Robotic Assessment of Motor, Sensory, and Cognitive Function in Acute Sport-Related Concussion and Recovery

Abstract

There is a need for better tools to objectively, reliably, and precisely assess neurological function after sport-related concussion (SRC). The aim of this study was to use a robotic device (Kinesiological Instrument for Normal and Altered Reaching Movements; KINARM) to quantify neurological impairments in athletes acutely and when clinically asymptomatic post-SRC. Robotic assessments included five KINARM standard tasks that evaluate aspects of motor, sensory, and cognitive function. We hypothesized that acutely concussed athletes would demonstrate significant rates of impairment on the robotic assessment, and that impairments would be associated with acute symptom severity. Pre-season assessments were conducted from 2011 to 2016 on 1051 athletes. Eighty-four athletes were reassessed acutely (≤10 days post-injury) and while symptomatic post-SRC and 89 when clinically asymptomatic. Forty-four parameters were measured from the KINARM assessment to characterize neurological function. Reliable change indices (80% confidence interval) identified impairments in healthy and concussed individuals for each parameter. In concussed individuals, impairment rate varied across parameters from 4% to 27% at the acute time point and from 2% to 18% when clinically asymptomatic. Healthy athlete impairment rates were between 2% and 16% across all testing time points. We identified relationships between acute symptom severity and task performance for only two parameters, both of which evaluated attributes of motor function. Overall, the KINARM identified impairments in motor, sensory, and cognitive function in athletes with SRC; however, impairment rates were low and largely did not relate to symptom severity. More complex tasks may be necessary to identify potentially subtle neurological impairments post-SRC.

Assessment of Postural Stability During an Upper Extremity Rapid, Bimanual Motor Task After Sport-Related Concussion

“…Moreover, compared with healthy control athletes, the percentage of athletes identified as impaired was generally higher among athletes who selfreported as symptomatic and were within 10 days of SRC. 6 Nevertheless, the SRC-related impairments were fewer on these tests than we expected to observe in subjectively symptomatic athletes (range ¼ 4%-27% using reliable change indices [RCIs] with an impairment cutoff of .80% confidence limit), 6,7 suggesting that more complex tasks that engage additional neurologic functions may be required to objectively detect impairments after SRC.…”

“…In previous studies, Mang et al 6 and Whitten et al 7 examined the potential utility of a robotic device, termed the Kinesiological Instrument for Normal and Altered Reaching Movements (KINARM; BKIN Technologies, Kingston, ON, Canada), for assessing neurologic function after SRC. Relative to traditional clinical tools, the potential benefits of applying robotic technology to SRC assessment include high levels of accuracy, precision, and objectivity.…”

“…8 In initial work 7,9 with healthy athletes, moderate to good test-retest reliability of several robotic tests (KINARM Standard Tests) designed to evaluate motor, sensory, and cognitive function was demonstrated. Briefly, researchers from our laboratory investigated 6 tests that together were designed to assess elements of upper extremity visuomotor capability, upper extremity proprioceptive capability (ie, position sense), rapid bimanual motor control, attention, rapid motor selection, response inhibition, task-switching, 6,[9][10][11] and spatial working memory performance. 7 These tests are efficient (approximately 2 minutes each) and collectively compose a multidimensional neurologic assessment.…”

“…Across the KINARM Standard Tests studied in the context of SRC, the highest proportions of impairment have been detected using the object-hit task. 6 During the object-hit task, participants grasp 2 handles that are represented on a screen as small paddles. Small red objects (ie, balls) are ''dropped'' from the top of the screen, and participants use both hands to hit away as many of the objects as possible before they reach the bottom.…”

“…The relatively large number of athletes identified as impaired using the object-hit task compared with other KINARM tests might relate to the particularly high and varied demands of the test. 6 A neurologic function that is commonly impaired in SRC but has not been assessed using the aforementioned KINARM Standard Tests is postural stability. 1,13,14 Clinical tools, such as the Balance Error Scoring System, and more comprehensive approaches, such as the Sensory Organization Test, have been used to identify SRC-related impairments in static balance by numerous investigators.…”