The Brief Kinesthesia test is feasible and sensitive: a study in stroke
Identifieur interne : 003F30 ( Ncbi/Merge ); précédent : 003F29; suivant : 003F31The Brief Kinesthesia test is feasible and sensitive: a study in stroke
Auteurs : Alexandra Borstad [États-Unis] ; Deborah S. Nichols-Larsen [États-Unis]Source :
- Brazilian Journal of Physical Therapy [ 1413-3555 ] ; 2016.
Abstract
Clinicians lack a quantitative measure of kinesthetic sense, an important contributor to sensorimotor control of the hand and arm.
The objective here was to determine the feasibility of administering the Brief Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from persons with chronic stroke and a healthy comparison group and 2) examining the relationship between the BKT scores and other valid sensory and motor measures.
Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-, and handedness-matched healthy comparison group (N=12) completed the BKT by reproducing three targeted reaching movements per hand with vision occluded.
the Hand Active Sensation Test (HASTe), Touch-Test(tm) monofilament aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log (MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores between groups. Pearson product-moment correlation coefficients assessed the relationship between BKT scores and other measures.
Post-stroke participants performed more poorly on the BKT than comparison participants with their contralesional and ipsilesional upper extremity. The mean difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34; p<0.008). The BKT score for the contralesional limb was strongly correlated with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the BBT (r=0.77, p=0.006).
The BKT was feasible to administer and sensitive to differences in reaching accuracy between persons with stroke and a comparison group. With further refinement, The BKT may become a valuable clinical measure of post-stroke kinesthetic impairment.
Url:
DOI: 10.1590/bjpt-rbf.2014.0132
PubMed: 26786083
PubMed Central: 4835168
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Brief Kinesthesia test is feasible and sensitive: a study in
stroke</title><author><name sortKey="Borstad, Alexandra" sort="Borstad, Alexandra" uniqKey="Borstad A" first="Alexandra" last="Borstad">Alexandra Borstad</name><affiliation wicri:level="2"><nlm:aff id="aff1">Division of Physical Therapy, The Ohio State University, Columbus, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Physical Therapy, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Nichols Larsen, Deborah S" sort="Nichols Larsen, Deborah S" uniqKey="Nichols Larsen D" first="Deborah S." last="Nichols-Larsen">Deborah S. Nichols-Larsen</name><affiliation wicri:level="2"><nlm:aff id="aff2">School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26786083</idno><idno type="pmc">4835168</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835168</idno><idno type="RBID">PMC:4835168</idno><idno type="doi">10.1590/bjpt-rbf.2014.0132</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000464</idno><idno type="wicri:Area/Pmc/Curation">000464</idno><idno type="wicri:Area/Pmc/Checkpoint">000032</idno><idno type="wicri:Area/Ncbi/Merge">003F30</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Brief Kinesthesia test is feasible and sensitive: a study in
stroke</title><author><name sortKey="Borstad, Alexandra" sort="Borstad, Alexandra" uniqKey="Borstad A" first="Alexandra" last="Borstad">Alexandra Borstad</name><affiliation wicri:level="2"><nlm:aff id="aff1">Division of Physical Therapy, The Ohio State University, Columbus, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Physical Therapy, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Nichols Larsen, Deborah S" sort="Nichols Larsen, Deborah S" uniqKey="Nichols Larsen D" first="Deborah S." last="Nichols-Larsen">Deborah S. Nichols-Larsen</name><affiliation wicri:level="2"><nlm:aff id="aff2">School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j">Brazilian Journal of Physical Therapy</title><idno type="ISSN">1413-3555</idno><idno type="eISSN">1809-9246</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND:</title><p> Clinicians lack a quantitative measure of kinesthetic sense, an important
contributor to sensorimotor control of the hand and arm.</p></sec><sec><title>OBJECTIVES:</title><p> The objective here was to determine the feasibility of administering the Brief
Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from
persons with chronic stroke and a healthy comparison group and 2) examining the
relationship between the BKT scores and other valid sensory and motor
measures.</p></sec><sec><title>METHOD:</title><p> Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-,
and handedness-matched healthy comparison group (N=12) completed the BKT by
reproducing three targeted reaching movements per hand with vision occluded.</p></sec><sec><title>OTHER MEASURES:</title><p> the Hand Active Sensation Test (HASTe), Touch-Test<sup>(tm)</sup> monofilament
aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log
(MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores
between groups. Pearson product-moment correlation coefficients assessed the
relationship between BKT scores and other measures.</p></sec><sec><title>RESULTS:</title><p> Post-stroke participants performed more poorly on the BKT than comparison
participants with their contralesional and ipsilesional upper extremity. The mean
difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34;
p<0.008). The BKT score for the contralesional limb was strongly correlated
with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf
