The Experts below are selected from a list of 1935 Experts worldwide ranked by ideXlab platform
Sean P. Dukelow - One of the best experts on this subject based on the ideXlab platform.
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Differential loss of position sense and Kinesthesia in sub-acute stroke
Cortex, 2019Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Position sense and Kinesthesia are thought to be independent sub-modalities of proprioception, based on neuromuscular recordings in the periphery. However, little evidence has demonstrated separation in the central nervous system (CNS). Stroke provides an interesting model to examine this dissociation in the CNS due to the heterogeneity of lesion locations and high incidence of proprioceptive impairment. Here, we aimed to determine if position sense and Kinesthesia are behaviorally dissociable in a stroke patient model, and if behavioral dissociations in proprioception corresponded to different stroke lesion damage. Position sense and Kinesthesia were assessed in subjects with unilateral stroke (N = 285) using two robotic tasks: Position Matching (PM) and Kinesthetic Matching (KIN). Without vision, the robot moved the subjects' stroke-affected arm and they mirror-matched perceived location (PM) or movement (KIN) with their opposite arm. Fifty-two percent of subjects had deficits in both PM and KIN, 22% had impairments in only one sub-modality (7% PM only, 15% KIN only). These subjects tended to have smaller lesions (internal capsule, basal ganglia, insula) compared to those with larger lesions affecting both sub-modalities. Overall, we observed separation of proprioceptive sub-modalities in a large number of stroke subjects, and that lesion load impacted the pattern of proprioceptive impairment.
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Vision of the upper limb fails to compensate for kinesthetic impairments in subacute stroke
Cortex, 2018Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Kinesthesia is an essential component of proprioception allowing for perception of movement. Due to neural injury, such as stroke, Kinesthesia can be significantly impaired. Throughout neurorehabilitation, clinicians may encourage use of vision to guide limb movement to retrain impaired Kinesthesia. However, little evidence exists that vision improves kinesthetic performance after stroke. We examined behavioral and neuroanatomical characteristics of Kinesthesia post-stroke to determine if these impairments improve with vision. Stroke subjects (N = 281) performed a robotic kinesthetic matching task (KIN) without and with vision at ∼10 days post-stroke. A robotic exoskeleton moved the stroke-affected arm while subjects mirror-matched the movement with the opposite arm. Performance was compared to 160 controls. Spatial and temporal parameters were used to quantify kinesthetic performance. A Kinesthetic Task Score was calculated to determine overall performance on KIN without and with vision. Acute stroke imaging (N = 236) was collected to determine commonalities in lesion characteristics amongst kinesthetic impairment groups. Forty-eight percent (N = 135) of subjects had post-stroke impairment in Kinesthesia both without and with vision. Only 19% (N = 52) improved to control-level performance with vision. Of the 48% of subjects that failed to improve with vision, many (N = 77, 57%) had neglect and/or field deficits. Notably 58 subjects (43%) did not have these deficits and still failed to improve with vision. Subjects who failed to improve with vision often had lesions affecting corticospinal tracts, insula, and parietal cortex, specifically the supramarginal gyrus and inferior parietal lobule. Many individuals could not use vision of the limb to correct for impaired Kinesthesia after stroke. Subjects that failed to improve Kinesthesia with vision had lesions affecting known sensorimotor integration areas. Our results suggest that integration of spatial information is impaired in many individuals post-stroke, particularly after parietal cortex damage. The result is a disconnect between kinesthetic and visuomotor processing necessary for visual limb guidance.
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Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton
BMC, 2017Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen H Scott, Sean P. DukelowAbstract:Abstract Background Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in Kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task. Methods Twenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task. Results We evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]). Conclusions The robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying Kinesthesia after stroke
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examining differences in patterns of sensory and motor recovery after stroke with robotics
Stroke, 2015Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Background and Purpose—Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. Methods—One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and Kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). Results—One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% Kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral...
