Kinarm Standard Tests
Providing researchers with sensitive and objective measures of cognitive, motor and sensory functions through the precise measurement of human behaviour – a method we call behaviourography™.
Kinarm Standard Tests™ provide objective assessment of brain function through quantitative measurement of human behaviour. By using the suite of standardized protocols, a clinical researcher can assess the neurological impairments of a subject in a Kinarm Lab in 30 to 60 minutes.
Features
- Ability to measure and discriminate subtle, but statistically significant, changes in performance.
- Continuous measurement offering high resolution, and no floor and ceiling effects.
- Task and parameter scores are converted to Z-space to provide a standardized, statistical approach to scoring. Statistical bounds on individual performance for KST as well as significant changes across repeated testing published.
- Covers a broad range of brain functions across entire cognitive-motor-sensory domains – from 20 minutes to one hour.
- Supports selection of patients for clinical trials based on a specific pattern of impairments.
- Multiple levels of data export options are available including the raw data
Specifications & Information Sheets
Functionality
Our robots have been designed to be interacted with by a person holding the robot. We use interactive robotics as a technique to collect data about a subject’s [motor action] behaviour during a test.
- We’ve designed tasks for the robot that allow us to measure different functions of your brain – all functions important to interact with the world around us.
- A subject is given instructions to follow to perform various tests. Often those tests will involve looking at virtual objects displayed in the plane of the robot
- To complete the test, the subject moves their hands while they are gripping the Kinarm robot.
- While the subject performs the test, the robot collects lots of data about the hand movement – kinematic and kinetic data that is then sent to a computer for processing.
After the task is completed (in 2-4 minutes), our proprietary software, Dexterit-E, completes a detailed analysis of the behaviour, comparing the subject’s behaviour to age, sex and handedness-matched control population. The kinematic and performance analysis is summarized on a report.
For example, a motor function such as point-to-point movement evaluation is currently evaluated by the clinician asking the patient to touch his finger and their nose repeatedly and scored 0, 1 or 2. In the Kinarm lab this motor function is evaluated by first quantifying the behaviour of a healthy subject with kinematic variables such as reaction time, speed differences between limbs and direction errors, and then assembling a large normative database of age-matched controls. The impaired subject performs the same task and their performance is then compared. The parameter is identified if performance is beyond the 5-95 confidence interval (Coderre, et al., 2010). This paradigm has been repeated in numerous behavioural tasks by Scott and others, and has enabled us to develop Kinarm Standard Tests.
Disclaimer: Kinarm Standard Tests are intended as research tools to contribute to the understanding of brain function and dysfunction. Kinarm Standard Tests do not directly offer a medical diagnosis of any type, nor are Kinarm Standard Tests to be used as an assessment tool to assist with diagnosis. A diagnosis of any brain injury or disease can be made only by a qualified physician or psychologist.
Summary of Tests
Kinarm Standard Tests™
| Test | Behavioural Task | Brain Function | Duration |
|---|---|---|---|
| COGNITIVE | |||
| Reverse Visually Guided Reaching | Subject reaches from a central target to a peripheral target where the visual feedback is reversed compared to the actual hand position. | Cognitive control of visuomotor skills Inhibitory control Attention | 3.5 min/arm |
| Object Hit & Avoid | Subject hits away targets with either hand and avoids distractors. Speed and number of objects increase with time. | Rapid motor decisions Inhibitory control Spatial attention | 2.5 min |
| Trails A&B | Trail A: trace a sequence of targets numbered 1 to 25; Trail B: trace alternating numeric-alpha sequence of targets 1-A-2-B etc. | Executive function: task switching | 2.5 min |
| Spatial Span | Sequence of squares displayed; subject replays sequence by reaching to the appropriate squares in sequence. | Visuospatial working memory | 5.5 min |
| Paired-Associates Learning* | Images shown in spatial locations then hidden. Upon presentation of an image, subject must indicate the spatial location of the hidden image. | Visuospatial working memory | 5 min |
| MOTOR | |||
| Visually Guided Reaching | Subject reaches from a central target to a peripheral target. | Visuomotor skills Multi-joint coordination | 2 min/arm |
| Object Hit | Subject hits away balls with either hand. Speed and number of balls increase with time. | Rapid visuomotor skills Spatial skills | 2.5 min |
| Ball on Bar | Subject moves a virtual ball balanced on a bar held by both hands to spatial targets. | Bimanual coordination Visuomotor skills | 3.5 min |
| Arm Posture Perturbation | Subject maintains hand at target and returns to the target after an unexpected disturbance. | Goal-directed motor corrections | 2 min/arm |
| Elbow Stretch | Subject relaxes; robot extends and flexes the elbow repeatedly (Exo only). | Assess presence of spasticity and high tone | 5 min/arm |
| SENSORY | |||
| Arm Position Matching | Robot moves one arm; the subject mirror-matches position with their other arm. | Somatosensation: position sense | 3 min/arm |
| Arm Movement Matching | Robot moves one arm; the subject mirror-matches movement with their other arm. | Somatosensation: kinesthesia | 3 min/arm |
Our Tests
Cognitive Tests
Reverse Visually Guided Reaching
The Reverse Visually Guided Reaching task is meant to assesses a subject’s attention, inhibitory control and cognitive control of visuomotor skills. During the task, the subject reaches the initial central target and in doing so, the movement of the cursor (white circle) representing hand position is mirror reversed relative to the central target (i.e. the visual feedback is reversed compared to the actual hand position). From there the task requires the subject to cognitively override the normal response to move the hand directly to a target and instead initiate a movement in the opposite direction.
