Validity of Robot-Based Assessments of Upper Extremity Function

Abstract

Objective To examine the validity of 5 robot-based assessments of arm motor function post-stroke. Design Cross sectional. Setting Outpatient clinical research center. Participants Volunteer sample of 40 participants, age >18 years, 3–6 months post-stroke, with arm motor deficits that had plateaued. Intervention None. Main Outcome Measures Clinical standards included the Fugl-Meyer Arm Motor Scale (FMA), and 5 secondary motor outcomes: hand/wrist subsection of the FMA; Action Research Arm Test (ART); Box & Blocks test (B/B); hand subscale of Stroke Impact Scale-2 (SIS); and the Barthel Index (BI). Robot-based assessments included: wrist targeting; finger targeting; finger movement speed; reaction time; and a robotic version of the (B/B) test. Anatomical measures included percentage injury to the corticospinal tract (CST) and primary motor cortex (M1, hand region) obtained from MRI. Results Subjects had moderate-severe impairment (arm FMA scores = 35.6±14.4, range 13.5–60). Performance on the robot-based tests, including speed (r=0.82, p<0.0001), wrist targeting (r=0.72, p<0.0001), and finger targeting (r=0.67, p<0.0001) correlated significantly with the FMA scores. Wrist targeting (r=0.57 – 0.82) and finger targeting (r=0.49 – 0.68) correlated significantly with all 5 secondary motor outcomes and with percent CST injury. The robotic version of the B/B correlated significantly with the clinical B/B test but was less prone to floor effect. Robot-based assessments were comparable to FMA score in relation to percent CST injury and superior in relation to M1 hand injury. Conclusions The current findings support using a battery of robot-based methods for assessing the upper extremity motor function in subjects with chronic stroke.

Predicting post‐stroke motor recovery of upper extremity using clinical variables and performance assays: A prospective cohort study protocol

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Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study

“…Colombo et al [ 23 – 25 ] further demonstrated a moderate correlation between robot-based kinematic parameters and FMA-UE scores; work by Zollo et al [ 26 ], Otaka et al [ 27 ], Duret et al [ 28 , 29 ], and Pila et al [ 30 ] made comparable observations. Other authors achieved similar results by collecting kinematic data during the performance of tasks consisting of drawing geometric figures of different shapes [ 31 , 32 ], tracing large semicircular arcs to measure UE active range of motion [ 33 ], or deriving kinematic parameters from distal movements (e.g., wrist and finger movements) [ 34 ]. Larger correlations were shown by Krebs et al [ 35 ] when implementing more complex analytical models than those utilized in previous work.…”

Robotic tests for position sense and movement discrimination in the upper limb reveal that they each are highly reproducible but not correlated in healthy individuals

“…Robotic technologies are emerging as a new approach for neurological assessment. They offer advantages over existing clinical tools as they can provide objective and precise measures of many sensory, motor and cognitive behaviours [18][19][20]. In recent years, there have been several new tasks developed using robotic technology for evaluating different aspects of proprioception including position sense [10,[20][21][22][23][24][25][26][27], sense of effort [28] and kinesthesia [29].…”