Robotic Measurement of Arm Movements After Stroke Establishes Biomarkers of Motor Recovery

Abstract

Background and Purpose Because robotic devices record the kinematics and kinetics of human movements with high resolution, we hypothesized that robotic measures collected longitudinally in patients after stroke would bear a significant relationship to standard clinical outcome measures and, therefore, might provide superior biomarkers. Methods In patients with moderate-to-severe acute ischemic stroke, we used clinical scales and robotic devices to measure arm movement 7, 14, 21, 30, and 90 days after the event at 2 clinical sites. The robots are interactive devices that measure speed, position, and force so that calculated kinematic and kinetic parameters could be compared with clinical assessments. Results Among 208 patients, robotic measures predicted well the clinical measures (cross-validated R2 of modified Rankin scale=0.60; National Institutes of Health Stroke Scale=0.63; Fugl-Meyer=0.73; Motor Power=0.75). When suitably scaled and combined by an artificial neural network, the robotic measures demonstrated greater sensitivity in measuring the recovery of patients from day 7 to day 90 (increased standardized effect=1.47). Conclusions These results demonstrate that robotic measures of motor performance will more than adequately capture outcome, and the altered effect size will reduce the required sample size. Reducing sample size will likely improve study efficiency.

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

“…This is actually smaller than rates seen in other recent, well-conducted larger studies in stroke rehabilitation that involved longitudinal follow-up. 5,22,35,52 Another limitation of our study is that we are only investigating a small subset of the stroke population, those with mild to moderate stroke. Although it is important to consider and assess those with more severe stroke, we believe that our results are robust in indicating that we see large variability in Figure 3 (Continued).…”

“…1,2,9,12 These have been criticized for problems with ceiling effects 18 or issues with reliability. 19 However, more recently, robotics have shown to be a powerful measurement tool 14,15,[20][21][22][23] for determining when impairment returns to normal using continuous performance metrics that allow for comparison of poststroke performance with neurologically intact humans.…”

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

“…Conventional rehabilitation protocols (e.g., bimanual movement training, robotic training, or power training) focusing on the recovery of affected muscles reveal evidence of robust force production improvements [1,[11][12][13][14][15]. These rehabilitation protocols facilitate improved muscle properties and motor control [16,17].…”

Using upper limb kinematics to assess cognitive deficits in people living with both HIV and stroke

“…To most effectively do this, metrics are needed to objectively assess the motor and cognitive deficits in an individual that can be tracked over the course of therapy. To this end, robot-assisted technologies have been implemented and motor performance has been assessed by kinematic measures, such as deviation from the desired line, peak speed, mean speed, movement smoothness, movement duration, and mean jerk [19], [20]. In addition, cognition, executive function, and attention have been shown to be correlated to motor recovery [21].…”