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Open Access Research

The independence of deficits in position sense and visually guided reaching following stroke

Sean P Dukelow1*, Troy M Herter123, Stephen D Bagg45 and Stephen H Scott26

Author Affiliations

1 Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada

2 Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada

3 Department of Exercise Science, University of South Carolina, Columbia, SC, USA

4 Providence Care, St. Mary’s of the Lake Hospital, Kingston, ON, Canada

5 Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada

6 Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada

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Journal of NeuroEngineering and Rehabilitation 2012, 9:72  doi:10.1186/1743-0003-9-72

Published: 4 October 2012

Abstract

Background

Several studies have found correlations between proprioception and visuomotor function during stroke recovery, however two more recent studies have found no correlation. Unfortunately, most of the studies to date have been conducted with clinical assessments of sensation that are observer-based and have poor reliability. We have recently developed new tests to assess position sense and motor function using robotic technology. The present study was conducted to reassess the relationship between position sense and upper limb movement following stroke.

Methods

We assessed position sense and motor performance of 100 inpatient stroke rehabilitation subjects and 231 non-disabled controls. All subjects completed quantitative assessments of position sense (arm-position matching task) and motor performance (visually-guided reaching task) using the KINARM robotic device. Subjects also completed clinical assessments including handedness, vision, Purdue Pegboard, Chedoke-McMaster Stroke Assessment-Impairment Inventory and Functional Independence Measure (FIM). Neuroimaging documented lesion localization. Fisher’s exact probability tests were used to determine the relationship between performances on the arm-position matching and visually-guided reaching task. Pearson’s correlations were conducted to determine the relationship between robotically measured parameters and clinical assessments.

Results

Performance by individual subjects on the matching and reaching tasks was statistically independent (Fisher’s test, P<0.01). However, performance on the matching and reaching tasks both exhibited relationships with abilities in daily activities as measured by the FIM. Performance on the reaching task also displayed strong relationships with other clinical measures of motor impairment.

Conclusions

Our data support the concept that position sense deficits are functionally relevant and point to the importance of assessing proprioceptive and motor impairments independently when planning treatment strategies.

Keywords:
Stroke; Rehabilitation; Position sense; Proprioception; Robotics; Visuomotor