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Anatomical correlates of proprioceptive impairments following acute stroke: A case series
Journal of the Neurological Sciences, 2014Co-Authors: Jeffrey M Kenzie, Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sonja E Findlater, Michael D Hill, Sean P. DukelowAbstract:Abstract Background Proprioception is the sensation of position and movement of our limbs and body in space. This sense is important for performing smooth coordinated movements and is impaired in approximately 50% of stroke survivors. In the present case series we wanted to determine how discrete stroke lesions to areas of the brain thought to be critical for somatosensation (thalamus, posterior limb of internal capsule, primary somatosensory cortex and posterior parietal cortex) would affect position sense and Kinesthesia in the acute stages post-stroke. Given the known issues with standard clinical measures of proprioception (i.e. poor sensitivity and reliability) we used more modern quantitative robotic assessments to measure proprioception. Methods Neuroimaging (MRI, n = 10 or CT, n = 2) was performed on 12 subjects 2–10 days post-stroke. Proprioception was assessed using a KINARM robot within the same time frame. Visually guided reaching was also assessed to allow us to compare and contrast proprioception with visuomotor performance. Results and Conclusions Proprioceptive impairments were observed in 7 of 12 subjects. Thalamic lesions (n = 4) were associated with position sense (n = 1) or position sense and Kinesthesia (n = 1) impairments. Posterior limb of the internal capsule lesions (n = 4) were associated with primarily position sense (n = 1) or Kinesthesia (n = 2) impairments. Lesions affecting primary somatosensory cortex and posterior parietal cortex (n = 2) were associated with significant position sense and Kinesthesia impairments. All subjects with damage to hypothesized structures displayed impairments with performance on the visually guided reaching task. Across the proprioceptive tasks, we saw that position sense and Kinesthesia were impaired to differing degrees, suggesting a potential dissociation between these two components of proprioception.
Shu Morioka - One of the best experts on this subject based on the ideXlab platform.
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Effects of illusory Kinesthesia by tendon vibratory stimulation on the postoperative neural activities of distal radius fracture patients.
Neuroreport, 2017Co-Authors: Ryota Imai, Michihiro Osumi, Tomoya Ishigaki, Takayuki Kodama, Sotaro Shimada, Shu MoriokaAbstract:Activation of motor-related regions with illusory Kinesthesia had been suspected to contribute toward pain alleviation. We used electroencephalography (EEG) to assess the sensorimotor cortex activation during illusory Kinesthesia by vibratory tendon stimulation in patients who were in pain. We investigated the relationship between the sensorimotor cortex and postoperative pain to clarify the analgesia mechanism. Patients who had undergone distal radius fracture surgery were studied. A hand massager provided the vibration stimulus for the illusory Kinesthesia on the extensor digitorum muscle at the nonaffected hand's wrist joint on 7 consecutive days starting 1 day after surgery. The main outcomes were pain intensity and EEG activity. EEG activity was recorded during illusory Kinesthesia. We also analyzed the high α rhythm (10-12 Hz) event-related desynchronization/event-related synchronization. The pain intensity was reduced. Attenuation of the high α wave was observed in the bilateral sensorimotor cortex (C3ch, C4ch) areas during illusory Kinesthesia. A significant negative correlation was also observed in the C3 and the C4 of event-related desynchronization/event-related synchronization% values and the variation of pain amelioration at rest. Activation of the sensorimotor cortex by illusory Kinesthesia might have influenced parts of the descending pain-inhibitory system. The postoperative pain in the patients might have been alleviated by the descending pain-inhibitory system.
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The influence of trait anxiety and illusory Kinesthesia on pain threshold.
