A composite robotic-based measure of upper limb proprioception

Jeffrey M Kenzie,Sean P Dukelow,Stephen H Scott,Michael D Hill,Jennifer A Semrau

doi:10.1186/s12984-017-0329-8

Jeffrey M Kenzie, Sean P Dukelow + Show 3 more

Open Access

https://doi.org/10.1186/s12984-017-0329-8

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Abstract

BackgroundProprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements. Proprioceptive disorders are common following stroke, but clinical tests for measuring impairments in proprioception are simple ordinal scales that are unreliable and relatively crude. We developed and validated specific kinematic parameters to quantify proprioception and compared two common metrics, Euclidean and Mahalanobis distances, to combine these parameters into an overall summary score of proprioception.MethodsWe used the KINARM robotic exoskeleton to assess proprioception of the upper limb in subjects with stroke (N = 285. Mean days post-stroke = 12 ± 15). Two aspects of proprioception (position sense and kinesthetic sense) were tested using two mirror-matching tasks without vision. The tasks produced 12 parameters to quantify position sense and eight to quantify kinesthesia. The Euclidean and Mahalanobis distances of the z-scores for these parameters were computed each for position sense, kinesthetic sense, and overall proprioceptive function (average score of position and kinesthetic sense).ResultsA high proportion of stroke subjects were impaired on position matching (57%), kinesthetic matching (65%), and overall proprioception (62%). Robotic tasks were significantly correlated with clinical measures of upper extremity proprioception, motor impairment, and overall functional independence. Composite scores derived from the Euclidean distance and Mahalanobis distance showed strong content validity as they were highly correlated (r = 0.97–0.99).ConclusionsWe have outlined a composite measure of upper extremity proprioception to provide a single continuous outcome measure of proprioceptive function for use in clinical trials of rehabilitation. Multiple aspects of proprioception including sense of position, direction, speed, and amplitude of movement were incorporated into this measure. Despite similarities in the scores obtained with these two distance metrics, the Mahalanobis distance was preferred.

Highlights

Proprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements
Establishing an objective and reproducible method to assess proprioceptive impairments post-stroke is vital to evaluating the efficacy of different treatments
Exclusion criteria were: stroke affecting both hemispheres of the brain, upper limb orthopedic injury, neuropathy, evidence of apraxia [33], any other neurological disease or injury (e.g. Parkinson’s Disease, Multiple Sclerosis), unable to follow task instructions due to aphasia or cognitive impairments or significant fatigue which limited task performance

Summary

Introduction

Proprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements. Some commonly used clinical assessments of proprioception post-stroke include: 1) simple passive limb movement detection test [14] in which an examiner moves a subject’s limb segment with their eyes closed, and subjects are asked to say which direction the limb was moved; 2) the Revised Nottingham Sensory Assessment [15, 16] in which the subject is asked to mirror match the movement of a passively moved limb by a therapist; and 3) the Thumb Localizing Test [17] which involves passive movement of a subject’s arm and hand to a random position overhead, and is followed by subjects reaching to grasp their thumb with the opposite (less affected) hand These assessments are scored crudely as normal, slightly impaired, or absent, and lack the sensitivity to detect smaller changes in proprioceptive function in part due to poor inter- and intrarater reliability [18, 19]. Establishing an objective and reproducible method to assess proprioceptive impairments post-stroke is vital to evaluating the efficacy of different treatments

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