Quantifying neurological impairments
Hotchkiss Brain Institute, University of Calgary,
Clinicians have always been able to use their keen perception of human behaviour to identify the presence of significant neurological deficits in their patients. However, there is a lack of large-scale quantitative data on the specific deficits associated with a broad range of brain-related diseases. Thus, Dr. Sean Dukelow, an Associate Professor at the University of Calgary, has spent the last 10 years using the Kinarm Exoskeleton Lab to collect objective data about neurological deficits resulting from a range of brain injuries and diseases.
He has published widely on the neurological impairments associated with stroke, sport concussion, traumatic brain injury (TBI), spinal cord injury, Tourette’s syndrome, Autism, Parkinson’s disease, cerebral palsy, tremor, and developmental coordination disorder (DCD). He has authored papers that use Kinarm Standard Tests (Visually Guided Reaching, Arm Position Matching and Object Hit), and has created a custom task called the Kinesthesia Task for measuring kinesthetic deficits. Importantly, he uses the Kinarm to explore the relationships between different types of deficits, such as: motor and proprioceptive deficits, and visuospatial (using BIT) and kinesthetic deficits (using Kinarm). He has also investigated the relationship between the anatomical location of the injury and proprioceptive deficits. The American Heart Association (AHA) recognized Dr. Dukelow’s studies as “generating data that cannot be obtained by a human examiner” (Winstein et al, 2016).
In an article by Alberta Health Services, Dr. Dukelow explains why he uses the Kinarm: “What we find is that the robot is more sensitive in picking the deficits up in terms of movement, and we hope this will give us new insight into developing treatments”. Although these more subtle deficits may not always be obvious on a standard clinical exam, they are important for day to day function. Therefore, Dr. Dukelow has also begun developing novel approaches towards patient recovery using the Kinarm Lab.
- Position sense deficits occur in 60% of strokes, are more commonly in left-affected subjects, and are correlated with lesion location (Dukelow, et al, 2010 ; Kenzie, et al, 2014)
- Visuospatial neglect after stroke is highly predictive of kinesthetic deficits; kinesthesic deficits occur in ~60% patients with stroke (Semrau, et al, 2015 ; Semrau, et al, 2013)
- Stroke to somatosensory brain areas can result in measurable proprioceptive deficits; position sense and kinesthesia impairments may occur independently post-stroke; proprioceptive and reaching impairments post-stroke may occur independently (Kenzie, et al, 2014)
- Subjects with mild to severe TBI may display significant deficits in one or both of the 9-target Visually Guided Reaching task and the 8-target Arm Position Matching task (both Kinarm Standard Tests), despite normal scores on traditional clinical motor and cognitive assessment measures (Debert et al, 2012; Note: Both tasks are now also available in shorter versions to reduce clinical time used for the test)
- Children and adolescent ice hockey players with a history of concussion display no significant impairments in Kinarm testing (Little et al, 2016)
Learn more about Dr. Dukelow’s research:
Discovering the effects of transient ischemic attack
Kingston General Hospital Research Institute, Queen’s University
The modern definition of transient ischemic attack (TIA) specifies that it is a self-resolved loss of blood flow to the brain causing no tissue death in the affected area. It is believed that because of the lack of tissue death, neurological impairments resulting from a TIA endure for less than 24 hours. This idea is generally confirmed by standard clinical tools, which are able to identify significant deficits in sensorimotor and cognitive function. However, recent studies using more sensitive tools such as the Kinarm have found evidence that TIA can cause more long-term impairments, despite the conclusion from MRI analysis that there was no tissue death in the brain.
Dr. Al Jin and his team of researchers are one of such groups studying the more enduring effects of TIA. Using the Kinarm Labs, they assessed individuals who had recently suffered from TIA using 8 different behavioural tasks. Their study found that although none of their subjects had evidence of tissue death and that all of their clinical symptoms had been resolved, many still displayed upper limb sensorimotor performance deficits as well as cognitive function deficits (Simmatis et al, 2017). These conclusions suggest that TIAs may affect brain structure and function in ways other than brain death and demonstrate the value of Kinarm Labs for enhancing clinical research.
Learn more about Dr. Jin’s research: