Volitional, coordinated movement depends on proprioception to the extent that a loss of proprioception can lead to a lifetime of dyscoordinated movement. Proprioception can be adversely affected by spinal cord injury (SCI), stroke, and traumatic brain injury (TBI). Given the influence of proprioception on normal movement and on movement disorders, the PI's laboratory has developed a novel approach to treat sensory and motor impairments in the limbs of persons with SCI, stroke, and TBI. This approach involves a robotic rehabilitation device that helps a patient move the affected limb while providing somatosensory stimulation. This approach is called AMES: Assisted Movement with Enhanced Sensation. Clinical studies have shown that AMES treatment reduces impairments, which can lead to a restoration of functional movement. The objective of the proposed research is to develop a proprioception assessment tool for the AMES robotic device, which will be used, in conjunction with existing tests of motor impairment, to track the level of sensory impairment while a patient is treated with AMES. The hypothesis underlying this proposed study is that, in persons with somatosensory, as well as motor, impairments, recovery of somatosensation is a prerequisite to the recovery of motor function. The proposed research has 2 specific aims. The first aim is to develop software to implement a proprioception assessment tool on an existing AMES robotic device, to modify the hardware of the device so that the proprioceptive acuity of patients with severe motor disability can be quantified, and to bench-test the new software and hardware. The second aim is to evaluate, preliminarily, this clinical assessment tool on a small number of persons with chronic incomplete SCI and to compare the results from the proprioception assessment tool to other existing somatosensory tests currently in use, in the clinic. Test results from this proposed research will then form the preliminary data for a Phase 2 application to validate the proprioception assessment tool in a multicenter study involving a larger group of SCI participants.
Public Health Relevance: This research addresses the need for an objective, quantitative assessment of proprioception that can be used, to evaluate the extent and type of proprioceptive loss in patients with motor deficits. With this proprioception assessment tool, clinicians using the AMES robotic device therapeutically may be better able to monitor the progressive loss or recovery of proprioceptive acuity in response to disease or to medical interventions, thereby guiding decisions about the treatment regimen to be used.
