Abstract
BackgroundKinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task.MethodsTwenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task.ResultsWe evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]).ConclusionsThe robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying kinesthesia after stroke.
Highlights
IntroductionKinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke
Kinesthesia has been extremely difficult to measure objectively, especially in individuals who have survived a stroke
When subjects completed the task with the use of vision, we found that Intra-class correlation (ICC) of most kinesthetic matching task (KIN) parameters were high (Fig. 3) (r-values, RL = 0.97, RLv = 0.96, PSR = 0.90, PSRv = 0.53, Initial direction error (IDE) = 0.94, Initial direction error variability (IDEv) = 0.93, Path length ratio (PLR) = 0.61, PLRv = 0.95)
Summary
Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. They often rely on the examiner to move a body segment (e.g., the finger) and ask the subject whether the finger has been moved upward or downward [11] Other tests, such as the Thumb Localizer Test [12], rely on the examiner to position the thumb of the Semrau et al Journal of NeuroEngineering and Rehabilitation (2017) 14:42 affected arm above the head and have the patient locate their thumb, without vision, using their unaffected arm. These clinical assessments often have poor sensitivity because they collapse across different components of proprioception (position sense and kinesthesia) and often utilize simplistic 2- or 3-point ordinal scales [10, 12]
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