Journal of Physical Therapy Science, 2017Co-Authors: Ryota Imai, Michihiro Osumi, Tomoya Ishigaki, Shu MoriokaAbstract:[Purpose] It has also been reported that decreased activity in the reward pathway causes a decrease in brain activity in the descending pain control system in people with high trait anxiety. Activation of this system is dependent on both the reward pathway and motor areas. Recently, studies have also shown that motor areas are activated by illusory Kinesthesia. It was aimed to explore whether anxiety trait modulates the influence of illusory Kinesthesia on pain threshold. [Subjects and Methods] The pain threshold and trait anxiety at rest before vibratory tendon stimulation (the task) were measured. After the task, the pain threshold, the illusory Kinesthesia angle, and the intensity of illusory Kinesthesia for patients with and without illusory Kinesthesia were measured. A total of 35 healthy right-handed students participated, among whom 22 and 13 were included in the illusion and no-illusion groups, respectively. [Results] There was a significant increase in the pain threshold after task completion in both groups; however, there was no statistically significant difference between the two groups. Correlational analysis revealed that State-Trait Anxiety Inventory-trait score correlated negatively with the pain threshold in the no-illusion group, but there was no correlation in the illusion group. [Conclusion] The pain threshold improved regardless of the size of trait anxiety in the illusion group, but did not improve merely through sensory input by vibratory stimulation in the no-illusion group. Thus, illusory Kinesthesia has effect of increasing the pain threshold.
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influence of illusory Kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures a quasi randomized controlled study
Clinical Rehabilitation, 2016Co-Authors: Ryota Imai, Michihiro Osumi, Shu MoriokaAbstract:Objectives:We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius.Design:A quasi-randomized controlled trial.Setting:Kawachi General Hospital, Japan.Subjects:A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory Kinesthesia group (n = 13) or control group (n = 13).Intervention:The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery.Main measures:Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion.Results:The illusory Kinesthesia group reported improved pain at rest (p < 0.001), movement pain (p < 0.001), pain catastrophizing scale (p < 0.001), Hospital Anxiety and Depression Scale (p < 0.01), and range of moti...
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Influence of illusory Kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures: A quasi-randomized controlled study
Clinical Rehabilitation, 2015Co-Authors: Ryota Imai, Michihiro Osumi, Shu MoriokaAbstract:Objectives:We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius.Design:A quasi-randomized controlled trial.Setting:Kawachi General Hospital, Japan.Subjects:A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory Kinesthesia group (n = 13) or control group (n = 13).Intervention:The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery.Main measures:Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion.Results:The illusory Kinesthesia group reported improved pain at rest (p
Ryota Imai - One of the best experts on this subject based on the ideXlab platform.
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Effects of illusory Kinesthesia by tendon vibratory stimulation on the postoperative neural activities of distal radius fracture patients.
Neuroreport, 2017Co-Authors: Ryota Imai, Michihiro Osumi, Tomoya Ishigaki, Takayuki Kodama, Sotaro Shimada, Shu MoriokaAbstract:Activation of motor-related regions with illusory Kinesthesia had been suspected to contribute toward pain alleviation. We used electroencephalography (EEG) to assess the sensorimotor cortex activation during illusory Kinesthesia by vibratory tendon stimulation in patients who were in pain. We investigated the relationship between the sensorimotor cortex and postoperative pain to clarify the analgesia mechanism. Patients who had undergone distal radius fracture surgery were studied. A hand massager provided the vibration stimulus for the illusory Kinesthesia on the extensor digitorum muscle at the nonaffected hand's wrist joint on 7 consecutive days starting 1 day after surgery. The main outcomes were pain intensity and EEG activity. EEG activity was recorded during illusory Kinesthesia. We also analyzed the high α rhythm (10-12 Hz) event-related desynchronization/event-related synchronization. The pain intensity was reduced. Attenuation of the high α wave was observed in the bilateral sensorimotor cortex (C3ch, C4ch) areas during illusory Kinesthesia. A significant negative correlation was also observed in the C3 and the C4 of event-related desynchronization/event-related synchronization% values and the variation of pain amelioration at rest. Activation of the sensorimotor cortex by illusory Kinesthesia might have influenced parts of the descending pain-inhibitory system. The postoperative pain in the patients might have been alleviated by the descending pain-inhibitory system.