(r=0.69, p=0.02), and the BBT (r=0.77, p=0.006).</p></sec><sec><title>CONCLUSIONS:</title><p> The BKT was feasible to administer and sensitive to differences in reaching
accuracy between persons with stroke and a comparison group. With further
refinement, The BKT may become a valuable clinical measure of post-stroke
kinesthetic impairment.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Carey, Lm" uniqKey="Carey L">LM Carey</name></author><author><name sortKey="Matyas, Ta" uniqKey="Matyas T">TA Matyas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nowak, Da" uniqKey="Nowak D">DA Nowak</name></author><author><name sortKey="Grefkes, C" uniqKey="Grefkes C">C Grefkes</name></author><author><name sortKey="Dafotakis, M" uniqKey="Dafotakis M">M Dafotakis</name></author><author><name sortKey="Kust, J" uniqKey="Kust J">J Küst</name></author><author><name sortKey="Karbe, H" uniqKey="Karbe H">H Karbe</name></author><author><name sortKey="Fink, Gr" uniqKey="Fink G">GR Fink</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sommerfeld, Dk" uniqKey="Sommerfeld D">DK Sommerfeld</name></author><author><name sortKey="Von Arbin, Mh" uniqKey="Von Arbin M">MH von Arbin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Semrau, Ja" uniqKey="Semrau J">JA Semrau</name></author><author><name sortKey="Herter, Tm" uniqKey="Herter T">TM Herter</name></author><author><name sortKey="Scott, Sh" uniqKey="Scott S">SH Scott</name></author><author><name sortKey="Dukelow, Sp" uniqKey="Dukelow S">SP Dukelow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nudo, Rj" uniqKey="Nudo R">RJ Nudo</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Dunn, W" uniqKey="Dunn W">W Dunn</name></author><author><name sortKey="Griffith, Jw" uniqKey="Griffith J">JW Griffith</name></author><author><name sortKey="Morrison, Mt" uniqKey="Morrison M">MT Morrison</name></author><author><name sortKey="Tanquary, J" uniqKey="Tanquary J">J Tanquary</name></author><author><name sortKey="Sabata, D" uniqKey="Sabata D">D Sabata</name></author><author><name sortKey="Victorson, D" uniqKey="Victorson D">D Victorson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Taub, E" uniqKey="Taub E">E Taub</name></author><author><name sortKey="Uswatte, G" uniqKey="Uswatte G">G Uswatte</name></author><author><name sortKey="Mark, Vw" uniqKey="Mark V">VW Mark</name></author><author><name sortKey="Morris, Dm" uniqKey="Morris D">DM Morris</name></author><author><name sortKey="Barman, J" uniqKey="Barman J">J Barman</name></author><author><name sortKey="Bowman, Mh" uniqKey="Bowman M">MH Bowman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fullerton, Kj" uniqKey="Fullerton K">KJ Fullerton</name></author><author><name sortKey="Mcsherry, D" uniqKey="Mcsherry D">D McSherry</name></author><author><name sortKey="Stout, Rw" uniqKey="Stout R">RW Stout</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Ps" uniqKey="Williams P">PS Williams</name></author><author><name sortKey="Basso, Dm" uniqKey="Basso D">DM Basso</name></author><author><name sortKey="Case Smith, J" uniqKey="Case Smith J">J Case-Smith</name></author><author><name sortKey="Nichols Larsen, Ds" uniqKey="Nichols Larsen D">DS Nichols-Larsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hunter, Jm" uniqKey="Hunter J">JM Hunter</name></author><author><name sortKey="Mackin, Ej" uniqKey="Mackin E">EJ Mackin</name></author><author><name sortKey="Callahan, Ad" uniqKey="Callahan A">AD Callahan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bogard, K" uniqKey="Bogard K">K Bogard</name></author><author><name sortKey="Wolf, S" uniqKey="Wolf S">S Wolf</name></author><author><name sortKey="Zhang, Q" uniqKey="Zhang Q">Q Zhang</name></author><author><name sortKey="Thompson, P" uniqKey="Thompson P">P Thompson</name></author><author><name sortKey="Morris, D" uniqKey="Morris D">D Morris</name></author><author><name sortKey="Nichols Larsen, D" uniqKey="Nichols Larsen D">D Nichols-Larsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hodics, Tm" uniqKey="Hodics T">TM Hodics</name></author><author><name sortKey="Nakatsuka, K" uniqKey="Nakatsuka K">K Nakatsuka</name></author><author><name sortKey="Upreti, B" uniqKey="Upreti B">B Upreti</name></author><author><name sortKey="Alex, A" uniqKey="Alex A">A Alex</name></author><author><name sortKey="Smith, Ps" uniqKey="Smith P">PS Smith</name></author><author><name sortKey="Pezzullo, Jc" uniqKey="Pezzullo J">JC Pezzullo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Uswatte, G" uniqKey="Uswatte G">G Uswatte</name></author><author><name sortKey="Taub, E" uniqKey="Taub E">E Taub</name></author><author><name sortKey="Morris, D" uniqKey="Morris D">D Morris</name></author><author><name sortKey="Light, K" uniqKey="Light K">K Light</name></author><author><name sortKey="Thompson, Pa" uniqKey="Thompson P">PA Thompson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mathiowetz, V" uniqKey="Mathiowetz V">V Mathiowetz</name></author><author><name sortKey="Volland, G" uniqKey="Volland G">G Volland</name></author><author><name sortKey="Kashman, N" uniqKey="Kashman N">N Kashman</name></author><author><name sortKey="Weber, K" uniqKey="Weber K">K Weber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Portney, Lg" uniqKey="Portney L">LG Portney</name></author><author><name sortKey="Watkins, Mp" uniqKey="Watkins M">MP Watkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Connell, La" uniqKey="Connell L">LA Connell</name></author><author><name sortKey="Lincoln, Nb" uniqKey="Lincoln N">NB Lincoln</name></author><author><name sortKey="Radford, Ka" uniqKey="Radford K">KA Radford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Borstad, Al" uniqKey="Borstad