Quantitative Assessment of Limb Position Sense Following Stroke

Abstract

Robotic technology can provide a reliable quantitative means to assess deficits in limb position sense following stroke.

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

“…Visually guided reaching (VGR) assesses visuomotor abilities by having participants perform center‐out reaching 28. Position matching (PM) is a test of proprioception (position sense), in which the robot moves the stroke‐affected arm to 1 of 9 locations, and the subject is instructed to move their other arm to the mirror‐image location with vision occluded 29, 30. Object hit (OH) is a test of bimanual sensorimotor control in which participants use virtual paddles at their fingertips to hit away balls that move toward them at increasing speed and frequency 31.…”

Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy

“…We have recently developed a robotbased system and quantified proprioceptive function of 45 patients at ~1 month poststroke and 65 age-matched nondisabled control subjects [73]. In this study, subjects' vision of the upper limbs was occluded, and the robot moved the paretic arm to different spatial locations in a random order.…”

“…Another recent study has used robotics to document proprioceptive deficits in the upper limbs of patients with stroke using an alternative approach to the one just described, which entailed the use of a two-alternative forced-choice paradigm to examine the perceptual detection threshold for hand perturbations [74]. Even a relatively simple task such as the limb-matching task in Dukelow et al [73] requires several different processes or brain structures to be functional: (1) the left cerebral hemisphere must sense the position of the right limb moved by the robot, (2) this proprioceptive information computed must be transferred to right cerebral hemisphere, (3) the right cerebral hemisphere must plan and control the movement of the left limb, (4) the right hemisphere must sense the final position of the left limb, and (5) the two hemispheres must work together to compare the position of both limbs. Further, tests could be developed to separate these factors such as to move the limb to a spatial location temporarily with the robot and then the subject could be asked to replicate this position with the same limb [75].…”

Identification of connectivity in human motor control: exciting the afferent pathways

“…Clinical scaling of sensory function has been shown to be unreliable (Lincoln et al, 1991). Although progress has been made to obtain more reliable clinical scoring of sensory function (Stolk-Hornsveld et al, 2006), especially impairment of proprioception is often overlooked (Dukelow et al, 2010). Position-cortical coherence could serve as an objective measure of sensory pathway integrity that reveals whether there still is sensory information arriving at the cortex.…”

“…Future work should include the longitudinal assessment of StrEP and sensorimotor function in a large cohort of patients from the subacute till the chronic phase to monitor changes in cortical processing of sensory input in relation to recovery. As clinical assessment of sensory function is shown to be unreliable (Lincoln et al, 1991), proprioceptive function may be evaluated with objective and quantitative assessment of position sense by robotic devices (Dukelow et al, 2010). Eliciting StrEPs can easily be combined with such robotic assessment of position sense or with robotic rehabilitation training.…”