Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception.
Mike D Rinderknecht, Olivier Lambercy, Vanessa Raible and 4 others
PMID 29880003WHAT IT FOUND
A robot test of finger position sense took about 12.3 minutes and was repeatable on the stroke-affected hand, but it did not match bedside sensory tests and was not repeatable on the less affected hand.
Key findings
01After right hemisphere stroke, the impaired hand averaged 3.95° and was significantly worse than controls (p < 0.001); after left hemisphere stroke, the impaired hand averaged 2.35° and was not significantly different from controls (p = 0.373).
02The robot test was repeatable on the impaired hand (ICC 0.73) but not on the unimpaired hand (ICC 0.16).
03The robot score did not correlate significantly with bedside sensory tests, and the up-down proprioception test showed a ceiling effect, with 90% of stroke scores at the maximum.
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 study analysed only 20 participants with stroke, so it is small. Two participants dropped out, and one was excluded because they could not follow the task. Participants who could not feel any large manual finger movements were excluded, so the sample did not include the most severe proprioceptive losses. People with aphasia, neglect, severe cognitive impairment, severe hand swelling, high tone, or pain were excluded, so the result may not apply to many stroke patients. The bedside sensory tests showed ceiling effects, and the up-down test scored almost everyone as normal, so there was no sensitive clinical reference. The reliability was poor for the unimpaired hand, and the confidence intervals were wide. Controls were age-matched only as a group, not person by person. The cutoff values for impairment are indicative and need a larger sample.
The easy way to misread this
Do not conclude this robot test replaces bedside sensory exams. It did not correlate significantly with clinical scales, and it was not reliable on the less affected hand.