Robotic Identification of Kinesthetic Deficits After Stroke

So what protocol is your doctor using to recover Kinesthesia?
http://stroke.ahajournals.org/content/44/12/3414.abstract?etoc

1. Jennifer A. Semrau, PhD;
2. Troy M. Herter, PhD;
3. Stephen H. Scott, PhD;
4. Sean P. Dukelow, MD, PhD

+ Author Affiliations

1. From the Hotchkiss Brain Institute (J.A.S., T.M.H., S.P.D.), and Department of Clinical Neurosciences (J.A.S., T.M.H., S.P.D.), University of Calgary, Alberta, Canada; Centre for Neuroscience Studies (T.M.H., S.H.S.), Department of Anatomy and Cell Biology (S.H.S.), and School of Medicine (S.H.S.), Queen’s University, Kingston, Ontario, Canada; and Department of Exercise Science, University of South Carolina, Columbia (T.M.H.).

1. 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.