Interoception and allostatic load after stroke: A scoping review

Physiological regulation is critical for survival. Interoception (the ability to sense internal body state) is a key mechanism by which allostasis (the proactive adjustment of physiological systems) is achieved to maintain physiological stability. Because of the crucial role of the central nervous system in these functions, studying the effects of brain damage can enhance knowledge of these processes. This scoping review synthesises empirical evidence on how stroke affects interoceptive functions and allostatic load (the long-term "cost" to the body of maintaining the internal milieu), and whether these disruptions relate to stroke outcomes, recovery, and specific neural substrates. We reviewed 39 studies examining interoceptive abilities or allostatic load in stroke patients. Only one study assessed allostatic load directly, highlighting a major gap in the literature. Results indicate that stroke frequently impairs interoception across multiple domains, including cardiac and respiratory awareness, affective touch, temperature perception, hunger, and fatigue. These impairments are often linked to poorer functional outcomes, including reduced recovery, cognitive dysfunction, and altered body awareness. Insular and somatosensory lesions were most commonly associated with interoceptive deficits, though lesion mapping was inconsistently reported. Findings from a single study suggest that allostatic load may exacerbate post-stroke cognitive decline and health disparities, particularly in high-risk populations. We conclude that stroke disrupts internal bodily regulation in ways that likely affect recovery trajectories, yet systematic research into the interoceptive and allostatic consequences of stroke is nascent. Future research should prioritise mechanistic studies, standardised assessments, and targeted interventions to address interoception-related physiological dysregulation in stroke rehabilitation.