Association of lower limb somatosensory impairments with walking, balance and falls in chronic stroke survivors: A cross-sectional study

Abstract

Background: Stroke is a major cause of disability worldwide, affecting physical, emotional and social aspects of life. Lower limb somatosensory impairments are common among chronic stroke survivors and are often linked to difficulties in walking, maintaining balance and preventing falls. Despite their clinical importance, sensory deficits remain under-addressed in stroke rehabilitation. Understanding the relationship between these sensory deficits and functional outcomes is essential for planning effective rehabilitation strategies. Objectives: To examine the association of lower limb somatosensory impairments with walking speed, balance and fall concern in individuals with chronic stroke. Methodology: A cross-sectional study was conducted among 123 chronic stroke survivors at the Centre for the Rehabilitation of the Paralyzed (CRP), Savar. Participants were divided into two groups based on presence or absence of somatosensory impairments. Among them 27 patients had sensory impairment with motor dysfunction. Participants were assessed using the Erasmus MC-modified Nottingham Sensory Assessment (EmNSA), 10-Meter Walk Test (10MWT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I). Statistical tests included, independent t-test, Mann–Whitney U test and Spearman’s correlation. Results: Somatosensory impairments were found in 22% of participants, predominantly in the toes and foot. Those with sensory impairments had significantly slower walking speed, poorer balance and higher fall concern (p < 0.05) than participants without sensory impairments and a significant positive correlation was found between light touch impairment and balance (r = 0.452, p = 0.018). Discussion: The study highlights that lower limb somatosensory deficits, particularly in light touch, are associated with impaired functional performance in walking, balance and increased fear of falling. These findings suggest a need for integrating sensory assessments and sensory-specific rehabilitation strategies in stroke care. Future rehabilitation programs should focus on sensory retraining alongside motor recovery to reduce fall risk and improve mobility in stroke survivors. Key words: Chronic stroke, Somatosensory impairment, Walking speed, Balance, Fall, EmNSA