Sensory problem

by Kate

Question:How normal is it to lose the sense of heat and cold on the side of the stroke? My partner cannot determine hot things at all. What can I do to help him?

Answer It is not uncommon to have sensory issues after stroke including impairment with detecting hot and cold. This particular sensory pathway controls pain and temperature. You can visit the sensory re-education page on this website for ideas if he is having other sensory issues as well. Ideas to help with problems detecting heat/cold include:

Apply cold and warmth in alternating fashion to his skin and see if he can detect temperature differences (you can put very warm water in a cup and ice cold water in another cup and alternate placing them against his skin for at least 3 seconds each). Have him focus on any difference he feels so that he can become more aware of temperature. He may not feel hot/cold but may notice subtle differences in the sensation felt which he can begin to identify with hot or cold. It's best to do the activity with his eyes closed.

If he cannot detect the difference at all, apply the heat/cold first to his non-affected side and then to his affected side to help give him some feedback.

Tell him to always check the temperature of water with his non-affected hand before getting into a bath/shower or washing his hands. He should also avoid standing around hot surfaces and using sharp objects as he will have trouble detecting pain/temperature on the affected side.

Loss of sensation

Question: My husband had a stroke in October 2009. He has lost all of the sensation on the left side of his body including his hand. What activities could I do with him to help him to regain sensation in his hand?

Question: I'm looking for a sensory program for stroke patient with home health care.


Answer: There are various sensory re-education techniques you can try. These can be found at www.stroke-rehab.com/sensory-re-education

Sensory Re-education for Leg

by Prabha
(Coimbatore)

Question How can you give sensory re-education to the legs at home?

Answer: Sensory re-education techniques are more often used for the hands, but some of the same principles can be used for the legs. Some of these techniques can include:

Try to differentiate between textures that are rubbed against your legs (i.e. cotton, sandpaper, satin, velcro, velvet, etc.)

Have another person touch you on one spot with your eyes open, then with your eyes closed. Try to associate where you saw object touch your skin to how it felt on your skin.

Have another person keep pressure still on your skin then move it around. Watch and pay attention how it feels. Close eyes and try to identify when the pressure is still versus when it is moving.

Have another person apply cold and or warmth to your skin and see if you can detect temperature differences.

Close eyes and have someone else position your affected leg. See if you can tell what position your leg is in (e.g. my knee is bent, my foot is pointing down, my leg is out to the side, etc.) then open your eyes to see what position it is in.

Close eyes. Have someone else place a lighter object on your leg then a heavier object. Try to determine which object was heavier or lighter.

Place your foot on a lightweight object (e.g. a paper sack that is opened). Only apply enough pressure to feel the sack without collapsing it.

Place your foot on a scale and experiment with placing different pressures on the scale. See if you can feel the difference between a little, medium, and maximal force applied.

Have your leg massaged or use vibration along the leg.

Use your imagination - basically any activity you can do with your legs that involves touch/pressure/temperature would be a sensory re-education activity. Do not use sharp items or extreme temperatures though as this would not be safe for a sensory impaired limb.

Hot and cold

Question: The right side of my body can not sense hot or cold. How long does this last and are there any treatments?

Answer: I have seen this last permanently is some individuals and return in others. You will have a better idea whether you will get return as you heal from your stroke. Your doctors may be able to provide insight based on the area of the brain damaged and the extent, but they will probably tell you the same thing that I do that only time will tell. You could look into the tab under sensory re-education on this website for treatment ideas.

Stroke and Constant Numbness

by Kevin
(Orlando Fl)

Question: I recently had a stroke in my right cerebral lobe and occipital lobe. My angiogram showed no blockages up through my carotid arteries. My question is why do I have constant numbness in my left arm and leg? My doctor gave me lyrica to help but it doesn't seem to work well.

Answer The occipital lobe is one of the lobes of the cerebrum. There are four cerebral lobes commonly identified and these are the parietal, occipital, frontal, and temporal lobes. The occipital lobe is mostly associated with vision. Numbness in the affected limbs is not uncommon after stroke and can be unrelenting for some patients. Mirror therapy/sensory re-education might be beneficial in helping the brain perceive normal sensory input from your left side. Mirror therapy has been used effectively in helping decrease phantom limb pain in amputees and has shown some promising results in other patient populations with sensory and pain issues. To find out more about graded motor imagery and mirror therapy, you can visit gradedmotorimagery.com or search mirror therapy online. There are also many helpful youtube videos on mirror therapy (make sure it's a credible source).