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The influence of trait anxiety and illusory Kinesthesia on pain threshold.
Journal of Physical Therapy Science, 2017Co-Authors: Ryota Imai, Michihiro Osumi, Tomoya Ishigaki, Shu MoriokaAbstract:[Purpose] It has also been reported that decreased activity in the reward pathway causes a decrease in brain activity in the descending pain control system in people with high trait anxiety. Activation of this system is dependent on both the reward pathway and motor areas. Recently, studies have also shown that motor areas are activated by illusory Kinesthesia. It was aimed to explore whether anxiety trait modulates the influence of illusory Kinesthesia on pain threshold. [Subjects and Methods] The pain threshold and trait anxiety at rest before vibratory tendon stimulation (the task) were measured. After the task, the pain threshold, the illusory Kinesthesia angle, and the intensity of illusory Kinesthesia for patients with and without illusory Kinesthesia were measured. A total of 35 healthy right-handed students participated, among whom 22 and 13 were included in the illusion and no-illusion groups, respectively. [Results] There was a significant increase in the pain threshold after task completion in both groups; however, there was no statistically significant difference between the two groups. Correlational analysis revealed that State-Trait Anxiety Inventory-trait score correlated negatively with the pain threshold in the no-illusion group, but there was no correlation in the illusion group. [Conclusion] The pain threshold improved regardless of the size of trait anxiety in the illusion group, but did not improve merely through sensory input by vibratory stimulation in the no-illusion group. Thus, illusory Kinesthesia has effect of increasing the pain threshold.
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influence of illusory Kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures a quasi randomized controlled study
Clinical Rehabilitation, 2016Co-Authors: Ryota Imai, Michihiro Osumi, Shu MoriokaAbstract:Objectives:We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius.Design:A quasi-randomized controlled trial.Setting:Kawachi General Hospital, Japan.Subjects:A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory Kinesthesia group (n = 13) or control group (n = 13).Intervention:The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery.Main measures:Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion.Results:The illusory Kinesthesia group reported improved pain at rest (p < 0.001), movement pain (p < 0.001), pain catastrophizing scale (p < 0.001), Hospital Anxiety and Depression Scale (p < 0.01), and range of moti...
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Influence of illusory Kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures: A quasi-randomized controlled study
Clinical Rehabilitation, 2015Co-Authors: Ryota Imai, Michihiro Osumi, Shu MoriokaAbstract:Objectives:We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius.Design:A quasi-randomized controlled trial.Setting:Kawachi General Hospital, Japan.Subjects:A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory Kinesthesia group (n = 13) or control group (n = 13).Intervention:The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery.Main measures:Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion.Results:The illusory Kinesthesia group reported improved pain at rest (p
Jennifer A. Semrau - One of the best experts on this subject based on the ideXlab platform.
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Differential loss of position sense and Kinesthesia in sub-acute stroke
Cortex, 2019Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Position sense and Kinesthesia are thought to be independent sub-modalities of proprioception, based on neuromuscular recordings in the periphery. However, little evidence has demonstrated separation in the central nervous system (CNS). Stroke provides an interesting model to examine this dissociation in the CNS due to the heterogeneity of lesion locations and high incidence of proprioceptive impairment. Here, we aimed to determine if position sense and Kinesthesia are behaviorally dissociable in a stroke patient model, and if behavioral dissociations in proprioception corresponded to different stroke lesion damage. Position sense and Kinesthesia were assessed in subjects with unilateral stroke (N = 285) using two robotic tasks: Position Matching (PM) and Kinesthetic Matching (KIN). Without vision, the robot moved the subjects' stroke-affected arm and they mirror-matched perceived location (PM) or movement (KIN) with their opposite arm. Fifty-two percent of subjects had deficits in both PM and KIN, 22% had impairments in only one sub-modality (7% PM only, 15% KIN only). These subjects tended to have smaller lesions (internal capsule, basal ganglia, insula) compared to those with larger lesions affecting both sub-modalities. Overall, we observed separation of proprioceptive sub-modalities in a large number of stroke subjects, and that lesion load impacted the pattern of proprioceptive impairment.
