A stroke can result in changes to any of the senses, including touch, vision, hearing, taste and smell. Little trial evidence exists regarding taste and smell, but evidence for cha...
A stroke can result in changes to any of the senses, including touch, vision, hearing, taste and smell. Little trial evidence exists regarding taste and smell, but evidence for changes to hearing after stroke is reported (Bamiou, 2015). Changes to vision or touch senses after stroke often lead to concerns regarding safety; visual impairment can significantly limit independence; and most sensory changes impact on aspects of social engagement. Hypersensitivity is also described across the senses, and may contribute to processing or attentional limitations. 
Sensory loss after stroke is a recognised impairment. Reported prevalence rates vary, with some estimating that up to 80% of people have loss or alteration in various somatic sensa...
Sensory loss after stroke is a recognised impairment. Reported prevalence rates vary, with some estimating that up to 80% of people have loss or alteration in various somatic sensations – touch, position sense, temperature, pain, etc. (Doyle et al, 2010). The severity of sensory loss is associated with the extent of motor loss, and so the independent importance of sensory loss is difficult to quantify but one example of a standardised assessment tool is the Nottingham Sensory Assessment. Sensory retraining can be passive using electrical stimulation, or active involving repeated exposure to varying stimuli such as texture, temperature, joint position sense or shape. 
People with stroke should be screened for altered sensation and if present, assessed for sensory impairments using standardised measures. 
People with sensory loss after stroke should be trained in how to avoid injury to the affected body parts. 
Visual problems after stroke are common. In a multicentre prospective cohort study, 58% of people with stroke were found to have visual problems and about half of them, regardless ...
Visual problems after stroke are common. In a multicentre prospective cohort study, 58% of people with stroke were found to have visual problems and about half of them, regardless of the visual impairment type, were visually asymptomatic (Rowe, 2017; Rowe et al, 2020). Visual problems include altered acuity, field loss such as hemianopia and disruption of eye movements causing diplopia, nystagmus, blurred vision and loss of depth perception (NICE, 2013b; Hepworth et al, 2015). Ocular stroke can cause visual loss due to central or branch retinal artery occlusion, but central visual loss can be due to coexistent ocular conditions. Perceptual disorders such as visual agnosia (Section 4.36 Perception) and neglect (Section 4.37 Neglect) should be distinguished from visual impairments. Visual disturbance has a significant impact on confidence, safety and independence and should therefore remain a focus for all members of the multidisciplinary team to support with identification, adjustment and adaptation. People with visual changes following stroke who were previously driving should be advised of the requirements and restrictions (see Section 4.14 Driving). 
People with stroke should be screened for visual changes by a professional with appropriate knowledge and skills, using a standardised approach. 
People with stroke should be:
- assessed for visual acuity whilst wearing their usual glasses or contact lenses to check their ability to read newspaper text and see distant objects clearly;
- examined for the presence of visual field deficit (e.g. hemianopia) and eye movement disorders (e.g. strabismus and motility deficit);
- assessed using adapted visual tests for those with communication impairment. 
People with altered vision, visual field defects or eye movement disorders after stroke should receive information, support and advice from an orthoptist and/or an ophthalmologist. 
People reporting visual disturbance following stroke should be assessed by an occupational therapist to assess its impact on their ability to carry out functional tasks independently, their confidence and safety. 
People with visual loss due to retinal artery occlusion should be jointly managed by an ophthalmologist and a stroke physician. 
Multidisciplinary treatment programmes should be developed with an orthoptist and should include restorative and compensatory approaches to maximise safety and independence, in accordance with the person’s presentation, goals and preferences. For people with visual field loss due to stroke, compensation training such as visual scanning or visual search training should be considered. 
People with visual deficits following stroke should be advised about driving restrictions and receive accessible written information regarding the process of assessment and decision making.