Proprioception the sense of body awareness is frequently impaired after stroke. Clinical tests used to detect proprioceptive impairments require substantial amounts of time and lack sensitivity. In contrast, robotic devices proprioceptive acuity. We here present results of a robot-aided bimanual test for wrist proprioception. Ten acute stroke patients with hemiplegic arm weakness and ten healthy subjects, participated to the experiment. Subjects actively moved the wrist of the unaffected limb to match the reference position of the affected wrist, which was passively displaced by the robot to a target across six directions.Our results are as follows. First, healthy individuals showed no effect of hand dominance. No acuity differences were found for between dominant or non-dominant hand. Second, the matching error varied significantly across movement directions. Third, subjects with stroke were less accurate than healthy individuals in matching the wrist position. Fourth, the assessment is clinically feasible. Stroke patients completed the test in about 8 minutes. We conclude that assessment of proprioception in stroke should map positions at different joint degrees of freedom to detect underlying proprioceptive abnormalities.

Objective The aim of the study was to pilot the use of Montreal Cognitive Assessment as a quick clinical screen for cognitive assessment in traumatic brain injury patients. Design The study recruited 61 participants with moderate to severe traumatic brain injury presenting to a tertiary rehabilitation center under the Brain Injury Program. A Montreal Cognitive Assessment questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status and Color Trails Test) were administered to participants who had completed inpatient rehabilitation. Results Receiver operating characteristic analysis for the Montreal Cognitive Assessment revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the Repeatable Battery for the Assessment of Neuropsychological Status. This achieved a sensitivity, specificity, PPV, and NPV of 73.9%, 86.5%, 77.3%, and 84.2%, respectively. Receiver operating characteristic analysis for the trail making subtest of the Montreal Cognitive Assessment achieved a sensitivity, specificity, PPV, and NPV of 79.4%, 74.1%, 79.4%, and 74.1% in identifying patients classified as less than 5th centile on Color Trail Test part 2. Conclusions The use of Montreal Cognitive Assessment displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment.

Proprioception is a critical component of sensorimotor functions which directly affect recovery after neurological injuries. However, clinical tests of proprioception still lack sensitivity and reliability, while robotic devices can provide quantitative, accurate, and repeatable metrics. This work presents the analysis of the efficacy of a robotic assessment of wrist proprioception in terms of the capability to discern between movements along the different DoFs in a healthy population with a broad range of age. The effect of aging on the proprioceptive matching was analyzed to select an appropriate control group for the comparison with stroke patients, designed to confirm the hypothesis that a high percentage of stroke patients presents proprioceptive impairments in the acute and subacute states. Results show that the protocol is capable of detecting differences in performance along different movement directions, and that wrist proprioception does not deteriorate in the age ranges analyzed. Finally, stroke patients were less accurate in matching the position of their wrist, confirming the hypothesis that proprioceptive performance is often impaired in the acute and subacute phases of stroke.

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