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Vision of the upper limb fails to compensate for kinesthetic impairments in subacute stroke
Cortex, 2018Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Kinesthesia is an essential component of proprioception allowing for perception of movement. Due to neural injury, such as stroke, Kinesthesia can be significantly impaired. Throughout neurorehabilitation, clinicians may encourage use of vision to guide limb movement to retrain impaired Kinesthesia. However, little evidence exists that vision improves kinesthetic performance after stroke. We examined behavioral and neuroanatomical characteristics of Kinesthesia post-stroke to determine if these impairments improve with vision. Stroke subjects (N = 281) performed a robotic kinesthetic matching task (KIN) without and with vision at ∼10 days post-stroke. A robotic exoskeleton moved the stroke-affected arm while subjects mirror-matched the movement with the opposite arm. Performance was compared to 160 controls. Spatial and temporal parameters were used to quantify kinesthetic performance. A Kinesthetic Task Score was calculated to determine overall performance on KIN without and with vision. Acute stroke imaging (N = 236) was collected to determine commonalities in lesion characteristics amongst kinesthetic impairment groups. Forty-eight percent (N = 135) of subjects had post-stroke impairment in Kinesthesia both without and with vision. Only 19% (N = 52) improved to control-level performance with vision. Of the 48% of subjects that failed to improve with vision, many (N = 77, 57%) had neglect and/or field deficits. Notably 58 subjects (43%) did not have these deficits and still failed to improve with vision. Subjects who failed to improve with vision often had lesions affecting corticospinal tracts, insula, and parietal cortex, specifically the supramarginal gyrus and inferior parietal lobule. Many individuals could not use vision of the limb to correct for impaired Kinesthesia after stroke. Subjects that failed to improve Kinesthesia with vision had lesions affecting known sensorimotor integration areas. Our results suggest that integration of spatial information is impaired in many individuals post-stroke, particularly after parietal cortex damage. The result is a disconnect between kinesthetic and visuomotor processing necessary for visual limb guidance.
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Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton
BMC, 2017Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen H Scott, Sean P. DukelowAbstract:Abstract Background Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in Kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task. Methods Twenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task. Results We evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]). Conclusions The robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying Kinesthesia after stroke
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examining differences in patterns of sensory and motor recovery after stroke with robotics
Stroke, 2015Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Background and Purpose—Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. Methods—One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and Kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). Results—One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% Kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral...
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Anatomical correlates of proprioceptive impairments following acute stroke: A case series
Journal of the Neurological Sciences, 2014Co-Authors: Jeffrey M Kenzie, Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sonja E Findlater, Michael D Hill, Sean P. DukelowAbstract:Abstract Background Proprioception is the sensation of position and movement of our limbs and body in space. This sense is important for performing smooth coordinated movements and is impaired in approximately 50% of stroke survivors. In the present case series we wanted to determine how discrete stroke lesions to areas of the brain thought to be critical for somatosensation (thalamus, posterior limb of internal capsule, primary somatosensory cortex and posterior parietal cortex) would affect position sense and Kinesthesia in the acute stages post-stroke. Given the known issues with standard clinical measures of proprioception (i.e. poor sensitivity and reliability) we used more modern quantitative robotic assessments to measure proprioception. Methods Neuroimaging (MRI, n = 10 or CT, n = 2) was performed on 12 subjects 2–10 days post-stroke. Proprioception was assessed using a KINARM robot within the same time frame. Visually guided reaching was also assessed to allow us to compare and contrast proprioception with visuomotor performance. Results and Conclusions Proprioceptive impairments were observed in 7 of 12 subjects. Thalamic lesions (n = 4) were associated with position sense (n = 1) or position sense and Kinesthesia (n = 1) impairments. Posterior limb of the internal capsule lesions (n = 4) were associated with primarily position sense (n = 1) or Kinesthesia (n = 2) impairments. Lesions affecting primary somatosensory cortex and posterior parietal cortex (n = 2) were associated with significant position sense and Kinesthesia impairments. All subjects with damage to hypothesized structures displayed impairments with performance on the visually guided reaching task. Across the proprioceptive tasks, we saw that position sense and Kinesthesia were impaired to differing degrees, suggesting a potential dissociation between these two components of proprioception.
