Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception.

BACKGROUND: Proprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic interventions, it is essential to quantify proprioceptive deficits accurately and sensitively. However, current clinical assessments lack sensitivity due to ordinal scales and suffer from poor reliability and ceiling effects. Robotic technology offers new possibilities to address some of these limitations. Nevertheless, it is important to investigate the psychometric and clinimetric properties of technology-assisted assessments. METHODS: We present an automated robot-assisted assessment of proprioception at the level of the metacarpophalangeal joint, and evaluate its reliability, validity, and clinical feasibility in a study with 23 participants with stroke and an age-matched group of 29 neurologically intact controls. The assessment uses a two-alternative forced choice paradigm and an adaptive sampling procedure to identify objectively the difference threshold of angular joint position. RESULTS: Results revealed a good reliability (ICC(2,1) = 0.73) for assessing proprioception of the impaired hand of participants with stroke. Assessments showed similar task execution characteristics (e.g., number of trials and duration per trial) between participants with stroke and controls and a short administration time of approximately 12 min. A difference in proprioceptive function could be found between participants with a right hemisphere stroke and control subjects (p<0.001). Furthermore, we observed larger proprioceptive deficits in participants with a right hemisphere stroke compared to a left hemisphere stroke (p=0.028), despite the exclusion of participants with neglect. No meaningful correlation could be established with clinical scales for different modalities of somatosensation. We hypothesize that this is due to their low resolution and ceiling effects. CONCLUSIONS: This study has demonstrated the assessment's applicability in the impaired population and promising integration into clinical routine. In conclusion, the proposed assessment has the potential to become a powerful tool to investigate proprioceptive deficits in longitudinal studies as well as to inform and adjust sensorimotor rehabilitation to the patient's deficits.

Age-based model for metacarpophalangeal joint proprioception in elderly.

Neurological injuries such as stroke can lead to proprioceptive impairment. For an informed diagnosis, prognosis, and treatment planning, it is essential to be able to distinguish between healthy performance and deficits following the neurological injury. Since there is some evidence that proprioception declines with age and stroke occurs predominantly in the elderly population, it is important to create a healthy reference model in this specific age group. However, most studies investigate age effects by comparing young and elderly subjects and do not provide a model within a target age range. Moreover, despite the functional relevance of the hand in activities of daily living, age-based models of distal proprioception are scarce. Here, we present a proprioception model based on the assessment of the metacarpophalangeal joint angle difference threshold in 30 healthy elderly subjects, aged 55-80 years (median: 63, interquartile range: 58-66), using a robotic tool to apply passive flexion-extension movements to the index finger. A two-alternative forced-choice paradigm combined with an adaptive algorithm to define stimulus magnitude was used. The mixed-effects model analysis revealed that aging has a significant, increasing effect on the difference threshold at the metacarpophalangeal joint, whereas other predictors (eg, tested hand or sex) did not show a significant effect. The adaptive algorithm allowed reaching an average assessment duration <15 minutes, making its clinical applicability realistic. This study provides further evidence for an age-related decline in proprioception at the level of the hand. The established age-based model of proprioception in elderly may serve as a reference model for the proprioceptive performance of stroke patients, or of any other patient group with central or peripheral proprioceptive impairments. Furthermore, it demonstrates the potential of such automated robotic tools as a rapid and quantitative assessment to be used in research and clinical settings.