http://www.jneuroengrehab.com/content/11/1/77/abstract
Journal of NeuroEngineering and Rehabilitation 2014, 11:77
doi:10.1186/1743-0003-11-77
Published: 30 April 2014
Published: 30 April 2014
Abstract (provisional)
Background
Proprioception plays important roles in planning and control of limb posture and movement.
The impact of proprioceptive deficits on motor function post-stroke has been difficult
to elucidate due to limitations in current tests of arm proprioception. Common clinical
tests only provide ordinal assessment of proprioceptive integrity (eg. intact, impaired
or absent). We introduce a standardized, quantitative method for evaluating proprioception
within the arm on a continuous, ratio scale. We demonstrate the approach, which is
based on signal detection theory of sensory psychophysics, in two tasks used to characterize
motor function after stroke.
Methods
Hemiparetic stroke survivors and neurologically intact participants attempted to detect
displacement- or force-perturbations robotically applied to their arm in a two-interval,
two-alternative forced-choice test. A logistic psychometric function parameterized
detection of limb perturbations. The shape of this function is determined by two parameters:
one corresponds to a signal detection threshold and the other to variability of responses
about that threshold. These two parameters define a space in which proprioceptive
sensation post-stroke can be compared to that of neurologically-intact people. We
used an auditory tone discrimination task to control for potential comprehension,
attention and memory deficits.
Results
All but one stroke survivor demonstrated competence in performing two-alternative
discrimination in the auditory training test. For the remaining stroke survivors,
those with clinically identified proprioceptive deficits in the hemiparetic arm or
hand had higher detection thresholds and exhibited greater response variability than
individuals without proprioceptive deficits. We then identified a normative parameter
space determined by the threshold and response variability data collected from neurologically
intact participants. By plotting displacement detection performance within this normative
space, stroke survivors with and without intact proprioception could be discriminated
on a continuous scale that was sensitive to small performance variations, e.g. practice
effects across days.
Conclusions
The proposed method uses robotic perturbations similar to those used in ongoing studies
of motor function post-stroke. The approach is sensitive to small changes in the proprioceptive
detection of hand motions. We expect this new robotic assessment will empower future
studies to characterize how proprioceptive deficits compromise limb posture and movement
control in stroke survivors.
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