Bilateral Mechanoreception Discrimination based on Bihemispheric Somatosensory Response Patterns is Associated with Proprioception and Motor Function After Stroke.

Objectives: Stroke commonly impairs proprioception and motor function, yet the cortical sensory processes underlying these impairments remain poorly understood. Prior electrophysiological studies have primarily focused on the average magnitude of unilateral cortical sensory responses to vibration, potentially overlooking distributed and trial-to-trial features of sensory processing that may be functionally relevant to proprioceptive processing and motor performance. We therefore aimed to characterize bilateral cortical sensory responses to determine their relationships with proprioceptive and motor function. Methods: EEG was recorded from forty-six individuals with chronic stroke during a rapid, passive, vibrotactile stimulation paradigm applied to the left and right fingertips. Somatosensory evoked potentials (SEPs) and event-related desynchronization (ERD) were quantified. Finger proprioceptive performance was assessed using a passive, robotic, finger crossing identification task, while motor function was evaluated using the Box and Block Test, Fugl-Meyer Assessment, and Nine Hole Peg Test. Associations with function were assessed using (i) unilateral sensory response magnitude at the contralateral parietal cortex and (ii) somatosensory decoder performance, defined as the accuracy with which a decoder identified the location of the stimulated hand (i.e. paretic vs. non-paretic) from combined bihemispheric response patterns. The association between these responses and proprioceptive ability and motor function was assessed. These associations were further evaluated jointly across multiple motor function measures using an exploratory analysis leveraging nonlinear dimensionality reduction and clustering. Results: Vibrotactile stimulation of the paretic hand elicited ipsilesional SEP and ERD that were reduced in magnitude compared to stimulation of the non-paretic hand. Both decreased SEP magnitude and reduced sensory decoder performance were associated with greater finger proprioceptive error. Unlike unilateral responses, the somatosensory decoder's performance was also strongly associated with motor function, explaining approximately 22.5% of the variance in motor performance. Dimensionality reduction and clustering across multiple motor assessment scores showed distinct subgroups, that showed significant differences in sensory decoding. Conclusions: The hemispheric distribution and discriminability of cortical sensory responses are functionally relevant markers of sensorimotor integrity after stroke. Assessing relative lateralization of somatosensory responses for each hand, rather than the magnitude of dominant contralateral responses alone, may better capture the reliability of sensory processing after stroke, as well as the distributed cortical reorganization supporting sensorimotor function. These findings support the potential value of a novel decoding-based neurophysiological measure for sensory-driven rehabilitation, biomarker development, and patient stratification.