Recovery of discriminative sensation after a stroke in the elderly
Smith, Dorothy Lindsay
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Thirty-one patients who had suffered a stroke which caused varying degrees of impairment of discriminative sensation were serially tested for stereognosis and 7 other modalities of sensation. Each patient was regularly tested from the time of onset of the stroke until reco¬ very had taken place if this was within one year and for no longer than one year in the absence of full recovery. The patterns of recovery of discriminative sensation were defined. An attempt was made to determine the effect of loss of discriminative sensation on the functional outcome of rehabilitation. The main findings were as follows: 1. Discriminative sensory loss at the onset of a stroke was associated with a poor prognosis for eventual functional outcome and a lengthened stay in hospital. The greater the sensory loss the poorer the chances of recovery and the greater the likelihood of a further stroke or death. 2. Persistent loss of discriminative sensation, in particular two point discrimination, was associated with a poor prognosis for eventual functional out¬ come. Once a particular level of function had been achieved, this was maintained after discharge from hospital in spite of the degree of sensory loss. Recovery of discriminative sensation was most marked during the first three months following the stroke, The ability to discriminate tickle and texture recovered first whereas two point discrimination was always last to return. In a partial impairment of discriminative sensation tickle and texture and the ability to appreciate size were the modalities most often spared. These modalities together with proprioception were most likely to recover in those patients with initial gross impairment of sensation. Stereognosis was shown to depend on cortical function. It was found that stereognosis may be intact with only h modalities present and may not when there are as many as 7. Stereognosis did not appear to be dependent on proprioception or two point dis¬ crimination o An inexplicable loss of two point discrimination in the unaffected hand at the time of admission was sometimes found. Its recovery paralleled that of tickle and texture in the affected hand.