUCH, J FULTON and J GERMAN. (1938). Sensory discrimination in monkey, chimpanzee, and man after lesions of the parietal lobe.
  154. A RUDD. (2004). Stroke : the comprehensive and medically accurate manual about stroke and how to deal with it London,
  155. T D SANGER and M M MERZENICH. (2000). Computational Model of the Role of Sensory Disorganization in Focal Task-Specific Dystonia.
  156. J SEMMES, S WEINSTEIN, L GHENT and H TEUBER. (1960). Somatosensory changes after penetrating brain wounds in man, Cambridge,
  157. J SEMMES, S WEINSTEIN, L GHENT and H L TEUBER. (1960). Somatosensory Changes after Penetrating Brain Wounds in Man. Cambridge,
  158. L SHERWOOD. (1997). Human physiology. From cells to systems,
  159. S SHIMOJO and L SHAMS. (2001). Sensory modalities are not separate modalities: plasticity and interactions.
  160. C E SKILBECK, D T WADE, R L HEWER and V A WOOD. (1983). Recovery after stroke.
  161. S L SMALL, P HLUSTIK, D C NOLL, C GENOVESE and A SOLODKIN. (2002). Cerebellar hemispheric activation ipsilateral to the paretic hand correlates with functional recovery after stroke.
  162. S L SMALL and A SOLODKIN. (1998). The neurobiology of stroke rehabilitation.
  163. N SMANIA, B MONTAGNANA, S FACCIOLI, A FIASCHI and S AGLIOTI. (2003). Rehabilitation of Somatic Sensation and Related Deficit of Motor Control in Patients with Pure Sensory Stroke.
  164. D L SMITH. (1979). The recovery of discriminative sensation after stroke in the elderly.
  165. D K SOMMERFIELD and M VON ARBIN. (2004). The impact of somatosensory function on activity performance and length of hospital stay in geriatric patients with stroke.
  166. B A STEINBERG and J R AUGUSTINE. (1997). Behavioral, anatomical, and physiological aspects of recovery of motor function following stroke.
  167. R STEPHENSON. (1993). A Review of Neuroplasticity: Some Implications for Physiotherapy in
  168. R STERZI, G BOTTINI, M G CELANI, E RIGHETTI, M LAMASSA, S RICCI and G VALLAR. (1993). Hemianopia, hemianaesthesia, and hemiplegia after right and left hemisphere damage. A hemispheric difference.
  169. B C STILLMAN. (2002). Making sense of proprioception: The meaning of proprioception, kinasethesia and related terms.
  170. F STOLK-HORNSFELD, J CROW, E HENDRIKS, R VAN DER BANN and H-V D W BC. (2006). The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders.
  171. S P STONE, S J ALLDER and J R F GLADMAN. (2000). Predicting outcome in acute stroke.
  172. C L M SUDLOW and C P WARLOW. (1996). Comparing stroke incidence worldwide: what makes studies comparable?
  173. L SWAN. (2001). Unilateral Spatial Neglect.
  174. L TESIO. (2003). Measuring Behaviours and Perceptions: Rasch Analysis as a Tool for Rehabilitation Research.
  175. (2004). Restoring Neurological Function: Putting the neurosciences to work in neurorehabilitation.
  176. (2000). Standards of Physiotherapy - Core Standards,
  177. C TOMBERG and J E DESMEDT. (1999). Failure to recognise objects by touch (astereognosia) results from lesion of parietal-cortex representation of finger kinaesthesis.
  178. M T TURVEY. (1996). Dynamic Touch.
  179. M T TURVEY, G BURTON, E L AMAZEEN, M BUTWILL and C CARELLO. (1998). Perceiving the width and height of a hand-held object by dynamic touch.
  180. S VAISHNAVI, J CALHOUN and A CHATTERJEE. (1999). Crossmodal and sensorimotor integration in tactile awareness.
  181. J C VAN SWIETEN, P J KOUDSTAAL, M C VISSER, H J A SCHOUTEN and J VAN GIJN. (1988). Interobserver agreement for the assessment of handicap in stroke patients.
  182. D T WADE. (1994). Stroke (acute cerebrovascular disease). Heath care needs assessment.
  183. D T WADE and C COLLIN. (1988). The Barthel ADL index: a standard measure of physical disability?
  184. D T WADE, R LANGTON-HEWER, V A WOOD, C E SKILBECK and H M ISMAIL. (1983). The hemiplegic are after stroke: measurement and recovery.
  185. D T WADE, V A WOOD, A HELLER, J MAGGS and R LANGTONHEWER. (1987). Walking after stroke. Measurement and recovery over the first three months.
  186. I WADELL, A KUFFOFSKY and B Y NILSSON. (1987). A follow-up study of stroke patients 5-6 years after their brain infarct.
  187. WARDLAW JM, DENNIS MS, LINDLEY RI and E A. (1996). The validity of a simple clinical classification of acute ischaemic stroke.
  188. Y WATANABE, M SHIKANO, M OHBA, M OHKUBO and T NIWA. (1989). Correlation between somatosensory evoked potentials and sensory disturbance in stroke patients.
  189. B J WEDER, K L LEENDERS, P VONTOBEL, M NIENHUSMEIER, A KEEL, W ZAUNBAUER, T VONESCH and H-P LUDIN. (1999). Impaired Somatosensory Discrimination of Shape in Parkinson's Disease: Association With Caudate Nucleus Dopaminergic Function.
  190. S WEINSTEIN. (1993). Fifty years of somatosensory research: From the Semmes-Weinstein monafilaments to the Weinstein enhanced sensory test.
  191. S WEINSTEIN. (1993). Fifty years of somatosensory research: From the Semmes-Winstein monofilaments to the Weinstein Enhanced Sensory Test.
  192. H WIKSTROM, R O ROINE, H J ARONEN, O SALONEN, J SINKKONEN, R J ILMONIEMI and J HUTTUNEN. (2000). Specific changes in somatosensory evoked magnetic fields during recovery from sensorimotor stroke.[comment].
  193. M WILSON. (2004). Constructing Measures: Am Item Response Modeling Approach,
  194. W WINLOW and C R MCCROHAN. (1987). Growth and plasticity of neural connections,
  195. C E WINWARD, P W HALLIGAN and D T WADE. (1999). Current practice and clinical relevance of somatosensory assessment after stroke.
  196. C E WINWARD, P W HALLIGAN and D T WADE. (2002). The Rivermead Assessment of Somatosensory Performance (RASP): standardisation and reliability data.
  197. WORLD HEALTH ORGANISATION. (1971). Cerebrovascular Diseases: Prevention, Treatment and Rehabilitation.
  198. WORLD HEALTH ORGANISATION. (1978). Cerebrovascular disorders: a clinical and research classification. Geneva, World Health Organisation.
  199. M YEKUTIEL. (2000). Sensory Re-education of the Hand After Stroke, London and Philadelphia,
  200. M YEKUTIEL and E GUTTMAN. (1993). A Controlled Trial of the Retraining of Sensory Function of the Hand.
  201. M YEKUTIEL, M JARIWALA and P STRETCH. (1994). Sensory deficit in the hands of children with cerebral palsy: a new look at assessment and prevalence.`.

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