Sensory impairment

Question:: Is there a specific Type of stroke, or Area in the brain that will results in a sensory impairment?

Answer: Damage to the parietal lobe where the somatosensory cortex is located can cause sensation issues. Damage to the thalamus and brainstem which relay sensory information to the cortex can also cause sensation issues. If you know the specific location of a stroke (e.g. a middle cerebral artery infarction), you can research it online to see the specific effects.

numbness in my leg

by Lynda Turnbull
(Blyth)

Question: I had a stroke 3 years ago that left me with mild numbness in my leg. It seems to be getting worse. I'm going to a physio at the moment who gave me exercises to do to strengthen my leg but it doesn't seem to be helping.

Answer: There is not a lot of good research on what helps with decreased sensation in stroke patients. Some treatments that showed promise in some small studies included intermittent pneumatic compression and mirror therapy. You might also ask your MD about trying Transcutaneous Electrical Nerve Stimulation or TENs.

Left hand is cold my father says after he had a mild light stroke, what can he do?

by LawStudent2017
(North Carolina)

Question: Dad is in his early eighties, never sick, and had a light to mild stroke. He is now doing fairly well, really good the Dr.said, and he spent 4 days in a hospital and then 2 weeks in a rehab at Bryant Aldridge in nice Rocky Mount, NC, and he is again doing exceptional. Howerver, his left hand is freezing cold, and this is almost all day off and on, and he doesn't have a doctor follow up until next Tuesday.

WHAT IS CAUSING THIS.
WILL IT PRECLUDE AND WHAT CAN WE DO?

He is taking meds, and again this is the only thing that is bothering him.

Everything else is coming along great for Dad.

Thank you.

Answer Hopefully, the MD will be able to help your father come up with a solution or refer him to a pain clinic. The sensation of cold could be due to impairment in part of the brain that deals with sensation, decreased blood flow to the extremity or Central Pain Syndrome to name a few causes. Some things that might help are a glove (or fingerless glove where fingers are exposed at the tips so he can still use the fingers), moving the arm/hand to increase circulation, massage, or hand warmers (only if sensation is intact because you don't want him to burn himself). He would want to make sure that the rest of his body his warm. If his torso or head is cold, then this will take away from blood flow to the hands as the body attempts to heat larger parts of the body. I would definitely pursue the help of a MD, and if you don't find one that has any answers, I would specifically visit a pain clinic with a pain management physician.

Sensation

by Esther
(Africa)

Question: I need to know what it means when someone who had a stroke that affected the use of her left side then weeks later recovered use of most parts except for left shoulder and hand weakness, started feeling feeling tingling sensations in her left shoulder and hand more recently?

Answer: It could mean the person is beginning to have increased sensation in the left hand and arm or it could be abnormal sensations due to the stroke. My advice is to keep working on the hand/arm and hopefully it will continue to get stronger and work better.

Numbness and tingling has gotten worse.

by GAIL
(NEW ORLEANS)

Question: Is it possible that the numbness and tingling has gotten worse? I had a stoke 22 months ago which affected my left side. After inpatient therapy, I was able to walk with a walker. During outpatient OT therapy I developed a frozen shoulder and was told to go to an orthopedic, after intensive therapy he said he thought the therapy made it worse. I have a new doctor now who wants to do manipulation surgery, which I haven't decided on yet.

The stroke also left me with a dropped foot and i wear a brace. For spasticity in my leg I have an implanted pump that sends baclofen to my spine. I have had this 5 months, they are still working on the right dosage, and I see no positive changes, in fact I keep saying that I feel that the numbness is getting worse in which they say that the baclofen has nothing to do with that. I'm definitely tired of being told that this numbness is normal and nothing will help make it better, but I think its worse, and I'm not imagining this. I had a bad fall recently, but did not break any bones so did not get checked out. I did have a hickey on the back of my head, but no bad headache. I sent a email to my neurologist but have not heard from him yet. I have been looking for a group that perhaps has someone with similar problems, I feel alone, with no one that relates to how I feel. I feel that the doctors don't really know how it feels. I did try to take my life a year after the stroke and I can say that I am still sorry I didn't succeed, but I don't want to but my family through that again.
I also take botox injections to help the spasticity in my hand, which helps some, but doesn't get rid of the extreme numbness.
I sincerely hope that I hear from someone, if only for the fact that they know what I feel like.

