A composite robotic-based measure of upper limb proprioception.
Jeffrey M Kenzie, Jennifer A Semrau, Michael D Hill and 2 others
PMID 29132388WHAT IT FOUND
A robotic test identifies proprioceptive impairment in over 60% of stroke patients, detecting more cases than standard clinical exams.
This composite score offers a precise, objective measure for tracking recovery and evaluating rehabilitation treatments.
Key findings
01The robotic composite score identified 63.9% (Euclidean) and 62.1% (Mahalanobis) of stroke subjects as having impaired proprioception.
02The robotic measures showed moderate correlation with clinical assessments of arm function and independence, but agreement with the Thumb Localizing Test was only fair (Kappa 0.32-0.33).
03Proprioceptive impairments were more common in right hemisphere strokes and were more frequently detected by the kinesthetic matching task than the position matching task.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The composite score does not assess distal joints (wrist, fingers), focusing only on the shoulder and elbow. There is currently no gold standard for upper limb proprioception, so the 'true' accuracy of the robotic score relative to clinical judgment is difficult to verify. The order of tasks (position matching always before kinesthetic matching) introduced a potential fatigue confound, although the authors deemed it minimal. The study did not determine the minimal clinically important difference for the composite score, limiting its use for tracking small changes in individual patients.
Declared interests
Funding was provided by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Alberta Innovates - Health Solutions, and the Ontario Research Fund. The robotic device (KINARM) was provided by BKIN Technologies, which also supplied the analysis software and custom scripts.
The easy way to misread this
Do not assume the robotic score is a simple replacement for clinical judgment in individual patient care. While it is highly sensitive for detecting impairment at a population level, the lack of a established minimal clinically important difference and its focus on proximal joints mean it may not yet guide specific day-to-day therapy decisions for a single patient.