A quantitative and standardized robotic method for the evaluation of arm proprioception after stroke

Stroke often results in both motor and sensory deficits, which may interact in the manifested functional impairment. Proprioception is known to play important roles in the planning and control of limb posture and movement; however, the impact of proprioceptive deficits on motor function has been difficult to elucidate due in part to the qualitative nature of available clinical tests. We present a quantitative and standardized method for evaluating proprioception in tasks directly relevant to those used to assess motor function. Using a robotic manipulandum that exerted controlled displacements of the hand, stroke participants were evaluated, and compared with a control group, in their ability to detect such displacements in a 2-alternative, forced-choice paradigm. A psychometric function parameterized the decision process underlying the detection of the hand displacements. The shape of this function was determined by a signal detection threshold and by the variability of the response about this threshold. Our automatic procedure differentiates between participants with and without proprioceptive deficits and quantifies functional proprioceptive sensation on a magnitude scale that is meaningful for ongoing studies of degraded motor function in comparable horizontal movements.