Quantitative assessment of joint position sense recovery in subacute stroke patients: a pilot study.

OBJECTIVE To assess joint position sense performance in subacute stroke patients using a novel quantitative assessment. DESIGN Proof-of-principle pilot study with a group of subacute stroke patients. Assessment at baseline and after 2 weeks of intervention. Additional data for a healthy age-matched control group. SUBJECTS/PATIENTS Ten subacute stroke patients (aged 65.41 years (standard deviation 2.5), 4 females, 2.3 weeks (standard deviation 0.2)) post-stroke receiving in-patient standard rehabilitation and repetitive electrical stimulation of the affected hand. METHODS Joint position sense was assessed based on the ability of correctly perceiving the opening angles of the finger joints. Patients had to report size differences of polystyrene balls of various sizes, whilst the balls were enclosed simultaneously by the affected and the non-affected hands. A total of 21 pairwise size comparisons was used to quantify joint position performance. RESULTS After 2 weeks of therapeutic intervention a significant improvement in joint position sense performance was observed; however, the performance level was still below that of a healthy control group. CONCLUSIONS The results indicate high feasibility and sensitivity of the joint position test in subacute stroke patients. Testing allowed quantification of both the deficit and the rehabilitation outcome.

[1]  J. Melvin,et al.  Somatosensory evoked potentials: their predictive value in right hemiplegia. , 1982, Archives of physical medicine and rehabilitation.

[2]  W. Garraway,et al.  Proprioception and spatial neglect after stroke. , 1983, Age and ageing.

[3]  Leeanne M. Carey,et al.  Somatosensory Loss after Stroke , 1995 .

[4]  L. Cohen,et al.  Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. , 2007, Archives of physical medicine and rehabilitation.

[5]  Uwe Proske,et al.  Kinesthesia: The role of muscle receptors , 2006, Muscle & nerve.

[6]  C. Redon,et al.  Proprioceptive control of goal-directed movements in man, studied by means of vibratory muscle tendon stimulation. , 1991, Journal of motor behavior.

[7]  L. Carey,et al.  Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. , 1993, Archives of physical medicine and rehabilitation.

[8]  B. Edin.  Cutaneous afferents provide information about knee joint movements in humans , 2001, The Journal of physiology.

[9]  R. Klatzky,et al.  Identifying objects from a haptic glance , 1995, Perception & psychophysics.

[10]  J. Gordon,et al.  Impairments of reaching movements in patients without proprioception. I. Spatial errors. , 1995, Journal of neurophysiology.

[11]  I. Hsueh,et al.  Inter-rater reliability and validity of the action research arm test in stroke patients. , 1998, Age and ageing.

[12]  L. Jones,et al.  The assessment and treatment of patients who have sensory loss following cortical lesions. , 1993, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[13]  R L Sainburg,et al.  Control of limb dynamics in normal subjects and patients without proprioception. , 1995, Journal of neurophysiology.

[14]  S. Frostick,et al.  The role of cutaneous sensation in the motor function of the hand , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[15]  J. Gordon,et al.  Impairments of reaching movements in patients without proprioception. II. Effects of visual information on accuracy. , 1995, Journal of neurophysiology.

[16]  Diane L Damiano,et al.  Joint-position sense and kinesthesia in cerebral palsy. , 2009, Archives of physical medicine and rehabilitation.

[17]  F. Horak,et al.  Proprioception and Motor Control in Parkinson's Disease , 2009, Journal of motor behavior.

[18]  S. Scott,et al.  Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy. , 2011, Journal of rehabilitation research and development.

[19]  Martin Tegenthoff,et al.  Age-related changes in the joint position sense of the human hand , 2012, Clinical interventions in aging.

[20]  Uwe Proske,et al.  What is the role of muscle receptors in proprioception? , 2005, Muscle & nerve.

[21]  Ziaul Hasan,et al.  Role of proprioceptors in neural control , 1992, Current Opinion in Neurobiology.

[22]  Tobias Kalisch,et al.  Effects of repetitive electrical stimulation to treat sensory loss in persons poststroke. , 2009, Archives of physical medicine and rehabilitation.

[23]  L. Carey,et al.  Impaired limb position sense after stroke: a quantitative test for clinical use. , 1996, Archives of physical medicine and rehabilitation.

[24]  Gereon R Fink,et al.  Neural mechanisms underlying reaching for remembered targets cued kinesthetically or visually in left or right hemispace , 2004, Human brain mapping.

[25]  S. Wolf,et al.  Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke , 2001, Stroke.

[26]  S. Chieffi,et al.  The role of proprioception in the control of prehension movements: a kinematic study in a peripherally deafferented patient and in normal subjects , 2004, Experimental Brain Research.

[27]  Nadina B. Lincoln,et al.  The unreliability of sensory assessments , 1991 .

[28]  S. Scott,et al.  Quantitative Assessment of Limb Position Sense Following Stroke , 2010, Neurorehabilitation and neural repair.

[29]  A. Sunderland,et al.  Arm function after stroke: measurement and recovery over the first three months. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[30]  N. Hogan,et al.  Robotic devices as therapeutic and diagnostic tools for stroke recovery. , 2009, Archives of neurology.

[31]  H. Flor,et al.  The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. , 1997, Archives of physical medicine and rehabilitation.

[32]  B. Volpe,et al.  Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper Limb Motor Performance in Patients With Chronic Stroke , 2010, Neurorehabilitation and neural repair.

[33]  S. Swinnen,et al.  Proprioceptive sensibility in the elderly: Degeneration, functional consequences and plastic-adaptive processes , 2009, Neuroscience & Biobehavioral Reviews.

[34]  S. Scott,et al.  The independence of deficits in position sense and visually guided reaching following stroke , 2012, Journal of NeuroEngineering and Rehabilitation.

[35]  R. Klatzky,et al.  Haptic classification of common objects: Knowledge-driven exploration , 1990, Cognitive Psychology.

[36]  H. Dinse,et al.  Long-term sensory stimulation therapy improves hand function and restores cortical responsiveness in patients with chronic cerebral lesions. Three single case studies , 2012, Front. Hum. Neurosci..

[37]  H. Bird,et al.  A novel device for the measurement of proprioception in the hand. , 2005, Rheumatology.

[38]  V. Dietz.  Proprioception and locomotor disorders , 2002, Nature Reviews Neuroscience.

[39]  N B Lincoln,et al.  Prediction of arm and hand function recovery in stroke patients , 1987, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[40]  Mitsuru Kawamura,et al.  ‘Thumb localizing test’ for detecting a lesion in the posterior column–medial lemniscal system , 1999, Journal of the Neurological Sciences.

[41]  Susan J. Lederman,et al.  Extracting object properties through haptic exploration. , 1993, Acta psychologica.

[42]  R. Klatzky,et al.  Haptic identification of common objects: Effects of constraining the manual exploration process , 2004, Perception & psychophysics.

[43]  M. Reding,et al.  A Model Stroke Classification Scheme and Its Use in Outcome Research , 1990, Stroke.