A">AL Borstad</name></author><author><name sortKey="Nichols Larsen, Ds" uniqKey="Nichols Larsen D">DS Nichols-Larsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goble, Dj" uniqKey="Goble D">DJ Goble</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Desrosiers, J" uniqKey="Desrosiers J">J Desrosiers</name></author><author><name sortKey="Bourbonnais, D" uniqKey="Bourbonnais D">D Bourbonnais</name></author><author><name sortKey="Bravo, G" uniqKey="Bravo G">G Bravo</name></author><author><name sortKey="Roy, P M" uniqKey="Roy P">P-M Roy</name></author><author><name sortKey="Guay, M" uniqKey="Guay M">M Guay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pohl, Ps" uniqKey="Pohl P">PS Pohl</name></author><author><name sortKey="Winstein, Cj" uniqKey="Winstein C">CJ 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sortKey="Lima, Nm" uniqKey="Lima N">NM Lima</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Braz J Phys Ther</journal-id><journal-id journal-id-type="iso-abbrev">Braz J Phys Ther</journal-id><journal-id journal-id-type="publisher-id">rbfis</journal-id><journal-title-group><journal-title>Brazilian Journal of Physical Therapy</journal-title></journal-title-group><issn pub-type="ppub">1413-3555</issn><issn pub-type="epub">1809-9246</issn><publisher><publisher-name>Associação Brasileira de Pesquisa e Pós-Graduação em
Fisioterapia</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26786083</article-id><article-id pub-id-type="pmc">4835168</article-id><article-id pub-id-type="doi">10.1590/bjpt-rbf.2014.0132</article-id><article-id pub-id-type="publisher-id" specific-use="previous-pid">S1413-35552016005000132</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>The Brief Kinesthesia test is feasible and sensitive: a study in
stroke</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Borstad</surname><given-names>Alexandra</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="c01">*</xref></contrib><contrib contrib-type="author"><name><surname>Nichols-Larsen</surname><given-names>Deborah S.</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label>Division of Physical Therapy, The Ohio State University, Columbus, OH, USA</aff><aff id="aff2"><label>2</label>School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA</aff><author-notes><corresp id="c01"><sup>*</sup><bold>Correspondence Alexandra Borstad The Ohio</bold> State University 453 W.
10<sup>th</sup> Avenue, 516H Atwell Hall Columbus, OH 43210 USA e-mail:
<email>Borstad.2@osu.edu</email></corresp></author-notes><pub-date pub-type="epub"><day>19</day><month>1</month><year>2016</year></pub-date><pub-date pub-type="ppub"><season>Jan-Feb</season><year>2016</year></pub-date><volume>20</volume><issue>1</issue><fpage>81</fpage><lpage>86</lpage><history><date date-type="received"><day>26</day><month>1</month><year>2015</year></date><date date-type="rev-recd"><day>21</day><month>5</month><year>2015</year></date><date date-type="accepted"><day>17</day><month>6</month><year>2015</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License</license-p></license></permissions><abstract><sec><title>BACKGROUND:</title><p> Clinicians lack a quantitative measure of kinesthetic sense, an important
contributor to sensorimotor control of the hand and arm.</p></sec><sec><title>OBJECTIVES:</title><p> The objective here was to determine the feasibility of administering the Brief
Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from
persons with chronic stroke and a healthy comparison group and 2) examining the
relationship between the BKT scores and other valid sensory and motor
measures.</p></sec><sec><title>METHOD:</title><p> Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-,
and handedness-matched healthy comparison group (N=12) completed the BKT by
reproducing three targeted reaching movements per hand with vision occluded.</p></sec><sec><title>OTHER MEASURES:</title><p> the Hand Active Sensation Test (HASTe), Touch-Test<sup>(tm)</sup> monofilament
aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log
(MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores
between groups. Pearson product-moment correlation coefficients assessed the
relationship between BKT scores and other measures.</p></sec><sec><title>RESULTS:</title><p> Post-stroke participants performed more poorly on the BKT than comparison
participants with their contralesional and ipsilesional upper extremity. The mean
difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34;
p<0.008). The BKT score for the contralesional limb was strongly correlated
with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf
(r=0.69, p=0.02), and the BBT (r=0.77, p=0.006).</p></sec><sec><title>CONCLUSIONS:</title><p> The BKT was feasible to administer and sensitive to differences in reaching
accuracy between persons with stroke and a comparison group. With further
refinement, The BKT may become a valuable clinical measure of post-stroke
kinesthetic impairment.</p></sec></abstract><kwd-group><kwd>hemiparesis</kwd><kwd>upper extremity</kwd><kwd>somatosensation</kwd><kwd>proprioception</kwd><kwd>position sense</kwd><kwd>measurement</kwd></kwd-group><counts><fig-count count="1"></fig-count><table-count count="1"></table-count><equation-count count="0"></equation-count><ref-count count="24"></ref-count><page-count count="6"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>Stroke is a common problem worldwide<xref rid="B01" ref-type="bibr">1</xref>. More
elusive than motor impairment, somatosensory impairment, in at least one modality,
affects 67% of individuals with stroke<xref rid="B02" ref-type="bibr">2</xref>.
