Neuroimaging and Robotic Assessment of Proprioceptive Impairments Post-Stroke
Abstract
Background: Proprioception is the sense of position (position sense) and movement (kinesthesia) of our limbs and body. It is important for performing coordinated volitional movements, and is often affected after stroke, leading to worse functional recovery. Proprioception is difficult to reliably assess with current clinical measures. This thesis performed proprioceptive assessments in subjects with recent stroke using a robotic exoskeleton called a KINARM. Chapter Two identified specific lesion locations in a sample of subjects with recent stroke (n=142) that were associated with impairments in different aspects of kinesthesia (e.g. speed, direction, and amplitude of movement perception). Lesions to frontal, parietal and temporal cortices, and the insula were associated with impairments in kinesthesia. Chapter Three incorporated multiple measures from position sense and kinesthesia robotic tasks into a single composite score of proprioception. Proprioceptive impairments were common (over 60%, n=285) after stroke, and were correlated with clinical measures of functional independence. This composite score will have utility in monitoring proprioceptive impairments in future rehabilitation clinical trials. Next, Chapters Four and Five utilized functional MRI (fMRI) to identify disruptions in brain activity related to proprioceptive impairments. Chapter Four used a position-matching device and task during fMRI to identify brain areas associated with impaired proprioception. The ipsilesional supramarginal and superior temporal gyri as well as bilateral supplementary motor and ipsilesional premotor cortices were associated with impaired proprioception in subjects with recent stroke (n=16). Chapter Five measured resting-state functional connectivity in subjects with stroke (n=17) using fMRI. Changes in functional connectivity were computed in relation to impaired proprioception (measured using the KINARM). Impaired proprioception was associated with decreased functional connectivity between 1) contralesional opercular area 1 (seed) and ipsilesional temporal and parietal areas, and 2) supplementary motor/premotor areas (seed) and ipsilesional SI and supramarginal gyrus. Conclusions: We have developed an objective and reproducible robotic-based outcome measure of upper limb proprioception. Proprioception in the human brain appears to involve primary sensorimotor structures (e.g. SI, MI) and higher-level association areas such as superior and inferior parietal cortices, supplementary motor and premotor cortices.
Description
Keywords
Anatomy, Neuroscience, Rehabilitation and Therapy, Robotics
Citation
Kenzie, J. (2017). Neuroimaging and Robotic Assessment of Proprioceptive Impairments Post-Stroke (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27083