Towards Understanding Upper Limb Rehabilitation After Stroke

Study Overview
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Brief Summary
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After a stroke, more than two out of three patients experience problems with upper limb movement and sensation. During the past decade, robotic technology has been increasingly used to asses these problems in a detailed and accurate manner. However, sensory processing, one of the most important sensory functions, has not been assessed using robotic technology yet. Therefore, the investigators have developed a robotic assessment of sensory processing. During this study, the investigators aim to initially validate this novel assessment. The investigators aim to examine 20 chronic stroke patients and 20 age-matched healthy controls using the robotic assessment on one hand, and a set of existing clinical assessments on the other hand. The investigators hypothesize that stroke patients will have a poorer performance on this novel robotic assessment compared to age-matched healthy controls, and that these findings are similar to what is found with existing clinical assessments.

Detailed Description
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Up to 70% of stroke survivors show upper limb impairments consisting of motor and/or somatosensory impairments. These impairments often persist well into the chronic stage, and may lead to significant limitations in activities of daily living and may negatively affect quality of life. It is therefore of utmost importance to accurately assess upper limb impairments. Clinical assessments exist for both motor and somatosensory function, but lack good psychometric properties. Robotic technology show promising potential and is readily available to assess motor function and proprioception. Robotic assessment for sensory processing is currently not yet available, despite being the most relevant somatosensory function. Indeed, sensory processing shows the strongest association with upper limb movement, and only shows incomplete recovery at 6 months after stroke. The investigators recently developed a novel robotic assessment of sensory processing, using the Kinarm End-Point Lab (BKIN Technologies Ltd., Canada). This cross-sectional study was set up to initially validate this novel robotic assessment and to collect pilot data to form the basis for future research. 20 chronic stroke patients and 20 age-matched controls will be recruited and will undergo extensive clinical and robotic assessment of upper limb motor and somatosensory function. The investigators hypothesize stoke patients with sensory processing deficits to have a worse performance on this novel robotic assessment compared to healthy controls and patients without sensory processing deficits. The investigators also hypothesize to see moderate to high correlations between the robotic assessment of sensory processing, and clinical assessments for both somatosensory and motor function.

Official Title
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Robotic Assessment of Upper Limb Passive and Active Sensory Processing in the Chronic Phase After Stroke

Conditions
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Stroke

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria - Stroke Patients: At least 18 years old A first-ever unilateral, supratentorial stroke (as defined by WHO) In the chronic phase after stroke (i.e. being at least 6 months after stroke) The ability to perform, at least to some extent, active shoulder abduction and wrist extension against gravity Exclusion Criteria - Stroke Patients: Any serious musculoskeletal and/or other neurological conditions Serious communication or cognitive deficits No written informed consent Inclusion Criteria - Healthy Controls: - At least 18 years old Exclusion Criteria - Healthy Controls: History of stroke or TIA Upper limb somatosensory and/or motor impairments Any serious musculoskeletal and/or other neurological conditions Serious communication or cognitive deficits No written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic stroke patients<br>Patients who are at least 6 months after a first unilateral stroke | |
| Healthy controls<br>Healthy subjects with no history of any neurological condition and who are in the same age group as the chronic stroke patients | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Kinarm: sensory processing task | Newly-developed task on the Kinarm End-Point Lab used to assess passive and active sensory processing | Once in the chronic phase (at least 6 months after stroke) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Kinarm: position matching task | Assessment of limb position sense using a 9-target mirror-matching task on the Kinarm End-Point Lab | Once in the chronic phase (at least 6 months after stroke) | 
| Kinarm: visually guided reaching | Assessment of motor function using a 4-target centre-out reaching task on the Kinarm End-Point Lab | Once in the chronic phase (at least 6 months after stroke) | 
| Erasmus modified Nottingham sensory assessment | Clinical assessment of sensory processing with an area under the curve based scoring system, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Tactile discrimination test | Clinical assessment of sensory processing with an area under the curve based scoring system, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Tactile functional object recognition | Clinical assessment of sensory processing on an ordinal scale ranging from 0 to 42, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Stereognosis section of the original Nottingham sensory assessment | Clinical assessment of sensory processing on an ordinal scale ranging from 0 to 22, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Wrist position sense test | Clinical assessment of wrist position sense on a continuous scale, with lower scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Perceptual threshold of touch | TENS-based assessment of exteroception on a continuous scale, with lower scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Fugl-Meyer upper extremity assessment | Clinical assessment of motor function on an ordinal scale ranging from 0 to 66, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Action research arm test | Clinical assessment of motor activity performance on an ordinal scale ranging from 0 to 57, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Barthel index | Clinical assessment of activities of daily living on an ordinal scale ranging from 0 to 20, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Montreal cognitive assessment | Clinical assessment of cognitive function on an ordinal scale ranging from 0 to 30, with higher scores meaning better performance | Once in the chronic phase (at least 6 months after stroke) | 
| Star cancellation test | Clinical assessment of visuospatial neglect on an ordinal scale ranging from 0 to 54, with higher scores meaning better performance, and a score below 44 indicating the presence of visuospatial neglect | Once in the chronic phase (at least 6 months after stroke) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, Upper limb, Somatosensation, Sensory processing, Robotic assessment, Kinematics