Wrist Proprioception in Acute and Subacute Stroke: A Robotic Protocol for Highly Impaired Patients

Contu, Sara; Basteris, Angelo; Plunkett, Tegan K.; Kuah, Christopher Wee Keong; Chua, Karen Sui Geok; Campolo, Domenico; Masia, Lorenzo

doi:10.1109/biorob.2018.8488083

Cited by 3 publications

(2 citation statements)

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“…Previous studies have demonstrated the e cacy of both active and passive proprioceptive training in neurologically intact participants and have shown improved proprioceptive thresholds and/or accuracy (19,20,49). Other studies have examined proprioceptive training in stroke survivors and have demonstrated positive outcomes for improvements in proprioceptive function of the upper limb and/or wrist (23,50,51). Notably, these previous studies in stroke have typically relied on passive movement of the limb coupled with verbal report about the status of the limb (i.e., psychometric tasks) or matched behavior with the less-affected limb.…”

Section: Targeted Training Approach For Improving Proprioceptionmentioning

confidence: 99%

A pilot study for self-guided, active robotic training of proprioception of the upper limb in chronic stroke

Tulimieri,

Kim,

Hoh

et al. 2024

Preprint

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Background Proprioceptive impairments of the upper limb are common after stroke. These impairments are not typically addressed during assessment or rehabilitation. Currently, most robotic paradigms for rehabilitative training of the upper limb have focused solely on improving motor function or have targeted proprioception in individuals with combined use of visual feedback. Our goal was to design a training paradigm that directly targets proprioception of the upper limb, while minimizing reliance on other sensory information to improve sensorimotor function after stroke. Methods In this pilot study, 5 stroke participants and 5 age-matched controls were tested on a single-day proprioceptive training paradigm. Here, participants used a joystick with their less-affected arm to send commands to a KINARM exoskeleton that would passively move their more-affected arm. To complete the passive reaching task, participants relied only on proprioceptive feedback from the more-affected arm and were only given knowledge of results information after each trial. Sensorimotor function of the upper limb was measured pre- and post-training via robotic measures of motor function (Visually Guided Reaching (VGR)) and position sense (Arm Position Matching (APM)). Sensorimotor function was quantified as a Task Score, which incorporated multiple task-relevant parameters for both VGR and APM. Changes in sensorimotor performance due to training were calculated as the pre- to post-training difference for VGR and APM within the control and stroke groups. Results We found significant improvements from pre-training to post-training for VGR in stroke participants (p < 0.001, CLES = 100) that were not observed in control participants (p = 0.87, CLES = 80). We observed significant changes from pre- to post-training in both VGR (Posture Speed, Reaction Time, Initial Direction Angle, Min-Max Speed Difference, and Movement Time) and APM (Contraction/Expansion Ratiox and Shifty) parameters. Conclusions Our novel proprioceptive training paradigm resulted in improvements in motor function and aspects of proprioceptive performance for individuals with chronic stroke. This pilot study demonstrates the feasibility of this training paradigm for targeted proprioceptive training to improve motor and sensory function in individuals with chronic stroke. Future studies aim to examine multi-day training to examine longer-term impacts on upper limb sensorimotor function.

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Section: Targeted Training Approach For Improving Proprioceptionmentioning

confidence: 99%

A pilot study for self-guided, active robotic training of proprioception of the upper limb in chronic stroke

Tulimieri,

Kim,

Hoh

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The methods proposed so far focus on the proximal joint of the upper limb [31,32], consist of tasks that target only a specific impairment modality (e.g. proprioception, without the possibility to concurrently assess motor function) [33][34][35][36], or fail to provide a detailed evaluation of clinimetric properties of their outcome measures (reliability, measurement error, validity) [11,37]. Reporting of test-retest reliability and measurement error is essential to understand the sensitivity of an assessment metric to capture different impairments and detect changes over time [37], while the study of concurrent validity is important to relate a new technological approach to the commonly accepted assessment methods [38].…”

Section: Introductionmentioning

confidence: 99%

Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

Zbytniewska

Kanzler

Jordan

et al. 2020

Preprint

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Background: Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods: For this purpose, a battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations rho) of these tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results: Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects on all metrics extracted from the robotic tasks. Concurrent validity was shown through moderate to strong correlations (rho=0.4-0.8) between the robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits were not strongly correlated, thereby presenting complementary information about a patient’s impairment profile. Conclusions: The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.

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Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

Zbytniewska

Kanzler

Jordan

et al. 2021

J NeuroEngineering Rehabil

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Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations $$\rho$$ ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations ($$\rho$$ ρ =0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other ($$\rho \le$$ ρ ≤ 0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.

show abstract

Wrist Proprioception in Acute and Subacute Stroke: A Robotic Protocol for Highly Impaired Patients

Cited by 3 publications

References 25 publications

A pilot study for self-guided, active robotic training of proprioception of the upper limb in chronic stroke

A pilot study for self-guided, active robotic training of proprioception of the upper limb in chronic stroke

Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

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