title: Anatomical correlates of proprioceptive impairments following acute stroke: a case series.
abstract: BACKGROUND
  Proprioception is the sensation of position and movement of our limbs and body in space. This sense is important for performing smooth coordinated movements and is impaired in approximately 50% of stroke survivors. In the present case series we wanted to determine how discrete stroke lesions to areas of the brain thought to be critical for somatosensation (thalamus, posterior limb of internal capsule, primary somatosensory cortex and posterior parietal cortex) would affect position sense and kinesthesia in the acute stages post-stroke. Given the known issues with standard clinical measures of proprioception (i.e. poor sensitivity and reliability) we used more modern quantitative robotic assessments to measure proprioception.
  
  
  METHODS
  Neuroimaging (MRI, n=10 or CT, n=2) was performed on 12 subjects 2-10 days post-stroke. Proprioception was assessed using a KINARM robot within the same time frame. Visually guided reaching was also assessed to allow us to compare and contrast proprioception with visuomotor performance.
  
  
  CONCLUSIONS
  Proprioceptive impairments were observed in 7 of 12 subjects. Thalamic lesions (n=4) were associated with position sense (n=1) or position sense and kinesthesia (n=1) impairments. Posterior limb of the internal capsule lesions (n=4) were associated with primarily position sense (n=1) or kinesthesia (n=2) impairments. Lesions affecting primary somatosensory cortex and posterior parietal cortex (n=2) were associated with significant position sense and kinesthesia impairments. All subjects with damage to hypothesized structures displayed impairments with performance on the visually guided reaching task. Across the proprioceptive tasks, we saw that position sense and kinesthesia were impaired to differing degrees, suggesting a potential dissociation between these two components of proprioception.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Kenzie
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Semrau
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
authors.forename: Sonja E
authors.initials: SE
authors.lastname: Findlater
authors.affiliation: Department of Exercise Science, University of South Carolina, 1300 Wheat St, Columbia, SC 29208, USA.
authors.forename: Troy M
authors.initials: TM
authors.lastname: Herter
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Department of Anatomy and Cell Biology, Queen's University, Botterell Hall, Room 219, Kingston, ON K7L 3N6, Canada; Providence Care, St. Mary's of the Lake Hospital, 340 Union St, Kingston, ON K7L 5A2, Canada.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Scott
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculties of Medicine and Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada; Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada. Electronic address: spdukelo@ucalgary.ca.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Dukelow
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000473:pathology; D007699:Kinesthesis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement; D012371:Robotics; D020886:Somatosensory Disorders / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D020521:Stroke / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013788:Thalamus / Q000473:pathology
keywords: Kinesthesia; Magnetic Resonance Imaging; Proprioception; Robotics; Stroke; Visually Guided Reaching