Post-stroke somatosensory impairment is associated with decreased coordination in
reaching and grasping<xref rid="B03" ref-type="bibr">3</xref>, decreased functional
mobility, and longer hospital stays<xref rid="B04" ref-type="bibr">4</xref>. Kinesthesia
is the somatosensory modality that includes limb position sense and perception of
movement and is a component of proprioception. Recent research using robotics suggests
that 61% of individuals with acute stroke have kinesthetic impairment<xref rid="B05" ref-type="bibr">5</xref>. It is commonly accepted that somatosensation is
an important contributor to sensorimotor control mechanisms and recovery from
stroke<xref rid="B06" ref-type="bibr">6</xref>; however, clinicians lack a brief and
inexpensive method to quantify the active, behavioral aspect of proprioception -
kinesthesia. It follows that practical, quantitative tools are needed to enable
clinicians to individualize stroke rehabilitation.</p><p>The Brief Kinesthesia Test (BKT) is freely available and takes approximately eight
minutes to administer<xref rid="B07" ref-type="bibr">7</xref>. For this test, error in
targeted reaching tasks is measured to evaluate kinesthetic impairment. The BKT was
recently shown to be valid and reliable (ICC=0.71) in healthy individuals across the
lifespan<xref rid="B08" ref-type="bibr">8</xref>. The objective of this study was to
determine the feasibility of administering the BKT and begin to validate it in persons
with mild to moderate post-stroke hemiparesis. Here we report BKT scores from a
heterogeneous group of persons with chronic stroke and a healthy comparison group and
examine the relationship between the BKT scores and other valid sensory and motor
measures.</p></sec><sec sec-type="methods"><title>Method</title><sec><title>Design and participants</title><p>Using a cross-sectional design, we studied a heterogeneous sample of
community-dwelling adults with chronic stroke (N=12) who were recruited through word
of mouth and through advertisement with local stroke support groups. We also studied
an age- (SD= 3 years), gender-, and handedness-matched healthy comparison group
(N=12). Recruitment for the study was done via ResearchMatch, a national health
volunteer registry that was created by several academic institutions and supported by
the U.S. National Institutes of Health as part of the Clinical Translational Science
Award (CTSA) program (<xref ref-type="table" rid="t01">Table 1</xref>). Inclusion
criteria were a single diagnosed stroke greater than three months prior to
enrollment; mild to moderate hemiparesis defined as greater than 10 degrees active
extension in the contralesional fingers and wrist (required for manipulation of test
objects); 45 degrees active elbow and shoulder flexion<xref rid="B09" ref-type="bibr">9</xref>; and communication in English. Potential participants were excluded if
they scored less than 24 on the Mini-Mental State examination (MMSE), indicating
potential difficulty following instructions; demonstrated severe spatial neglect on
Albert's test<xref rid="B10" ref-type="bibr">10</xref>; demonstrated apraxia as
determined by object naming on the MMSE; or reported another neurologic or sensory
disorder such as Parkinson's disease or peripheral neuropathy. One control
participant was excluded who reported a history of peripheral neuropathy.
