Evaluation of upper limb perception after stroke: a prevalence and longitudinal study with the new Affected Limb Perception Questionnaire (ALPQ)

Abstract Background Following a stroke, patients may suffer from alterations in the perception of their own body due to an acquired deficit in body representations. While such changes may impact their quality of life as well as recovery, they are not systematically assessed in clinical practice. This study aims at providing a better understanding of the prevalence, evolution and impact on recovery of upper-limb body perceptions (BPs) alterations following stroke. In addition, we will investigate associations among BPs alterations items, their associations with the sensorimotor functions, upper-limb usage, damages in brain structure and connectivity. Methods We developed a new tool named ALPQ (for Affected Limb Perception Questionnaire) to address the present study objectives. It assesses subjective disturbances in the perception of the affected upper limb (UL) following stroke, by measuring several dimensions, namely: anosognosia for hemiplegia, anosodiaphoria for hemiplegia, hemiasomatognosia, somatoparaphrenia, personification of the affected limb, illusion of modification of physical characteristics (temperature, weight, length), illusory movements, super- or undernumerary limb, upper-limb disconnection, misoplegia, and involuntary movement. This study combines a cross-sectional and longitudinal design. The ALPQ will be administered to minimum 60 acute and 100 sub-acute stroke patients. When possible, patients will be followed up to the chronic stage. Complementary evaluations will be administered to assess patients’ sensorimotor and cognitive functions as well as upper-limb activity, and brain lesions will be analysed. Discussion The ALPQ is a new tool to evaluate patient’s body perceptions which has the advantages to cover a broad range of BPs distortions, to be compatible with the clinical context, and to have a quantitative approach. This study will provide a better understanding of BPs alterations following stroke: their prevalence and evolution, as well as their associations with sensorimotor deficit, cognitive profile and spontaneous arm activity, brain lesions and recovery. Ultimately, the results could support the personalization of rehabilitation strategy accordingly to patients’ UL perception to maximize their recovery. Trial registration https://osf.io/p6v7f.