Examining Differences in Patterns of Sensory and Motor Recovery After Stroke With Robotics

Abstract

Background and Purpose-Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. Methods-One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). Results-One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral movement). Interindividual recovery on robotic measures was highly variable. However, we characterized recovery as early (normal by 6 weeks post stroke), late (normal by 26 weeks post stroke), or incomplete (impaired at 26 weeks post stroke). Proprioceptive and motor recovery often followed different timelines. Across all time points, robotic measures were correlated with clinical measures. Conclusions-These results highlight the need for more sensitive, targeted identification of sensory and motor deficits to optimize rehabilitation after stroke. Furthermore, the trajectory of recovery for some individuals with mild to moderate stroke may be much longer than previously considered.

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

“…Recovery can vary greatly between individuals,2 as well as within an individual across different domains, such as sensory and motor recovery 3. Predicting recovery is important to both clinicians and patients, and can assist in personalizing treatment plans and allocating resources.…”

Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

“…We evaluated inter-rater reliability of a previously described kinesthetic matching task (KIN) [4, 5, 22]. We evaluated kinesthetic behavior in 25 neurologically-intact control subjects and 15 individuals with first-time stroke.…”

“…These scores were compared to 95% normative ranges derived from a large sample of neurologically intact subjects ( N  = 166), a group that includes the control subjects described in this study. We considered the potential influence of age, sex and handedness on task performance [5]. If a subject scored outside of the 95% range (one-tailed, z > 1.65), they were determined to have failed the individual parameter, as lying outside the 95% range indicates that behavior on that parameter was significantly different from controls.…”

“…Proprioceptive deficits (our sense of limb position and motion [1]) have received far less attention in both research and clinical practice. Evidence has shown that sensory impairments occur in the majority of stroke survivors [2–5], and are thought to negatively impact functional ability and recovery after stroke [6–9]. Further, differences have been found in the timing and trajectory of motor and proprioceptive recoveries after stroke [5].…”

“…Evidence has shown that sensory impairments occur in the majority of stroke survivors [2–5], and are thought to negatively impact functional ability and recovery after stroke [6–9]. Further, differences have been found in the timing and trajectory of motor and proprioceptive recoveries after stroke [5]. Our understanding of proprioceptive impairments after stroke has been limited by the fact that proprioception is difficult to measure using standard clinical examinations [10].…”