Article
Impaired limb position sense after stroke: A quantitative test for clinical use☆,☆☆,★

https://doi.org/10.1016/S0003-9993(96)90192-6Get rights and content

Abstract

Objective: A quantitative measure of wrist position sense was developed to advance clinical measurement of proprioceptive limb sensibility after stroke. Test-retest reliability, normative standards, and ability to discriminate impaired and unimpaired performance were investigated.

Design: Retest reliability was assessed over three sessions, and a matched-pairs study compared stroke and unimpaired subjects. Both wrists were tested, in counterbalanced order.

Setting: Patients were tested in hospital-based rehabilitation units.

Patients and Other Participants: Reliability was investigated on a consecutive sample of 35 adult stroke patients with a range of proprioceptive discrimination abilities and no evidence of neglect. A consecutive sample of 50 stroke patients and convenience sample of 50 healthy volunteers, matched for age, sex, and hand dominance, were tested in the normative-discriminative study. Age and sex were representative of the adult stroke population.

Main Outcome Measures: The test required matching of imposed wrist positions using a pointer aligned with the axis of movement and a protractor scale.

Results: The test was reliable (r = .88 and .92) and observed changes of 8° can be interpreted, with 95% confidence, as genuine. Scores of healthy volunteers ranged from 3.1° to 10.9° average error. The criterion of impairment was conservatively defined as 11° (±4.8°) average error. Impaired and unimpaired performance were well differentiated.

Conclusions: Clinicians can confidently and quantitatively sample one aspect of proprioceptive sensibility in stroke patients using the wrist position sense test. Development of tests on other joints using the present approach is supported by our findings.

References (70)

  • LM Carey

    Somatosensory loss after stroke

    Crit Rev Phys Rehabil Med

    (1995)
  • M Critchley

    The parietal lobes

    (1953)
  • H Head et al.

    Sensory disturbances from cerebral lesions

    Brain

    (1911–1912)
  • C Sartor-Glittenberg et al.

    Quantitative measurement of kinesthesia following cerebral vascular accident

    Physiother Canada

    (1993)
  • LM Carey

    Tactile and proprioceptive discrimination loss after stroke: training effects and quantitative measurement [dissertati

    (1993)
  • SK Shah

    Deficits affecting the function of the paralysed arm following hemiplegia

    Aust Occup Ther J

    (1978)
  • DL Smith et al.

    Proprioception and spatial neglect after stroke

    Age Ageing

    (1983)
  • GG Chalsen et al.

    Prevalence of the shoulder-hand pain syndrome in an inpatient stroke rehabilitation population: a quantitative cross-sectional study

    J Neurol Rehabil

    (1987)
  • G McClatchie

    Survey of the rehabilitation outcome of strokes

    Med J Aust

    (1980)
  • W De Weerdt et al.

    Prediction of arm and hand function recovery in stroke patients

    Int J Rehabil Res

    (1987)
  • A Kusoffsky et al.

    The relationship between sensory impairment and motor recovery in patients with hemiplegia

    Scand J Rehabil Med

    (1982)
  • WJ La Joie et al.

    Somatosensory evoked potentials: their predictive value in right hemiplegia

    Arch Phys Med Rehabil

    (1982)
  • AP Pavot et al.

    The prognostic value of somatosensory evoked potentials in cerebrovascular accidents

    Electromyogr Clin Neurophysiol

    (1986)
  • DT Wade et al.

    The hemiplegic arm after stroke: measurement and recovery

    J Neurol Neurosurg Psychiatry

    (1983)
  • I Wadell et al.

    A follow-up study of stroke patients 5–6 years after their brain infarct

    Int J Rehabil Res

    (1987)
  • DI McCloskey

    Kinesthetic sensibility

    Physiol Rev

    (1978)
  • C Redon et al.

    Proprioceptive control of goal-directed movements in man, studied by means of vibratory muscle tendon stimulation

    J Motor Behav

    (1991)
  • JC Rothwell et al.

    Manual motor performance in a deafferented man

    Brain

    (1982)
  • PJ Cordo

    Kinesthetic control of a multijoint movement sequence

    J Neurophysiol

    (1990)
  • M Jeannerod

    The neural and behavioural organization of goal-directed movements

  • M Gentilucci et al.

    The role of proprioception in the control of prehension movements: a kinematic study in peripherally deafferented patient and in normal subjects

    Exp Brain Res

    (1994)
  • M Jeannerod et al.

    The control of hand movements in a case of hemianaesthesia following a parietal lesion

    Brain

    (1984)
  • KC Leo et al.

    Relationship between perception of joint position sense and limb synergies in patients with hemiplegia

    Phys Ther

    (1981)
  • PJ Bairstow et al.

    Kinaesthetic sensitivity to passive movements and its relationship to motor development and motor control

    Dev Med Child Neurol

    (1981)
  • J Dickinson

    Proprioceptive control of human movement

    • Cited by (173)

    • The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study

      2024, Archives of Physical Medicine and Rehabilitation

    • The effects of supervised and non-supervised upper limb virtual reality exercises on upper limb sensory-motor functions in patients with idiopathic Parkinson's disease

      2022, Human Movement Science
      Citation Excerpt :

      This test is performed with the eyes closed and its score is equal to the mean absolute error in 20 wrist positions. High test-retest reliability of WPST has been reported (ICC = 0.88–0.92) (Carey, Oke, & Matyas, 1996). BBT measures gross manual dexterity.

    • Impaired proprioception and magnified scaling of proprioceptive error responses in chronic stroke

      2024, Journal of NeuroEngineering and Rehabilitation

    • Quantitative Upper Limb Impairment Assessment for Stroke Rehabilitation: A Review

      2024, IEEE Sensors Journal

    • 2023 Sylvia Docker lecture: Ignite your passion, and connect, to make a difference

      2024, Australian Occupational Therapy Journal

    • Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians

      2024, Topics in Stroke Rehabilitation
    View all citing articles on Scopus
    ☆

    Research supported by La Trobe University Research and Higher Degrees Research grants 4/88 and 46/88, World Federation of Occupational Therapists Foundation Research Award, and an Australian Postgraduate Research Award, awarded to the first author.

    ☆☆

    Manuscript preparation supported in part by a grant from La Trobe University, Faculty of Health Sciences Research Committee, also to the first author.

    ★

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    View full text
    Copyright © 1996 Published by Elsevier Inc.