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

Abstract

BackgroundProprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic interventions, it is essential to quantify proprioceptive deficits accurately and sensitively. However, current clinical assessments lack sensitivity due to ordinal scales and suffer from poor reliability and ceiling effects. Robotic technology offers new possibilities to address some of these limitations. Nevertheless, it is important to investigate the psychometric and clinimetric properties of technology-assisted assessments.MethodsWe present an automated robot-assisted assessment of proprioception at the level of the metacarpophalangeal joint, and evaluate its reliability, validity, and clinical feasibility in a study with 23 participants with stroke and an age-matched group of 29 neurologically intact controls. The assessment uses a two-alternative forced choice paradigm and an adaptive sampling procedure to identify objectively the difference threshold of angular joint position.ResultsResults revealed a good reliability (ICC(2,1) = 0.73) for assessing proprioception of the impaired hand of participants with stroke. Assessments showed similar task execution characteristics (e.g., number of trials and duration per trial) between participants with stroke and controls and a short administration time of approximately 12 min. A difference in proprioceptive function could be found between participants with a right hemisphere stroke and control subjects (p<0.001). Furthermore, we observed larger proprioceptive deficits in participants with a right hemisphere stroke compared to a left hemisphere stroke (p=0.028), despite the exclusion of participants with neglect. No meaningful correlation could be established with clinical scales for different modalities of somatosensation. We hypothesize that this is due to their low resolution and ceiling effects.ConclusionsThis study has demonstrated the assessment’s applicability in the impaired population and promising integration into clinical routine. In conclusion, the proposed assessment has the potential to become a powerful tool to investigate proprioceptive deficits in longitudinal studies as well as to inform and adjust sensorimotor rehabilitation to the patient’s deficits.

Design and Characterization of a Robotic Device for the Assessment of Hand Proprioceptive, Motor, and Sensorimotor Impairments

“…Firstly, the robot has the technical capabilities to perform the desired assessments. It can execute accurate finger displacements, with a steady-state error below the average human perception limits at the MCP joint [14], which is required for the gauge position matching experiment. Static friction is not compensated, but low (below 1% of the peak motor torque).…”

“…Finally, the gauge position matching task was successfully implemented and tested with different neurologically impaired patients. This method is faster and less prone to attention confounds, compared to the psychophysical assessment paradigms implemented on previous robotic platforms [14]. Future work will focus on evaluating additional assessment tasks (addressing individual motor and combined sensorimotor functions), as well as validating the outcome measures against clinical and neurophysiological scores.…”

“…As a main part of this assessment battery, the device should be capable of performing a gauge position matching task, based on the Wrist Position Sense Test [20]. This approach is selected as the most appropriate for clinical use, since, comparing to previously used psychophysical methods [14], [21], it is faster and simpler, yet reliable [15]. The subject is asked to indicate the perceived finger location after a flexion/extension movement stimulus is applied.…”

“…While there exist sophisticated platforms for quantifying the level of sensorimotor impairment at the proximal joints of the upper limb (e.g., KINARM [9], MIT-Manus [10], VPIT [11]), solutions supporting the assessment of hand somatosensory function are limited. Some are primarily used for research purposes [12], [13], while others, although proven reliable and valid for quantifying hand proprioception [14], are not suitable for conducting multiple assessments (i.e., motor and sensorimotor) and take too much time to be integrated into the clinical routine. A rapid proprioception evaluation using a robotic platform has been shown feasible for the wrist [15].…”

Robotic tests for position sense and movement discrimination in the upper limb reveal that they each are highly reproducible but not correlated in healthy individuals

“…They offer advantages over existing clinical tools as they can provide objective and precise measures of many sensory, motor and cognitive behaviours [18][19][20]. In recent years, there have been several new tasks developed using robotic technology for evaluating different aspects of proprioception including position sense [10,[20][21][22][23][24][25][26][27], sense of effort [28] and kinesthesia [29]. Many of these studies highlight that impairments in proprioception are common following stroke with highly variable patterns of recovery [11].…”