You described a problem and suggest developing solutions to address it. Good, but it means your mentors and senior researchers were woefully deficient is setting up your research to actually provide that solution.
Assessing bilateral ankle proprioceptive acuity in stroke survivors: An exploratory study
Li Pan1,2, 
Dongyan Xu1, 
Weining Wang1, 
Jifeng Rong3, Jinyao Xu4, 
Amanda Ferland5, 
Roger Adams4, 
Jia Han2,4,6,7* and 
Yulian Zhu1*- 1Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
- 2School of Kinesiology, Shanghai University of Sport, Shanghai, China
- 3The First Rehabilitation Hospital of Shanghai, Shanghai, China
- 4Research Institute for Sport and Exercise, University of Canberra, Canberra, NSW, Australia
- 5USC Division of Biokinesiology and Physical Therapy, Orthopedic Physical Therapy Residency, and Spine Rehabilitation Fellowship, The First Rehabilitation Hospital of Shanghai, Shanghai, China
- 6College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- 7Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
Background: Bilateral proprioception deficits were reported in stroke survivors. However, whether bilateral proprioception deficits exist in the ankle joint after stroke was unclear. Ankle proprioception is a significant predictor of balance dysfunction after stroke, and previous studies to date are lacking appropriate evaluation methods.
Objectives: We want to determine whether the active movement extent discrimination apparatus (AMEDA) is a reliable tool for assessing ankle proprioceptive acuity in stroke survivors and the presence of deficits in ankle proprioception on the affected and unaffected sides in patients after stroke.
Methods: Bilateral ankle proprioception was assessed in 20 stroke patients and 20 age-matched healthy controls using AMEDA. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC).
Results: The ICC in the affected and unaffected sides was 0.713 and 0.74, respectively. Analysis of variance revealed significant deficits in ankle proprioception in subacute stroke survivors vs. healthy controls (F = 2.719, p = 0.045). However, there were no significant differences in proprioception acuity scores between the affected and unaffected sides in patients after stroke (F = 1.14, p = 0.331).
Conclusions: Stroke survivors had bilateral deficits in ankle proprioceptive acuity during active movements compared with age-matched healthy controls, underscoring the need to evaluate these deficits on both sides of the body and develop effective sensorimotor rehabilitation methods for this patient population. The AMEDA can reliably determine bilateral ankle proprioceptive acuity in stroke survivors.
Introduction
Proprioception, which is the perception of body position and movement (1), is bilaterally reduced after unilateral stroke (2–5). In fact, to date, the majority of bilateral proprioceptive studies for stroke survivors focused on the upper limb (2–5), while fewer studies investigated proprioception in the lower limb (6, 7) and even fewer in the ankle (8, 9). Deficient suitable evaluation methods could be one reason for the lack of understanding characteristics of bilateral ankle proprioceptive impairment after stroke (10, 11). A recent study reported that deficits in ankle proprioceptive function were the strongest predictor of balance dysfunction after stroke (12), but different evaluation methods were reported to show different proprioceptive performance (13). Therefore, it is essential to find appropriate evaluation methods and understand the general characteristics of bilateral ankle proprioceptive function after stroke.
Clinical evaluation methods of ankle proprioception in stroke survivors are usually performed superficially (14, 15), including the Sensory subscale of the Fugl-Meyer-Scale (Fugl-Meyer), Revised version of the Nottingham Sensory Assessment (Revised NSA), Erasmus modifications to the revised Nottingham Sensory Assessment (Em-NSA), and Rivermead assessment of sensory performance (RASP). These classic scales are mainly for differential screening, which means it is only to assess whether there is a decline in proprioception, and it is not designed to quantify the severity of the decline. The threshold of detection of passive motion (TTDPM) (8) and joint position reproduction (JPR) (9, 16) are used to evaluate bilateral ankle proprioception for stroke survivors by using mechanical pieces of equipment [such as BiodexTM Isokinetic Systems (9)]. However, during these studies, all the participants are required to wear eye masks, which is a highly artificial situation. It is argued that this kind of method isolates the proprioception from the version, which does not match the actual surroundings in daily life (17, 18). Besides, both of these methods present with relatively high equipment and time cost, and effort constraints limit terms of applicability in clinical and large population studies. Alternatively, active movement extent discrimination apparatus (AMEDA) is one of the typical proprioception assessment methods, which is economic and easy to use and has shown excellent ecological (17). It presents with sufficient sensitivity to evaluate ankle proprioceptive acuity in healthy elder adults (19) and healthy young adults (20), chronic ankle instability (21, 22), neurological degeneration associated with aging, and Parkinson's disease (23, 24). However, considering this is the first study to use AMEDA in stroke survivors, we will include an assessment of the test-retest reliability and detect the standard error of the mean (SEM) and minimal detectable change (MDC).
Accordingly, we hypothesize that AMEDA is a reliable tool for assessing ankle proprioceptive acuity in stroke survivors. We also hypothesize that bilateral ankle proprioception is lower in stroke patients than in age-matched controls. These findings will help establish clearly certain essential characteristics for patients after stroke.
More at link.
No comments:
Post a Comment