Participants provided written informed consent prior to participation. The Biomedical
Institutional Review Board of The Ohio State University, Columbus, OH, USA, approved
this study (approval number 2011H0029).</p><p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><title>- Demographic and clinical characteristics of participants.</title></caption><table frame="hsides" rules="groups" style="border-top: 1px solid black; border-bottom: 1px solid black; width: 100%"><thead><tr><th rowspan="1" colspan="1">ID</th><th rowspan="1" colspan="1">Age</th><th rowspan="1" colspan="1">Sex</th><th rowspan="1" colspan="1">Dom.Hand</th><th rowspan="1" colspan="1">Most Affected Hand</th><th rowspan="1" colspan="1">Chronicity (Months)</th><th rowspan="1" colspan="1">Lesion vascular distribution/location</th><th rowspan="1" colspan="1">BKT (cm) contralesional/ ipsilesional</th><th rowspan="1" colspan="1">Wolf (Rate metric/60 sec.)</th><th rowspan="1" colspan="1">BBT</th><th rowspan="1" colspan="1">MAL <break></break>HM/HW</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">011</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">M</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">Lacunar/ thalamus</td><td rowspan="1" colspan="1">10.8/11</td><td rowspan="1" colspan="1">19.8</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">0.73/0.85</td></tr><tr><td rowspan="1" colspan="1">012</td><td rowspan="1" colspan="1">62</td><td rowspan="1" colspan="1">M</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">Lacunar/ PLIC</td><td rowspan="1" colspan="1">5.2/7.4</td><td rowspan="1" colspan="1">35.6</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">3.16/3.76</td></tr><tr><td rowspan="1" colspan="1">013</td><td rowspan="1" colspan="1">39</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">Lacunar/ thalamus</td><td rowspan="1" colspan="1">12.4/3.2</td><td rowspan="1" colspan="1">18.34</td><td rowspan="1" colspan="1">27</td><td rowspan="1" colspan="1">1.85/3.08</td></tr><tr><td rowspan="1" colspan="1">014</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">Lacunar/ thalamus</td><td rowspan="1" colspan="1">10.8/5.5</td><td rowspan="1" colspan="1">33.91</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">2.5/2.8</td></tr><tr><td rowspan="1" colspan="1">015</td><td rowspan="1" colspan="1">77</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">MCA/ frontal</td><td rowspan="1" colspan="1">5.8/3.4</td><td rowspan="1" colspan="1">41.88</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">4.83/4.42</td></tr><tr><td rowspan="1" colspan="1">016</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">M</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">Lacunar/ thalamus</td><td rowspan="1" colspan="1">4.9/7.1</td><td rowspan="1" colspan="1">53.9</td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">5/5</td></tr><tr><td rowspan="1" colspan="1">017</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">94</td><td rowspan="1" colspan="1">MCA/ parietal</td><td rowspan="1" colspan="1">8/7.3</td><td rowspan="1" colspan="1">23.01</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">2.62/2.5</td></tr><tr><td rowspan="1" colspan="1">018</td><td rowspan="1" colspan="1">85</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">Lacunar/ PLIC</td><td rowspan="1" colspan="1">6/6.6</td><td rowspan="1" colspan="1">42.81</td><td rowspan="1" colspan="1">46</td><td rowspan="1" colspan="1">4.53/4.9</td></tr><tr><td rowspan="1" colspan="1">019</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">M</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">Lacunar/ PLIC</td><td rowspan="1" colspan="1">10.6/7.3</td><td rowspan="1" colspan="1">24.27</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">1.61/1.37</td></tr><tr><td rowspan="1" colspan="1">020</td><td rowspan="1" colspan="1">71</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">L</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">MCA/ frontal</td><td rowspan="1" colspan="1">6.6/6.9</td><td rowspan="1" colspan="1">38.5</td><td rowspan="1" colspan="1">39</td><td rowspan="1" colspan="1">3.71/3.96</td></tr><tr><td rowspan="1" colspan="1">021</td><td rowspan="1" colspan="1">69</td><td rowspan="1" colspan="1">M</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">MCA-ACA/ frontal</td><td rowspan="1" colspan="1">NA/5.9</td><td rowspan="1" colspan="1">1.97</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">1.83/1.33</td></tr><tr><td rowspan="1" colspan="1">022</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">F</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">MCA/ corona radiata</td><td rowspan="1" colspan="1">4.4/5.7</td><td rowspan="1" colspan="1">27.08</td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">3.78/3.93</td></tr><tr><td rowspan="1" colspan="1">Mean</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">7F/ 5M</td><td rowspan="1" colspan="1">11R/1L</td><td rowspan="1" colspan="1">7L/5R</td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">7.8/6.4</td><td rowspan="1" colspan="1">30.09</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">3.01/3.16</td></tr><tr><td rowspan="1" colspan="1">Comparison (n=12)</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">7F/ 5M</td><td rowspan="1" colspan="1">11R/1L</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">4.2/4.9*</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NA</td></tr></tbody></table><table-wrap-foot><fn id="TFN01"><p>R: Right; L: Left; NA: Not Applicable; MCA: Middle Cerebral Artery; PLIC:
