Carrying an unseen weight: the neuro-perceptual landscape of limb heaviness after stroke- a scoping review

BACKGROUND: Perceived limb heaviness is an under-recognised stroke symptom. Survivors may report heavy limbs or excessive effort to move without clear weakness or spasticity. This may indicate sensorimotor processing issues not detected by standard assessments. Proposed mechanisms include altered sensorimotor integration, impaired proprioception, disrupted body representation, altered sensory feedback, and perceived effort. OBJECTIVE: To map and synthesise evidence on perceived limb heaviness after stroke, including mechanisms, functional impact, assessment, and rehabilitation. ELIGIBILITY CRITERIA: We included studies of adults with stroke that examined perceived limb heaviness, perceived effort, or related perceptual constructs. Peer-reviewed articles and conference abstracts were included. SOURCES OF EVIDENCE: PubMed, Scopus, and Google Scholar were searched from inception to November 2025.Charting Methods: Data were extracted using predefined methods and synthesised in accordance with PRISMA-ScR and JBI guidance. RESULTS: Eighty-two records were identified. After removing 10 duplicates, 72 records were screened. Thirty were excluded, and 42 sources (30 full-text articles and 12 abstracts) were included. Evidence suggests that perceived limb heaviness is distinct from weakness and fatigue, although these may coexist and interact. Proposed mechanisms include altered sensorimotor integration, impaired efference-copy processing, disrupted body representation, and altered sensory feedback and perceived effort. Studies of sustained muscle contraction suggest contributions from perceived effort and fatigue. CONCLUSION: Perceived limb heaviness is a poorly defined post-stroke symptom that may affect motor performance, activity, and rehab participation. Greater recognition, standardised assessment, and neurorehabilitation are needed.