Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke
Abstract Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of...
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doaj-e4ed50d51e7d4ed2be5a31d6e549b63f2021-07-18T11:48:31ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032021-07-0118112010.1186/s12984-021-00904-5Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after strokeMonika Zbytniewska0Christoph M. Kanzler1Lisa Jordan2Christian Salzmann3Joachim Liepert4Olivier Lambercy5Roger Gassert6Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH ZurichRehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH ZurichRehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH ZurichKliniken Schmieder AllensbachKliniken Schmieder AllensbachRehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH ZurichRehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH ZurichAbstract Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations $$\rho$$ ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations ( $$\rho$$ ρ =0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other ( $$\rho \le$$ ρ ≤ 0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.https://doi.org/10.1186/s12984-021-00904-5Robot-assisted assessmentsNeurorehabilitationStrokeRecoverySomatosensationProprioception |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Monika Zbytniewska Christoph M. Kanzler Lisa Jordan Christian Salzmann Joachim Liepert Olivier Lambercy Roger Gassert |
spellingShingle |
Monika Zbytniewska Christoph M. Kanzler Lisa Jordan Christian Salzmann Joachim Liepert Olivier Lambercy Roger Gassert Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke Journal of NeuroEngineering and Rehabilitation Robot-assisted assessments Neurorehabilitation Stroke Recovery Somatosensation Proprioception |
author_facet |
Monika Zbytniewska Christoph M. Kanzler Lisa Jordan Christian Salzmann Joachim Liepert Olivier Lambercy Roger Gassert |
author_sort |
Monika Zbytniewska |
title |
Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
title_short |
Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
title_full |
Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
title_fullStr |
Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
title_full_unstemmed |
Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
title_sort |
reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke |
publisher |
BMC |
series |
Journal of NeuroEngineering and Rehabilitation |
issn |
1743-0003 |
publishDate |
2021-07-01 |
description |
Abstract Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations $$\rho$$ ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations ( $$\rho$$ ρ =0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other ( $$\rho \le$$ ρ ≤ 0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. |
topic |
Robot-assisted assessments Neurorehabilitation Stroke Recovery Somatosensation Proprioception |
url |
https://doi.org/10.1186/s12984-021-00904-5 |
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