The independence of deficits in position sense and visually guided reaching following stroke

Scott, Dukelow, Herter, Bagg

Description

Several studies have found correlations between proprioception and visuomotor function during stroke recovery, however two more recent studies have found no correlation. Unfortunately, most of the studies to date have been conducted with clinical assessments of sensation that are observer-based and have poor reliability. We have recently developed new tests to assess position sense and motor function using robotic technology. The present study was conducted to reassess the relationship between position sense and upper limb movement following stroke. Methods We assessed position sense and motor performance of 100 inpatient stroke rehabilitation subjects and 231 non-disabled controls. All subjects completed quantitative assessments of position sense (arm-position matching task) and motor performance (visually-guided reaching task) using the KINARM robotic device. Subjects also completed clinical assessments including handedness, vision, Purdue Pegboard, Chedoke-McMaster Stroke Assessment-Impairment Inventory and Functional Independence Measure (FIM). Neuroimaging documented lesion localization. Fisher’s exact probability tests were used to determine the relationship between performances on the arm-position matching and visually-guided reaching task. Pearson’s correlations were conducted to determine the relationship between robotically measured parameters and clinical assessments. Results Performance by individual subjects on the matching and reaching tasks was statistically independent (Fisher’s test, P<0.01). However, performance on the matching and reaching tasks both exhibited relationships with abilities in daily activities as measured by the FIM. Performance on the reaching task also displayed strong relationships with other clinical measures of motor impairment. Conclusions Our data support the concept that position sense deficits are functionally relevant and point to the importance of assessing proprioceptive and motor impairments independently when planning treatment strategies.

Sujets

• Stroke
• Réhabilitation
• Proprioception
• Robotics

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 7
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Dukelow et al. Journal of NeuroEngineering and Rehabilitation 2012, 9 :72 http://www.jneuroengrehab.com/content/9/1/72

J N E R J A O N U D R   N RE A H L  A O B F I   LI N T E A U TI R O O N ENGINEERING

R E S E A R C H Open Access The independence of deficits in position sense and visually guided reaching following stroke Sean P Dukelow 1* , Troy M Herter 1,2,3 , Stephen D Bagg 4,5 and Stephen H Scott 2,6

Abstract Background: Several studies have found correlations between proprioception and visuomotor function during stroke recovery, however two more recent studies have found no correlation. Unfortunately, most of the studies to date have been conducted with clinical assessments of sensation that are observer-based and have poor reliability. We have recently developed new tests to assess position sense and motor function using robotic technology. The present study was conducted to reassess the relationship between position sense and upper limb movement following stroke. Methods: We assessed position sense and motor performance of 100 inpatient stroke rehabilitation subjects and 231 non-disabled controls. All subjects completed quantitative assessments of position sense (arm-position matching task) and motor performance (visually-guided reaching task) using the KINARM robotic device. Subjects also completed clinical assessments including handedness, vision, Purdue Pegboard, Chedoke-McMaster Stroke Assessment-Impairment Inventory and Functional Independence Measure (FIM). Neuroimaging documented lesion localization. Fisher ’ s exact probability tests were used to determine the relationship between performances on the arm-position matching and visually-guided reaching task. Pearson ’ s correlations were conducted to determine the relationship between robotically measured parameters and clinical assessments. Results: Performance by individual subjects on the matching and reaching tasks was statistically independent (Fisher ’ s test, P<0.01). However, performance on the matching and reaching tasks both exhibited relationships with abilities in daily activities as measured by the FIM. Performance on the reaching task also displayed strong relationships with other clinical measures of motor impairment. Conclusions: Our data support the concept that position sense deficits are functionally relevant and point to the importance of assessing proprioceptive and motor impairments independently when planning treatment strategies. Keywords: Stroke, Rehabilitation, Position sense, Proprioception, Robotics, Visuomotor

Background Although some reports have indicated that position Sensory deficits are particularly common following sense, a sub-component of proprioception [8], strongly stroke, occurring in up to 70% of patients [1]. Many correlates with motor recovery of the hemiplegic arm studies have indicated a connection between impaired after stroke [9-13], two studies have failed to support sensation and functional recovery of the upper extrem- this relationship [14,15]. One of the studies [14] that ity. In particular, proprioceptive deficits have been failed to demonstrate a relationship used the Thumb shown to negatively impact safety, postural stability Localizer Test [16] of proprioception while the other re- and motor function [2]. Impaired proprioception has lied on a simple clinician administered two point rating also been shown to have prognostic significance in scale (impaired vs. normal) [15]. These and similar clin- self-care, likelihood of discharge home and length of ical assessments of proprioception have been shown to hospital stay [3-7]. have poor inter- and intra-rater reliability and tend to use coarse ordinal scales [17,18]. Recent technological 1 * D C e o p r a r r e t s m po e n nt de o n f c C e l : in s i e c a a n l .d N u e k ur el o o sc w ie @ n a c l e b s e , rt H a o h t e c a h lt ki h s s s er B v r i a c i e n s. I c n a stitute,Universityof a m d e v n a t n s ce o s fp h r a o v p e ri t o h c e ep p ti o o tenti n a d lt m o ot c o r r ea f t u e nc b ti e o tt n er in m p e a a t s i u e r n e t - s Calgary, Calgary, AB, Canada n a Full list of author information is available at the end of the article © 2012 Dukelow et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.