Posterior limb of the internal capsule; ACA: Anterior cerebral artery;
BKT: Brief Kinesthesia Test; Wolf: Wolf Motor Function Test; BBT: Box and
Blocks Test; MAL: Motor Activity Log; HM: How much scale; HW: How well
scale. *scores from the matched upper extremities of the healthy control
participants.</p></fn></table-wrap-foot></table-wrap></p></sec><sec><title>The Brief Kinesthesia Test and other measures</title><p>The BKT was administered with the participants seated in a standard height chair (19
inches) in front of a standard height table (29 inches) with vision occluded by a
curtain. Participants reproduced targeted reaching movements from a starting location
to a target location on a test page after being guided by the examiner (<xref ref-type="fig" rid="f01">Figure 1</xref>A). The distance from the response
location to the target location was recorded in centimeters. Additional equipment
needed to administer the BKT includes a visual shield (<xref ref-type="fig" rid="f01">Figure 1</xref>A) and a tape measure. There were three trials per hand (two
longer reaches and one shorter reach) as can be seen on the test page in <xref ref-type="fig" rid="f01">Figure 1</xref>A. The BKT took an average of 8 minutes to
administer including set-up. Our feasibility outcome for the BKT was whether or not
participants, who met our criteria, could complete the test with standard
administration<xref rid="B07" ref-type="bibr">7</xref>. Our criteria for
feasibility was 90% of participants completing the test. The BKT score used here was
the sum of the distance from the target in centimeters for the two longest reaches
for each hand, as originally published by Dunn et al.<xref rid="B08" ref-type="bibr">8</xref> (<xref ref-type="fig" rid="f01">Figure 1</xref>B).</p><p><fig id="f01" orientation="portrait" position="float"><label>Figure 1</label><caption><title>- A: BKT set-up example. B: Box plot of BKT scores (sum of the error in
centimeters for the two longest reaches) for ipsilesional and contralesional
upper extremity (UE). C: Pearson correlation coefficient of 0.77 (p=0.006)
indicates a strong relationship between the Box and Blocks Test (BBT) and
the BKT. D: Pearson correlation coefficient of 0.84 (p=0.001) indicates a
strong relationship between the Motor Activity Log (MAL)-How much scale and
the BKT.</title></caption><graphic xlink:href="1413-3555-rbfis-20-01-00081-gf01"></graphic></fig></p><p>Other measures collected and the construct they measure are listed here. The Hand
Active Sensation Test (HASTe), a measure of haptic performance of the hand, includes
trials of weight and texture discrimination<xref rid="B11" ref-type="bibr">11</xref>.
The Touch-Test<sup>(tm)</sup> monofilament aesthesiometer is a measure of sensitivity
to touch<xref rid="B12" ref-type="bibr">12</xref>, and the 6-item Wolf Motor Function
Test (Wolf)<xref rid="B13" ref-type="bibr">13</xref> quantifies upper extremity motor
ability through timed and functional tasks. Wolf scores are reported using the rate
metric proposed by Hodics et al.<xref rid="B14" ref-type="bibr">14</xref>, that is,
the number of times on average a participant could perform the tasks in one minute.
The Motor Activity Log (MAL) assesses daily use of the affected upper extremity and
is based on subjective rating of how much and how well the extremity performs common
tasks<xref rid="B15" ref-type="bibr">15</xref>. The Box and Blocks Test (BBT) is a
test of manual dexterity in which individuals transfer 1-inch blocks from one side of
a partitioned box to another. The BBT score is the number of blocks transferred in
one minute<xref rid="B16" ref-type="bibr">16</xref>. Bilateral upper extremities of
participants were tested on a single occasion by one examiner. For consistency, the
following order of testing was used for all participants: Touch-Test<sup>(tm)</sup>,
BKT, HASTe, BBT, Wolf, and MAL. When both hands were tested, the less affected or
dominant hand were tested first.</p></sec><sec><title>Statistics</title><p>A paired t-test was conducted to compare BKT scores between post-stroke and
comparison groups. The alpha was set at p≤0.05. Pearson product-moment correlation
coefficients were computed to assess the relationship between BKT scores and sensory
and motor measures. We used the Portney and Watkins criteria for interpretation<xref rid="B17" ref-type="bibr">17</xref>. The relative standard error of the mean
(RSEM) was calculated to describe the variability of the BKT scores in our sample.
The magnitude of difference between post-stroke and comparison groups for BKT scores
for both upper extremities was calculated using effect size. All data were analyzed
using JMP<sup>(r)</sup> Pro 11.0.0.</p></sec></sec><sec sec-type="results"><title>Results</title><p>Demographic and clinical characteristics are given in <xref ref-type="table" rid="t01">Table 1</xref>. One post-stroke participant out of 12 was unable to complete the BKT
with their contralesional upper extremity (UE); therefore, the feasibility criterion of
90% was met. BKT scores for both stroke and comparison groups were normally distributed.