Answer: I think it would benefit you to talk to others who are having similar issues. There is a forum that deals with all types of neurological conditions at www.neurotalk.com. I would look through and find the right discussion for you. You could also search for "baclofen pump" on the forum and see if there are others with similar symptoms. Until they get the dosing right, you may have various symptoms. If after a long period of time, you don't feel it has any benefits, then you should discuss that with your doctors, but I definitely would let them try to get the dosing right first before you make up your mind.

I think something that could help you emotionally is to connect with others, so definitely check out the forum. Most medical professionals have not been in the same situations as their patients, so it is very hard for them to relate to their symptoms and circumstances. Personally, I think the lack of empathy or understanding from some medical professionals is part of the personality traits that allow them to be in the profession. They are able to separate themselves from a situation which for most people would be too overwhelming and heartbreaking. That is helpful for the medical professional not to become emotionally drained, however, it makes the patient feel alone and misunderstood. I'm not saying that there aren't compassionate medical professionals, because there are, but you are more likely to get the emotional support and understanding you need from other patients in support groups or online forums. It really helps to talk to others that have dealt with the same issues or symptoms.

As far as your shoulder, I have seen some good results with manipulation, but you need to consider what kind of movement or use you have of the arm. If you have movement, then it may be beneficial. If you have paralysis from the stroke with little movement or use, the shoulder could just end up frozen again so I would discuss the pros and cons with the surgeon.

sensory re-education problem ,please help

by Ghena
(Jordan , Amman)

Question: My patient had a left CVA, and her right hand is affected, the sensation and localization in fingers is impaired, the palm sensation good but not much, her manipulation also. My long term goal is sensory re-education. Can you give me a strategies how to do it in different ways in the first phase???

Answer: I would first explain to the patient what is going on and talk to the patient about safety precautions such as avoiding hot surfaces, hot water, and sharp objects. I would also tell the patient to do a visual check of the hand frequently to make sure it is not in a bad position. I would see if the patient can feel vibration on the various fingers. I like to use a small vibrator/massager like this one: mini massager. If the patient can feel vibration on each finger, then you can move on to other forms of sensory re-education, but if they cannot feel vibration very well, then I would work on the patient identifying what finger the vibration is being applied to while their eyes are closed. I would also work on trying to find objects hidden in rice. They would have to do this with their eyes closed or looking away from the rice as you don't want them compensating with their vision to find the object. I usually try various sizes and shapes of objects. If they have trouble with this, then I try bigger objects. I have even put objects as big as a bottle of lotion in rice for people that have severely impaired sensation.

Normally, I would use things like marbles, blocks, clothespins, but if these are too hard to find, then try much larger objects. Sometimes people have better luck finding metal objects because they are colder to the touch and they can feel the cold. You can also try placing heavy and lighter objects in their hand when their eyes are closed and see if they can identify which object is heavier. I also will have them close their eyes and apply various textures to the hand and see if they can feel the difference between something rough (like sandpaper) and smooth (like a silk cloth).

In addition to trying to identify touch/vibration with eyes closed, I also test for proprioception. I will have the patient close their eyes and see if they can tell what I am doing to their fingers (e.g. bending the ring finger, straightening the index finger, making an entire fist). I will also put the non-affected hand in different positions and see if they can imitate the position with the affected hand (eyes still closed). If they do not have good position sense of the affected hand, then I will give my patients a sign language hand out of the alphabet and have them try imitating the pictures first with eyes opened and then with eyes shut.

If you need further ideas, feel free to contact me. Please note that when you work with a patient during a session, do the vibration activities last as this may impair their ability to locate objects in rice or feel light touch. Also, always do sensory re-education before strengthening and fine motor activities. For more ideas, you can visit https://www.stroke-rehab.com/sensory-re-education.html.

Hand and fingers

by Pamela Allen
(England )

Question: I had a stroke in September last year - I think I’ve had a good recovery, but I have a problem with my hand - it feels as though I have a handful of grit all the time. I’ve been putting hand cream on but it makes no difference.... also I have pins and needles in my fingertips - I have been doing exercises to get the senses back - I’ve even started knitting again - slowly but surely! Has anyone else got these problems? I would appreciate some help and advice. Thank you 😊

Answer: If you haven't already, try the sensory re-education exercises at https://www.stroke-rehab.com/sensory-re-education.html

Phantom pain, balance, spastic motion in hand, mouth problems

Question: In 2014 I suffered a brain lesion that left me with spastic hand motion in my left hand and milder issues in my left leg. After trying tetrabenazine for about a year, the expense and minimal effect made me quit that. While my doctors thought it would heal, it hasn't. though it has improved.

