Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children

Andrea M Kuczynski,Jennifer A Semrau,Adam Kirton,Sean P Dukelow

doi:10.1186/s12984-017-0221-6

Abstract

BackgroundWhile sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function.MethodsCase–control study. Participants were 6–19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function.ResultsForty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures.ConclusionsRobotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

Highlights

While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools
There are two common types of ischemic perinatal stroke: large arterial ischemic strokes (AIS) which typically occur at term and damage cortical and subcortical structures, and periventricular venous infarctions (PVI), earlier fetal lesions restricted to the subcortical white matter [11]
Each participant had clinical confirmation of symptomatic hemiparetic CP (Pediatric Stroke Outcome Measure (PSOM) [32] ≥0.5 and Manual Abilities Classification System (MACS) [33] grade I-IV and child/parent perceived functional limitations) and MRI-confirmed unilateral perinatal stroke according to validated criteria [11]

Summary

Introduction

While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function. There are two common types of ischemic perinatal stroke: large arterial ischemic strokes (AIS) which typically occur at term and damage cortical and subcortical structures, and periventricular venous infarctions (PVI), earlier fetal lesions restricted to the subcortical white matter [11]. Both stroke types usually damage major components of the sensorimotor system but location and timing are different.

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Discussion

Conclusion