Regarding variability in BKT scores, the RSEM for the post-stroke group contralesional
and ipsilesional and for the comparison group contralesional and ipsilesional were 11%,
9%, 8%, and 10%, respectively. Contralesional UE scores for the post-stroke group (n=11,
<italic>x̅</italic>=7.8 centimeters (cm), SD=2.9, 95% CI=5.8-9.7 cm) and the
comparison group (n=12, <italic>x̅</italic>=4.2 cm, SD=1.2, 95% CI=3.4-4.9 m) were
statistically different. The mean difference between groups was 3.7 cm (SE=1.1, t=3.34;
p<0.008). Cohen's effect size value (d=0.96) suggests a large practical difference
between groups. Ipsilesional UE scores for the post-stroke group (n=12,
<italic>x̅</italic>=6.4 cm, SD=2.0, 95% CI=5.2-7.6 cm) and the comparison group
(n=12, <italic>x̅</italic>=4.9 cm, SD=1.7, 95% CI=3.8-6.0 cm) were also statistically
different. Here the mean between group difference was 1.5 cm (SE=0.6, t=2.49; p=0.03).
Cohen's effect size value (d=.47) suggests a low to moderate practical difference
between groups. Contralateral UE BKT scores strongly correlated with the MAL-how much
(r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the
BBT (r=-0.77, p=0.006) but did not correlate with HASTe (r=0.355, p=0.29) or Touch-Test
(r=0.095, p=0.77). In a previous study, the 95% confidence interval for BKT scores in
healthy participants in the age range of our participants was 5.0 - 5.87 cm<xref rid="B08" ref-type="bibr">8</xref>. Given this, 58% of our post-stroke participants
were outside of this range with their contralesional UE, while 50% were outside of this
range with their ipsilesional UE.</p></sec><sec sec-type="discussion"><title>Discussion</title><p>Data from this preliminary study suggest the BKT is feasible to administer and may be a
useful tool to identify kinesthetic impairment in individuals with mild to moderate
post-stroke hemiparesis. To our knowledge, this is the first report of a clinically
practical tool with the potential to quantify UE kinesthesia post-stroke. Kinesthetic
awareness informs movement; therefore, it is not surprising that a strong relationship
was identified between the BKT and participants' subjective rating of how well their arm
performs tasks (MAL) and the objective measures (Wolf and BBT). It is also possible that
a participant's ability to generate motor output affected the BKT scores in this study.
Determining the discrete somatosensory and motor contributions to this sensorimotor task
is an area for future research.</p><p>Post-stroke somatosensory impairment is difficult to recognize unless the loss is
profound. The nature and extent of post-stroke somatosensory impairment has been
difficult to describe due to a variety of factors including: 1) stroke heterogeneity; 2)
multiple somatosensory modalities; 3) multiple body areas effected; and 4) scarce
quantitative measurement tools. Our finding that BKT was not related to touch perception
or haptic performance is consistent with evidence that there is low agreement between
modalities in post-stroke somatosensory impairment<xref rid="B18" ref-type="bibr">18</xref>. Touch perception threshold is low in the somatosensory hierarchy<xref rid="B19" ref-type="bibr">19</xref> and reflects cutaneous receptor function of the
index finger without a movement requirement. The HASTe is a measure of haptic
performance, which requires cutaneous receptors of the hand, proprioceptive receptors of
the UE, and active movement and is an example of a higher-level somatosensory
process<xref rid="B19" ref-type="bibr">19</xref>. The BKT would also be considered
higher level, given that scaling of distances is required with proprioception of the UE
and active movement is essential to the task. Therefore, while the BKT shares with the
HASTe the requirement of UE proprioceptive information, it differs from both other
somatosensory measures used here in that cutaneous input will not drive performance. As
with all studies of this size, interpretation should be done with caution.</p><p>In comparison to the commonly used method of joint position matching<xref rid="B20" ref-type="bibr">20</xref>, the BKT has the following advantages. First, the
BKT has a ratio scale of measurement. BKT scores from this study were normally
distributed and ranged from 3.2 to 12.4 cm error for post-stroke and from 2.3-9.2 cm
error for comparison participants. Ratio scales of measurement are unambiguous and allow
all mathematical and statistical operations<xref rid="B17" ref-type="bibr">17</xref>.
