Quantitative assessment of limb position sense following stroke.
BACKGROUND
Impairment of position sense of the upper extremity (UE) may impede activities of daily living and limit motor gains after stroke. Most clinical assessments of position sense rely on categorical or ordinal ratings by clinicians that lack sensitivity to change or the ability to discriminate subtle deficits.


OBJECTIVE
Use robotic technology to develop a reliable, quantitative technique with a continuous scale to assess UE position sense following stroke.


METHODS
Forty-five patients recruited from an inpatient stroke rehabilitation service and 65 age-matched healthy controls performed an arm position matching task. Each UE was fitted in the exoskeleton of a KINARM device. One UE was passively placed in one of 9 positions, and the subject was told to match his or her position with the other UE. Patients were compared with statistical distributions of control data to identify those with deficits in UE position sense. Test-retest sessions using 2 raters established interrater reliability.


RESULTS
Two thirds of left hemiparetic and one third of right hemiparetic patients had deficits in limb position sense. Left-affected stroke subjects demonstrated significantly more trial-to-trial variability than right-affected or control subjects. The robotic assessment technique demonstrated good interrater reliability but limited agreement with the clinical thumb localizing test.


CONCLUSIONS
Robotic technology can provide a reliable quantitative means to assess deficits in limb position sense following stroke.
University of Calgary, Calgary, Alberta, Canada.
Sean P
SP
Dukelow
Troy M
TM
Herter
Kimberly D
KD
Moore
Mary Jo
MJ
Demers
Janice I
JI
Glasgow
Stephen D
SD
Bagg
Kathleen E
KE
Norman
Stephen H
SH
Scott
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000175:diagnosis* / Q000209:etiology; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D034941:Upper Extremity / Q000294:innervation*; D055815:Young Adult