Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

Who gives a shit about inter-rater reliability you blithering idiots? We want to know the efficacy and results of recovering using this. My god, the stupidity out there is appalling. How well would environmental enrichment and following Margaret Yekutiel in the book, 'Sensory Re-Education of the Hand After Stroke' in 2001 lead to better recovery?

Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton

• Jennifer A. SemrauEmail author,
• Troy M. Herter,
• Stephen H. Scott and
• Sean P. Dukelow

Journal of NeuroEngineering and Rehabilitation201714:42

DOI: 10.1186/s12984-017-0260-z

©  The Author(s). 2017

Received: 3 August 2016

Accepted: 16 May 2017

Published: 22 May 2017

Abstract

Background

Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task.

Methods

Twenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task.

Results

We evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]).

Conclusions

The robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying kinesthesia after stroke.

Relationship Between Visuospatial Neglect and Kinesthetic Deficits After Stroke

If there is any way to treat these deficits I don't know of them. With the vast number of survivors having these it seems criminal not to have publically available stroke protocols for this.
http://nnr.sagepub.com/content/29/4/318?etoc

1. Jennifer A. Semrau, PhD1,4
2. Jeffery C. Wang1,4
3. Troy M. Herter, PhD2
4. Stephen H. Scott, PhD3
5. Sean P. Dukelow, MD, PhD1,4

1. ¹University of Calgary, Calgary, AB, Canada
2. ²University of South Carolina, Columbia, SC, USA
3. ³Queen’s University, Kingston, ON, Canada
4. ⁴Hotchkiss Brain Institute, Calgary, Alberta, Canada

1. Sean P. Dukelow, University of Calgary, 1403 29th St NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada. Email: spdukelo@ucalgary.ca

1. Authors’ Note JAS and JCW contributed equally to this work.

Abstract

Background. After stroke, visuospatial and kinesthetic (sense of limb motion) deficits are common, occurring in approximately 30% and 60% of individuals, respectively. Although both types of deficits affect aspects of spatial processing necessary for daily function, few studies have investigated the relationship between these 2 deficits after stroke. Objective. We aimed to characterize the relationship between visuospatial and kinesthetic deficits after stroke using the Behavioral Inattention Test (BIT) and a robotic measure of kinesthetic function. Methods. Visuospatial attention (using the BIT) and kinesthesia (using robotics) were measured in 158 individuals an average of 18 days after stroke. In the kinesthetic matching task, the robot moved the participant’s stroke-affected arm at a preset direction, speed, and magnitude. Participants mirror-matched the robotic movement with the less/unaffected arm as soon as they felt movement in their stroke affected arm. Results. We found that participants with visuospatial inattention (neglect) had impaired kinesthesia 100% of the time, whereas only 59% of participants without neglect were impaired. For those without neglect, we observed that a higher percentage of participants with lower but passing BIT scores displayed impaired kinesthetic behavior (78%) compared with those participants who scored perfect or nearly perfect on the BIT (49%). Conclusions. The presence of visuospatial neglect after stroke is highly predictive of the presence of kinesthetic deficits. However, the presence of kinesthetic deficits does not necessarily always indicate the presence of visuospatial neglect. Our findings highlight the importance of assessment and treatment of kinesthetic deficits after stroke, especially in patients with visuospatial neglect.