Second, normative data are available by age group<xref rid="B08" ref-type="bibr">8</xref>, eliminating the need to compare to the ipsilesional extremity, which may
be problematic as discussed below. In comparison to robotics<xref rid="B05" ref-type="bibr">5</xref>, the primary advantage of the BKT is that it is freely available
and does not require special equipment to administer, therefore being practical for
therapists in settings worldwide. The primary disadvantage is that the BKT scores are
based on localization of the target; other metrics that may reflect kinesthesia, such as
velocity of movement and smoothness of reaching trajectory and response latency, are not
quantified with the BKT. Comparisons in larger studies using a gold-standard measure of
kinesthetic impairment, such as robotics<xref rid="B05" ref-type="bibr">5</xref>, are
needed to further validate the BKT as a method of quantifying post-stroke
kinesthesia.</p><p>Importantly, the exact contribution of motor and somatosensory impairment to BKT scores
in this study is uncertain. This is the primary limitation of attempting to quantify
kinesthetic impairment using a targeted reaching task in this population. This
limitation applies to simple tests, such as the BKT, as well as to sophisticated
approaches such as robotics<xref rid="B05" ref-type="bibr">5</xref>. After stroke, poor
reaching accuracy may be due to limited motor output versus poor control of movement
secondary to impaired kinesthetic sense, the latter being what we aim to quantify with
the BKT. One participant who met the criteria for this study was unable to perform the
BKT due to insufficient motor ability to reach across the test page, highlighting this
circumstance. We suggest this limitation can be addressed by establishing minimum motor
criteria for the BKT. Minimum motor criteria would establish that an individual
possesses the motor ability to perform the reach, ideally leaving kinesthetic sense as
the primary variable captured. The extent to which standardized table and chair heights
affected BKT scores in this study is unknown. A limitation of this particular study is
the small sample size; therefore, the results may not generalize to the population of
individuals with mild and moderate stroke.</p><p>As a group, post-stroke participants in this study also performed significantly more
poorly on the BKT with their <italic>ipsilesional</italic> UE than the comparison group
suggesting that the BKT may be sensitive to subtle ipsilesional changes in kinesthetic
awareness (<xref ref-type="fig" rid="f01">Figure 1</xref>B). Ipsilesional impairment in
sensorimotor performance<xref rid="B21" ref-type="bibr">21</xref>, manual dexterity<xref rid="B03" ref-type="bibr">3</xref>, ipsilesional reaching<xref rid="B22" ref-type="bibr">22</xref>, and grip force modulation<xref rid="B23" ref-type="bibr">23</xref> have also been reported after unilateral stroke. While we can only
speculate as to the sensorimotor processing problem that causes ipsilesional impairment,
these data and other studies<xref rid="B05" ref-type="bibr">5</xref><sup>,</sup><xref rid="B21" ref-type="bibr">21</xref> suggest that bilateral hemispheres likely
contribute to normal kinesthetic performance. Additionally, these data call into
question the concept of an 'unaffected' UE and highlight the importance of using healthy
comparison groups for normative UE performance data.</p><p>The BKT has the potential to be a useful clinical tool with some additional development.
Advantages of the BKT include that it is inexpensive, standardized, quantifiable, and
quick to administer. The results from this study do not suggest there is a ceiling
effect, unlike the Nottingham Sensory Assessment and the Fugl-Meyer Assessment<xref rid="B24" ref-type="bibr">24</xref>. Low RSEM values suggest BKT scores may provide a
relatively precise estimate of the population. The simple instructions may limit the
potential for confounding by cognitive impairment seen with other somatosensory
measures. Future research should be directed at establishing validity, reliability, and
the minimum clinically important difference in the post-stroke population. Minimum motor
criteria should be established. Also of interest is whether BKT scores would be useful
to predict motor recovery from stroke and whether the measure will be sensitive to
change following UE rehabilitation.</p><p>The implications for improving identification of post-stroke kinesthetic impairment
include enhanced understanding of the impairments that result in disordered reaching,
improved assignment of rehabilitation treatments, and possible prediction of motor
recovery. The data from this preliminary study suggest that, with further refinement,
the BKT may emerge as a valuable clinical measure of kinesthetic awareness
post-stroke.</p></sec><sec><title>Clinical message</title><p>Inexpensive and quick to administer, the BKT may become a valuable clinical measure of
post-stroke kinesthetic impairment.</p></sec></body><back><ack><title>Acknowledgements</title><p>This study was supported by the OSU CCTS grant number UL1TR001070, and OSU Neuroscience
Signature program and by The Foundation for Physical Therapy through an award to Dr.
Borstad.</p></ack><fn-group><fn fn-type="other"><p><list list-type="bullet"><title>BULLET POINTS</title><list-item><p>Clinicians lack a quantitative measure of upper extremity kinesthetic
sense.</p></list-item><list-item><p>Brief Kinesthesia Test was validated for healthy people across the life
span.</p></list-item><list-item><p>Brief Kinesthesia Test is freely available, quantifiable, merits
development.</p></list-item><list-item><p>Brief Kinesthesia Test is practical, feasible for mild to moderate
hemiparesis.</p></list-item><list-item><p>Identification of kinesthetic impairment will inform hand/arm
rehabilitation.</p></list-item></list></p></fn></fn-group><ref-list><title>References</title><ref id="B01"><label>1</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organization - WHO</collab></person-group><source>The World Health Report 2008: Primary Health care: now more than
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