Abstract
BackgroundNeurological 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).MethodsA 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 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.ResultsEighty-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=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 le0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile.ConclusionsThe 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.
Highlights
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
Somatosensory function is frequently affected and has been shown to be associated with poor functional recovery and higher activity limitations, the reporting prevalence varies between 23 and 67% [17,18,19,20,21,22]
30 stroke subjects were included in the data analysis, aged 64.50 ± 14.02 years, 19 males, 4 left-handed before stroke, 12 with left hemispheric stroke, 21 with ischemic and 9 with hemorrhagic stroke
Summary
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. For example when grasping a small object, proprioception is necessary to sense the current position of the limb [5, 6] This sensory input is integrated by the central nervous system to shape the motor output, a process called sensorimotor integration [7, 8]. The motor system is responsible for eliciting and executing the planned movement [9] Neurological injuries such as stroke often disrupt specific aspects of this process, which prevents affected individuals from performing ADLs [10, 11]. Somatosensory function is frequently affected and has been shown to be associated with poor functional recovery and higher activity limitations, the reporting prevalence varies between 23 and 67% [17,18,19,20,21,22]
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