Troy M. Herter - One of the best experts on this subject based on the ideXlab platform.
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Differential loss of position sense and Kinesthesia in sub-acute stroke
Cortex, 2019Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Position sense and Kinesthesia are thought to be independent sub-modalities of proprioception, based on neuromuscular recordings in the periphery. However, little evidence has demonstrated separation in the central nervous system (CNS). Stroke provides an interesting model to examine this dissociation in the CNS due to the heterogeneity of lesion locations and high incidence of proprioceptive impairment. Here, we aimed to determine if position sense and Kinesthesia are behaviorally dissociable in a stroke patient model, and if behavioral dissociations in proprioception corresponded to different stroke lesion damage. Position sense and Kinesthesia were assessed in subjects with unilateral stroke (N = 285) using two robotic tasks: Position Matching (PM) and Kinesthetic Matching (KIN). Without vision, the robot moved the subjects' stroke-affected arm and they mirror-matched perceived location (PM) or movement (KIN) with their opposite arm. Fifty-two percent of subjects had deficits in both PM and KIN, 22% had impairments in only one sub-modality (7% PM only, 15% KIN only). These subjects tended to have smaller lesions (internal capsule, basal ganglia, insula) compared to those with larger lesions affecting both sub-modalities. Overall, we observed separation of proprioceptive sub-modalities in a large number of stroke subjects, and that lesion load impacted the pattern of proprioceptive impairment.
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Vision of the upper limb fails to compensate for kinesthetic impairments in subacute stroke
Cortex, 2018Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Abstract Kinesthesia is an essential component of proprioception allowing for perception of movement. Due to neural injury, such as stroke, Kinesthesia can be significantly impaired. Throughout neurorehabilitation, clinicians may encourage use of vision to guide limb movement to retrain impaired Kinesthesia. However, little evidence exists that vision improves kinesthetic performance after stroke. We examined behavioral and neuroanatomical characteristics of Kinesthesia post-stroke to determine if these impairments improve with vision. Stroke subjects (N = 281) performed a robotic kinesthetic matching task (KIN) without and with vision at ∼10 days post-stroke. A robotic exoskeleton moved the stroke-affected arm while subjects mirror-matched the movement with the opposite arm. Performance was compared to 160 controls. Spatial and temporal parameters were used to quantify kinesthetic performance. A Kinesthetic Task Score was calculated to determine overall performance on KIN without and with vision. Acute stroke imaging (N = 236) was collected to determine commonalities in lesion characteristics amongst kinesthetic impairment groups. Forty-eight percent (N = 135) of subjects had post-stroke impairment in Kinesthesia both without and with vision. Only 19% (N = 52) improved to control-level performance with vision. Of the 48% of subjects that failed to improve with vision, many (N = 77, 57%) had neglect and/or field deficits. Notably 58 subjects (43%) did not have these deficits and still failed to improve with vision. Subjects who failed to improve with vision often had lesions affecting corticospinal tracts, insula, and parietal cortex, specifically the supramarginal gyrus and inferior parietal lobule. Many individuals could not use vision of the limb to correct for impaired Kinesthesia after stroke. Subjects that failed to improve Kinesthesia with vision had lesions affecting known sensorimotor integration areas. Our results suggest that integration of spatial information is impaired in many individuals post-stroke, particularly after parietal cortex damage. The result is a disconnect between kinesthetic and visuomotor processing necessary for visual limb guidance.
