Posts Tagged Sensory
[Abstract] Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis
[ARTICLE] Quantification of upper limb position sense using an exoskeleton and a virtual reality display – Full Text
Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability.
Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant’s arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant’s arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant’s arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm).
Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (− 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47).
This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke.
Proprioception is defined as the ability to perceive body segment positions and movements in space . Sensory receptors involved in proprioception are mostly located in muscle [2, 3, 4], joint [5, 6] and skin [3, 7]. Proprioceptive sense is known to play a significant role in motor control [8, 9, 10, 11] and learning [8, 12], particularly in the absence of vision. The importance of proprioceptive inputs has been demonstrated while studying individuals who presented lack of proprioception due to large-fiber sensory neuropathy [11, 12]. Despite an intact motor system, somatosensory deafferentation may lead to limitations in several activities involving motor skills, such as eating or dressing . These disabilities may also be observed in individuals with proprioceptive impairments due to a stroke. Indeed, approximately half of the individuals who sustained a stroke present proprioceptive impairments in contralesional upper limb . After a stroke, proprioception is known to be related to recovery of functional mobility and independence in activities of daily living (ADL; ). Fewer individuals with significant proprioceptive and motor losses (25%) were independent in ADL than individuals with motor deficits alone (78%). Moreover, fewer individuals with proprioceptive deficits (60%) after a stroke are discharged from the hospital directly to home compared to those without proprioceptive deficits (92%) .
Although the negative impact of proprioceptive impairments on motor and functional recovery is known, a large proportion of clinicians (70%) report not using standardised assessment to evaluate somatosensory deficits in patients with a stroke . In clinical and research settings, proprioception is most frequently assessed with limb-matching tasks. Two types of matching tasks have commonly been used: the ipsilateral remembered matching task and the contralateral concurrent matching task . In an ipsilateral remembered matching task, the evaluator or robotic device brings the patient’s limb to a target joint position, when the patient’s eyes are closed, keeps the limb in this position for several seconds, and then moves back the limb to the initial position. The patient needs to memorize the reference position and replicate it with the same (ipsilateral) limb. This task cannot, however, be used to evaluate proprioception in individuals with working memory issues, which represent around 25% of individuals who sustained a stroke . In such cases, the matching error observed could reflect memory deficits, rather than proprioceptive impairments. Moreover, upper limb paresis affects 76% of individuals who sustained a stroke , making the task’s execution difficult or impossible. Assessing proprioception with the less affected arm as the indicator arm is therefore frequently considered in patients with hemiparesis. Indeed, in a contralateral concurrent matching task, the patient has to reproduce a mirror image of the evaluated limb position with the opposite (contralateral) limb . However, considering that 20% of individuals who sustained a stroke also presents proprioceptive impairment on the ipsilateral side of the lesion , it would be difficult to ascertain whether the error is due to deficits in the evaluated arm, the opposite arm or both. In addition, interhemispheric communication is required in a contralateral concurrent matching task. Individuals with asymmetric stroke or with transcallosal degeneration would therefore be particularly disadvantaged while being assessed with a contralateral concurrent matching task .
In order to study proprioception in individuals who sustained a stroke, we developed an assessment protocol, that combines the use of an exoskeleton and a virtual reality system, enabling the quantification of position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The primary objective of the present study was to validate the assessment protocol by quantifying the elbow joint position sense of healthy adults, before using this protocol with individuals who sustained a stroke. As a secondary objective, test-retest reliability of the assessment protocol was investigated.[…]
When a traumatic brain injury occurs, according to the National Institutes of Health, several brain functions are disrupted causing various degrees of damage from mild to permanent.
Traumatic brain injury can be caused by blunt force trauma or by an object piercing the brain tissue.
Symptoms may be mild and temporary, moderate, or severe. Often, the injury requires brain surgery to remove ruptured blood vessels or bruised brain tissue.
Disabilities may arise depending on the extent of damage from the traumatic brain injury.
The following six brain functions suffer the most after a traumatic brain injury, according to the Mayo Clinic:
When an injury occurs at the base of the skull and damages the cranial nerves, the following complications may result:
- Facial muscle paralysis
- Eye nerve damage resulting in double vision
- Loss of sense of smell
- Vision loss
- Loss of facial sensation
- Problems with swallowing
A traumatic brain injury, depending on the severity of damage, can cause significant changes in cognitive and executive functioning abilities including the following:
- Mental processing speed
- Attention or concentration
- Problem-solving skills
- Multitasking abilities
- Task initiation or completion ability
Traumatic brain injuries can significantly disrupt and affect cognitive and communication skills and have lasting social implications. The following communication and social problems may result from a traumatic brain injury:
- Difficulty understanding speech or writing
- Difficulty with speech or writing
- Disorganized thoughts
- Conversational confusion and awkwardnes
Behavioral changes may be seen after a traumatic brain injury and may include the following:
- Lack of self-control
- Risky behavior
- Self-image issues
- Social difficulties
- Verbal or physical outbursts
Emotional changes may include the following:
- Mood swings
- Lack of empathy
- Insomnia and other sleep-related problems
- Self-esteem changes
Damage from a traumatic brain injury may greatly affect a person’s senses including:
- Ringing in the ears
- Problems with hand-eye coordination
- Blind spots or double vision
- Issues with taste or smell
- Tingling, pain, or itching of the skin
- Dizziness or vertigo
- Object-recognition difficulties