Abstract
There is a pressing need for strategies to slow or treat the progression of functional decline in people living with HIV. This paper explores a novel rehabilitation robotics approach to measuring cognitive and motor impairment in adults living with HIV, including a subset with stroke. We conducted a cross-sectional study with 21 subjects exhibiting varying levels of cognitive and motor impairment. We tested three robot-based tasks – trajectory tracking, N-back, and spatial span – to assess if metrics derived from these tasks were sensitive to differences in subjects with varying levels of executive function and upper limb motor impairments. We also examined how well these metrics could estimate clinical cognitive and motor scores. The results showed that the average sequence length on the robot-based spatial span task was the most sensitive to differences between various cognitive and motor impairment levels. We observed strong correlations between robot-based measures and clinical cognitive and motor assessments relevant to the HIV population, such as the Color Trails 1 (rho = 0.83), Color Trails 2 (rho = 0.71), Digit Symbol – Coding (rho = 0.81), Montreal Cognitive Assessment – Executive Function subscore (rho = 0.70), and Box and Block Test (rho = 0.74). Importantly, our results highlight that gross motor impairment may be overlooked in the assessment of HIV-related disability. This study shows that rehabilitation robotics can be expanded to new populations beyond stroke, namely to people living with HIV and those with cognitive impairments.
Highlights
T ODAY, there are nearly 37 million persons living with human immunodeficiency virus (PLWH) worldwide [1]
Fourteen subjects had Montreal Cognitive Assessment (MoCA)-EF scores below 3.5 and sixteen subjects displayed moderate motor impairment in at least one limb based on Box and Blocks Test (BBT) scores
Subjects in both the HIV and HIV-stroke groups demonstrated mild to moderate impairment in executive function, information processing, and upper limb fine and gross motor domains relative to published population normal performance values in uninfected populations
Summary
T ODAY, there are nearly 37 million persons living with human immunodeficiency virus (PLWH) worldwide [1]. As PLWH age due to the success of antiretroviral therapy (ART), the challenges have shifted to managing the chronic effects of living with HIV. Many of these challenges can be attributed to neurological complications caused by HIV-associated neurocognitive disorders (HAND), accelerated aging, drug abuse, and HIV-related comorbidities [2]. Upwards of 80% of PLWH reported dealing with at least one impairment, activity limitation or disability, or social participation restriction [4]. These deficits are often tied to impairments in executive function, memory, and visuospatial domains [5].
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