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Inter-rater reliability of kinesthetic measurements with the KINARM robotic exoskeleton
BMC, 2017Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen H Scott, Sean P. DukelowAbstract:Abstract Background Kinesthesia (sense of limb movement) has been extremely difficult to measure objectively, especially in individuals who have survived a stroke. The development of valid and reliable measurements for proprioception is important to developing a better understanding of proprioceptive impairments after stroke and their impact on the ability to perform daily activities. We recently developed a robotic task to evaluate kinesthetic deficits after stroke and found that the majority (~60%) of stroke survivors exhibit significant deficits in Kinesthesia within the first 10 days post-stroke. Here we aim to determine the inter-rater reliability of this robotic kinesthetic matching task. Methods Twenty-five neurologically intact control subjects and 15 individuals with first-time stroke were evaluated on a robotic kinesthetic matching task (KIN). Subjects sat in a robotic exoskeleton with their arms supported against gravity. In the KIN task, the robot moved the subjects’ stroke-affected arm at a preset speed, direction and distance. As soon as subjects felt the robot begin to move their affected arm, they matched the robot movement with the unaffected arm. Subjects were tested in two sessions on the KIN task: initial session and then a second session (within an average of 18.2 ± 13.8 h of the initial session for stroke subjects), which were supervised by different technicians. The task was performed both with and without the use of vision in both sessions. We evaluated intra-class correlations of spatial and temporal parameters derived from the KIN task to determine the reliability of the robotic task. Results We evaluated 8 spatial and temporal parameters that quantify kinesthetic behavior. We found that the parameters exhibited moderate to high intra-class correlations between the initial and retest conditions (Range, r-value = [0.53–0.97]). Conclusions The robotic KIN task exhibited good inter-rater reliability. This validates the KIN task as a reliable, objective method for quantifying Kinesthesia after stroke
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examining differences in patterns of sensory and motor recovery after stroke with robotics
Stroke, 2015Co-Authors: Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sean P. DukelowAbstract:Background and Purpose—Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. Methods—One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and Kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). Results—One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% Kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral...
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Anatomical correlates of proprioceptive impairments following acute stroke: A case series
Journal of the Neurological Sciences, 2014Co-Authors: Jeffrey M Kenzie, Jennifer A. Semrau, Troy M. Herter, Stephen Scott, Sonja E Findlater, Michael D Hill, Sean P. DukelowAbstract:Abstract Background Proprioception is the sensation of position and movement of our limbs and body in space. This sense is important for performing smooth coordinated movements and is impaired in approximately 50% of stroke survivors. In the present case series we wanted to determine how discrete stroke lesions to areas of the brain thought to be critical for somatosensation (thalamus, posterior limb of internal capsule, primary somatosensory cortex and posterior parietal cortex) would affect position sense and Kinesthesia in the acute stages post-stroke. Given the known issues with standard clinical measures of proprioception (i.e. poor sensitivity and reliability) we used more modern quantitative robotic assessments to measure proprioception. Methods Neuroimaging (MRI, n = 10 or CT, n = 2) was performed on 12 subjects 2–10 days post-stroke. Proprioception was assessed using a KINARM robot within the same time frame. Visually guided reaching was also assessed to allow us to compare and contrast proprioception with visuomotor performance. Results and Conclusions Proprioceptive impairments were observed in 7 of 12 subjects. Thalamic lesions (n = 4) were associated with position sense (n = 1) or position sense and Kinesthesia (n = 1) impairments. Posterior limb of the internal capsule lesions (n = 4) were associated with primarily position sense (n = 1) or Kinesthesia (n = 2) impairments. Lesions affecting primary somatosensory cortex and posterior parietal cortex (n = 2) were associated with significant position sense and Kinesthesia impairments. All subjects with damage to hypothesized structures displayed impairments with performance on the visually guided reaching task. Across the proprioceptive tasks, we saw that position sense and Kinesthesia were impaired to differing degrees, suggesting a potential dissociation between these two components of proprioception.