In 2016, I had a small stroke in the thalamus area of my brain. That left me with phantom pain (numbness) in my right index finger and thumb. It also left me with some numbness around my lips, affecting my speech. I also have balance problems.

What neuroplastic exercises can I do to address these issues?

Thanks,
Mike

Answer: Some exercises that have been done to help with hand pain are Graded Motor Imagery exercises which consists of laterality training, motor imagery, and mirror therapy. You can read about this technique at www.gradedmotorimagery.com. When I have patients that have numbness in the fingers, I often use sensory re-education along with fine motor activities. These can be viewed at www.stroke-rehab.com/sensory-re-education.html and www.stroke-rehab.com/hand-exercises.html.

I would advise you to check with a speech language pathologist regarding exercises or sensory re-education for the facial numbness and with an OT regarding your hand issues. You can also ask your physician or OT/SLP about NMES (neuromuscular electrical stimulation) to see if it might be appropriate or helpful.

Four years post stroke - get rid of numb fingers?

Question: Husband had Cortical Right MCA stroke August 2016. He has had his hand feel like pins and needles since then. His neurologist says there is nothing that will help him. I read about resensitization and mirror therapy maybe helping him get back normal sensation. Could it help or is it a waste of time?

Answer: The good thing about mirror therapy and sensory re-education techniques is that they can be done easily and inexpensively and aren't harmful, so it wouldn't hurt to try them and see if there is benefit. If they turn out to not be helpful, they could be seen as a waste of time, but if it does happen to help, then it will be well worth it.

Sensory issue on right hand

by Roger Cox
(Jupiter Florida )

Question: What can be done, it’s been 25 days and my hand is ice cold some days worse than others, I’ve been scared of Covid and not sure of rehab, drop foot is a 3/4 getting better. Have mobility of hand just tingles and coldness is toughest symptom. Neurologist saw for teleconference only useless. In er was told they had 40 on ventilators so I got out and they agreed.

Answer: A stroke can cause problems with sensation and the brain's ability to interpret stimuli. It is not uncommon to have temperature changes or altered sensation in the extremities. The brain continues healing for several months (and even longer), so I would give it time to see if it resolves. In the mean time, you may try local warming to the hand to see if that helps. Possibly an arthritis glove may work. You can find them on Amazon. I have had patients use IMAK or Vive brands. Sometimes though pressure or touch to an extremity affected by stroke can be sensitive, so the pressure from the glove may be warming, but it may end up being painful if the hand is sensitive. I think with time that the coldness will resolve, but it is not guaranteed. If you continue to have the coldness or pain for several months, you could consult with a physician for other options such as medication. It could be possible that you have decreased circulation to the hand or neuropathy. You might also check with a vascular doctor if the problem persists. Some other ideas are exercising the hand to increase blood flow (e.g. squeezing a ball, open/close the hand, grip exerciser, stretching a rubber band with the fingers or doing theraputty exercises to name a few).

Numbness, Sensory Re-education, and Mirror Therapy

by William
(Ohio)

Question: Hello, 13 months ago, I had three strokes in less than two days. I have movement but have very little sensation in my right hand and arm. I can feel pressure but not much else. It makes it very difficult to do daily tasks like buttoning my shirt and tying my shoes. I am looking into sensory reeducation exercises but I’m also interested in knowing if mirror therapy would also be good to improve sensation? And if so, how should I do it? For example, do I just rub different textures with my non effected hand while looking in the mirror? I hope you can help me

Answer: I have not used specific sensory re-education techniques combined with mirror therapy, so I cannot comment on any results I have seen personally. I do know of one research study with positive results that was done in India. The technique they used was to hide the affected arm behind the mirror and tactile stimulation was applied to the good or non-affected arm while the participant watched in the mirror. This essentially tries to trick the brain into thinking the affected arm is "feeling" something because the participant perceives the arm in the mirror as the affected arm. You can read about the technique they used on this poster at https://cdn.technologynetworks.com/ep/pdfs/mirror-therapy-in-management-of-somatosensory-impairment-among-post-stroke-hemiparesis.pdf.

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