The Cortical Response Evoked by Robotic Wrist Perturbations Reflects Level of Proprioceptive Impairment After Stroke

Journal article (2021)

Authors

J. van Kordelaar Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering
M.L. van de Ruit Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering
T. Solis Escalante Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering , Radboud University Medical Center
Leo A.M. Aerden Reinier de Graaf Gasthuis
Carel G M Meskers Amsterdam UMC
Erwin E H Van Wegen Amsterdam UMC
A.C. Schouten University of Twente, Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering
Gert Kwakkel Amsterdam UMC
Frans van der Helm Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering
Research Group
Biomechatronics & Human-Machine Control (Mechanical, Maritime and Materials Engineering) (TU Delft)
Copyright: © 2021 , J. van Kordelaar, M.L. van de Ruit, T. Solis Escalante, Leo A.M. Aerden, Carel G.M. Meskers, Erwin E.H. van Wegen, A.C. Schouten, Gert Kwakkel, F.C.T. van der Helm
DOI: https://doi.org/10.3389/fnhum.2021.695366
More Info
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Published Date

2021

Language

English

Faculty

Mechanical, Maritime and Materials Engineering

Department

Biomechanical Engineering

Research Group

Biomechatronics & Human-Machine Control

Abstract

Background: Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalography (EEG) may be an objective method to support current clinical assessments of proprioception. Objective: To establish whether evoked cortical responses reflect proprioceptive deficits as assessed by clinical scales and whether they predict upper extremity motor function at 26 weeks after stroke. Methods: Thirty-one patients with stroke were included. In week 1, 3, 5, 12, and 26 after stroke, the upper extremity sections of the Erasmus modified Nottingham Sensory Assessment (EmNSA-UE) and the Fugl-Meyer Motor Assessment (FM-UE) and the EEG responses (64 channels) to robotic wrist perturbations were measured. The extent to which proprioceptive input was conveyed to the affected hemisphere was estimated by the signal-to-noise ratio (SNR) of the evoked response. The relationships between SNR and EmNSA-UE as well as SNR and time after stroke were investigated using linear regression. Receiver-operating-characteristic curves were used to compare the predictive values of SNR and EmNSA-UE for predicting whether patients regained some selective motor control (FM-UE > 22) or whether they could only move their paretic upper extremity within basic limb synergies (FM-UE ≤ 22) at 26 weeks after stroke. Results: Patients (N = 7) with impaired proprioception (EmNSA-UE proprioception score < 8) had significantly smaller SNR than patients with unimpaired proprioception (N = 24) [EmNSA-UE proprioception score = 8, t(29) = 2.36, p = 0.03]. No significant effect of time after stroke on SNR was observed. Furthermore, there was no significant difference in the predictive value between EmNSA-UE and SNR for predicting motor function at 26 weeks after stroke. Conclusion: The SNR of the evoked cortical response does not significantly change as a function of time after stroke and differs between patients with clinically assessed impaired and unimpaired proprioception, suggesting that SNR reflects persistent damage to proprioceptive pathways. A similar predictive value with respect to EmNSA-UE suggests that SNR may be used as an objective predictor next to clinical sensory assessments for predicting motor function at 26 weeks after stroke.