http://stroke.ahajournals.org/content/44/12/3414.abstract?etoc
- Jennifer A. Semrau, PhD;
- Troy M. Herter, PhD;
- Stephen H. Scott, PhD;
- Sean P. Dukelow, MD, PhD
+ Author Affiliations
- Correspondence to Sean P. Dukelow, MD, PhD, 1403 29th St NW, Foothills Medical Centre, South Tower, Room 905, Calgary, Alberta T2N 2T9, Canada. E-mail spdukelo@ucalgary.ca
Abstract
Background and Purpose—Kinesthesia,
the sense of body motion, is essential to proper control and execution
of movement. Despite its importance for
activities of daily living, no current
clinical measures can objectively measure kinesthetic deficits. The goal
of this study
was to use robotic technology to quantify
prevalence and severity of kinesthetic deficits of the upper limb
poststroke.
Methods—Seventy-four
neurologically intact subjects and 113 subjects with stroke (62
left-affected, 51 right-affected) performed a
robot-based kinesthetic matching task with
vision occluded. The robot moved the most affected arm at a preset
speed, direction,
and magnitude. Subjects were instructed to
mirror-match the movement with their opposite arm (active arm).
Results—A large
number of subjects with stroke were significantly impaired on measures
of kinesthesia. We observed impairments in
ability to match movement direction (69% and
49% impaired for left- and right-affected subjects, respectively) and
movement
magnitude (42% and 31%). We observed
impairments to match movement speed (32% and 27%) and increased response
latencies (48%
and 20%). Movement direction errors and
response latencies were related to clinical measures of function, motor
recovery,
and dexterity.
Conclusions—Using a
robotic approach, we found that 61% of acute stroke survivors (n=69)
had kinesthetic deficits. Additionally, these
deficits were highly related to existing
clinical measures, suggesting the importance of kinesthesia in
day-to-day function.
Our methods allow for more sensitive,
accurate, and objective identification of kinesthetic deficits after
stroke. With this
information, we can better inform clinical
treatment strategies to improve poststroke rehabilitative care and
outcomes.
Therapists have been doing this mirroring assessment for decades. I never lost the ability to tell how my hemiplegic hand or foot has moved when I concentrate on them. Yet I drop objects I am holding in my hemiplegic hand or have tucked in my hemiplegic armpit as soon as I think about something else. Conscious kinesthesia is not functional.
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