What is your doctors proprioception stroke protocol?
If none, Why the hell are you paying them?
http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.01037/full?
Dalia De Santis1*,
Jacopo Zenzeri1,
Maura Casadio1,2,
Lorenzo Masia1,3,
Assunta Riva4,
Pietro Morasso1,2 and
Valentina Squeri1
- 1Motor Learning and Robotic
Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive
Sciences (RBCS), Istituto Italiano di Tecnologia, Genova, Italy
- 2NeuroLab, Department of Informatics, Bioengineering, Robotics and Systems (DIBRIS), University of Genova, Genova, Italy
- 3Assistive Robotics and Interactive
Ergonomic Systems Laboratory, Division of Mechatronics and Design,
Robotic Research Center, School of Mechanical and Aerospace Engineering
(MAE), Nanyang Technological University (NTU), Singapore
- 4SI4LIFE – Innovation Hub for Elderly and Disabled People, Genova, Italy
Proprioception has a crucial role in promoting or hindering motor
learning.
In particular, an intact position sense strongly correlates
with the chances of recovery after stroke. A great majority of
neurological patients present both motor dysfunctions and impairments in
kinesthesia, but traditional robot and virtual reality training
techniques focus either in recovering motor functions or in assessing
proprioceptive deficits. An open challenge is to implement effective and
reliable tests and training protocols for proprioception that go beyond
the mere position sense evaluation and exploit the intrinsic
bidirectionality of the kinesthetic sense, which refers to both sense of
position and sense of movement. Modulated haptic interaction has a
leading role in promoting sensorimotor integration, and it is a natural
way to enhance volitional effort. Therefore, we designed a preliminary
clinical study to test a new proprioception-based motor training
technique for augmenting kinesthetic awareness via haptic feedback. The
feedback was provided by a robotic manipulandum and the test involved
seven chronic hemiparetic subjects over 3 weeks. The protocol included
evaluation sessions that consisted of a psychometric estimate of the
subject’s kinesthetic sensation, and training sessions, in which the
subject executed planar reaching movements in the absence of vision and
under a minimally assistive haptic guidance made by sequences of graded
force pulses. The bidirectional haptic interaction between the subject
and the robot was optimally adapted to each participant in order to
achieve a uniform task difficulty over the workspace. All the subjects
consistently improved in the perceptual scores as a consequence of
training. Moreover, they could minimize the level of haptic guidance in
time.
Results suggest that the proposed method is effective in enhancing
kinesthetic acuity, but the level of impairment may affect the ability
of subjects to retain their improvement in time.
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