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

Abstract

BackgroundKinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task.MethodsTwenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task.ResultsWe evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]).ConclusionsThe robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying kinesthesia after stroke.

Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception

“…Studies evaluating other assessment approaches using various matching paradigms for different upper limb joints [ 14 , 31 , 32 , 34 , 35 , 38 , 41 , 50 , 54 , 56 , 60 ] or similar joint position DL estimation methods [ 34 , 59 ] reported coefficients of reliability ranging from fair to excellent for most outcome measures. However, it is difficult to compare results, as other approaches may measure different aspects of proprioception, or because some studies investigated the reliability in NIC subjects instead of in the target population, which may lead to non-representative results, due to different inter- and intra-subject variabilities [ 88 ].…”

“…To increase clinical acceptance, set-up and testing time, as well as the complexity and cost of the robotic devices should be reduced as much as possible. While some of these properties have been evaluated for matching and perturbation assessments, mostly targeting proximal joints such as shoulder and elbow (e.g., [ 38 , 54 , 60 ]), assessments estimating proprioceptive difference thresholds at finger joints have not been sufficiently optimized and evaluated so far.…”

Sensorimotor Robotic Measures of tDCS- and HD-tDCS-Enhanced Motor Learning in Children

“…The KINARM robot is a validated, well-studied, objective measure of sensorimotor function. Previous studies have demonstrated that the retest reliability of visually guided reaching [27, 48], kinesthesia [54], and position matching [28, 48] tasks is strong. The retest reliability of the object hit may be more variable, as retest reliability is high in adults [46], but a learning effect is seen in pediatric population [48].…”

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

“…In addition, robotic devices, because of their built-in technology in terms of sensors and actuators, are able to objectively quantify the motor status of patients after brain damage, as well as their motor recovery. In fact, such devices are able to acquire kinematic and kinetic data which are processed to obtain quantitative indices [23][24][25][26][27][28][29][30][31][32][33][34]. These robot-derived measures can potentially add meaningful information about the patient's performance, helping the clinicians in patient's assessment.…”