Building: Bourbon Cataratas Convention Centre, Foz do Iguaçu
Room: Cataratas II
Date: 2014-05-06 03:15 PM – 03:30 PM
Last modified: 2014-02-09
Abstract
Background: Perinatal stroke causes most hemiplegic cerebral palsy. Sensory dysfunction is an understudied contributor to disability in part due to limited objective measurement tools. Robotic technology can quantify complex sensory function in adult stroke but has not been applied to children.
We hypothesized that proprioceptive dysfunction is measureable in children with perinatal stroke and correlates with stroke type and level of disability.
Methods: Children from the Perinatal Stroke Project had MRI confirmed unilateral perinatal stroke (arterial stroke or periventricular venous infarction) and upper extremity functional deficit. A bilateral exoskeletal robot (KINARM) tested planar upper limb movements in an augmented reality environment. Primary outcomes were two-dimensional variability, shift, and contraction/expansion scores of a position-matching task. Clinical measures of sensory function (touch, proprioception, graphesthesia, stereognosis) were scored. Matched controls (age/gender) were tested.
Results: Eight perinatal stroke children (median 15+/-2 years, 4 female) (3 PVI, 5 arterial) were compared to 9 healthy controls. Stroke children demonstrated marked impairment in position matching including variability (6.04±1.4 vs 3.93±0.6cm, p= 0.004) and shift (5.16±1.9 vs 1.91±1.1cm, p<0.001). Contraction/expansion ratios also appeared abnormal (0.56±0.27 vs 0.31±0.22; p=0.09). Deficits were greater in arterial lesions compared to PVI. Clinical sensory scores were lower in cases but correlated poorly with robotic measures and motor function. Assessments were well tolerated with no adverse events.
Conclusion: Robotic quantification of proprioception is feasible in perinatal stroke. Sensitivity and quantification appear superior to clinical exam. Disordered proprioception is an under-recognized component of disability and a novel therapeutic target.