Citation: The primary reference for the task’s development is Lowrey et al, 2022. Hawkins and Sergio 2015 found the task to be highly sensitive to subtle impairments and harbours the potential of identifying adults at risk of Alzheimer’s.
Healthy Behaviour
Unhealthy Behaviour
Object Hit and Avoid
The Object Hit and Avoid task is meant to assess spatial attention, rapid motor selection and inhibition control. At the start of the task the subject is shown 2 target shapes which the subject is instructed to memorize as the only shapes to hit during the task; they are instructed to avoid all other shapes or distractors (of which there are 6).
Citation: Bourke et al. 2016 concludes that the task is able to identify that many subjects with stroke have impairments in the rapid selection and generation of motor responses to task specific spatial goals in the workspace.
US Patent No. 8,740,794
Healthy Behaviour
Unhealthy Behaviour
Trail Making A/B
Trail Making tests are commonly used cognitive tests from the field of neuropsychology to assess task switching abilities. The version implemented for the Kinarm Labs is similar to the standard pen and paper versions, but with additional measurement parameters and accuracy. There are two parts to the overall task. In the first part, the subject must trace through a sequence of targets numbered 1 to 25 as quickly as possible (Trail A). In the second part, the subject must trace through an alternating alpha-numeric sequence of targets 1-A-2-B etc. up to 13, again for a total of 25 targets (Trail B).
Citations: Bowie and Harvey 2006 and Corrigan and Hinkeldey 1987 discuss the utility of this classic test.
Healthy Trail A Behaviour
Healthy Trail B Behaviour
Spatial Span
The Spatial Span test is a classic test of visuospatial working memory; it tests the component of working memory that enables one to temporarily hold and manipulate information about places. Like the Trail Making test, the Spatial Span test has been adapted for the Kinarm Lab to provide easy inclusion into a battery of tests. During each trial of the task, the subject must reach to a starting location, after which 12 squares are displayed in a 3×4 grid, and a sequence of those squares will light up in random order. The subject is instructed to replay the sequence by reaching and pausing at the appropriate squares. If the subject can correctly replay the sequence, then on the next trial the length of the sequence will increase by 1, up to a maximum of 12.
Citations: Berch, Krikorian and Huha 1998; Owens, Evans and Petrides 1996; Owens et al. 1995; Owens et al. 1990 provide further context for the utility of this classic test.
Healthy Behaviour
Unhealthy Behaviour
Paired Associates Learning
The Paired Associates Learning task is another classic test of visuospatial working memory that is meant measure a participant’s memory by testing their ability to associate patterns with spatial locations and recall them after a delay. Like the Trail Making test and the Spatial Span test, it has been adapted for the Kinarm Lab to provide easy inclusion into a battery of tests. During the task, images are shown in spatial locations and then hidden. Upon presentation of an image, the subject must indicate the spatial location of the hidden image.
Citation: Calkins 1896 serves as the primary reference for the development of this classic test.
Healthy Behaviour
Unhealthy Behaviour
Motor Tests
Visually Guided Reaching
The Visually Guided Reaching task provides a measure of the subject’s visuomotor capabilities and multi-joint coordination. During this task, the subject is instructed to an initial central target. Once there, the subject is instructed to quickly and accurately move to a peripheral target that appears. This process is repeated a number of times both to explore the workspace and to measure variability in the subject’s responses.
Citation: Coderre et al. 2010 serves as the primary reference for the task. The paper concludes that the task can provide reliable information with greater sensitivity about a patient’s sensorimotor impairments following stroke when compared to a standard clinical assessment scale.
Healthy Behaviour
Unhealthy Behaviour
Object Hit
The Object Hit task is a rapid sensorimotor decision and control test. It was developed to objectively assess the ability of a subject to select and engage motor actions with both hands over a range of speeds and a large workspace, measuring both visuomotor skills and spatial skills. In this task, virtual paddles appear at the subject’s fingertips. The subject is instructed to use these paddles to hit and push away balls that are moving randomly towards the subject from one of 10 locations (i.e. bins). As the task proceeds the balls move at greater speeds and appear more often, making the task more difficult as time progresses.
Citation: Tyryshkin et al. 2014 documents the development of the task and its use for studying deficits in stroke. Most participants with stroke displayed asymmetric performance between their affected and non-affected limbs with regards to number of balls hit, workspace area covered by the limb and hand speed. Inter-rater reliability of task parameters was high and there were significant correlations were observed between many of the task parameters and the Functional Independence Measure and/or the Behavioural Inattention Test.
US Patent No. 8,740,794
Healthy Behaviour
Unhealthy Behaviour
Ball on Bar
The Ball on Bar task assesses bimanual coordination and visuomotor skills. During the task, a virtual bar is presented in between the subject’s hands and a virtual ball is placed on the bar. There are 4 target circles that are presented to the subject one at a time. The object of the task is to move the virtual ball on the bar into each presented target as quickly and accurately as possible. The task has three levels. On the first level the ball is fixed to the centre of the bar. On the second level the ball’s position on the bar is a function of the angle of the bar. On the third level the ball can move freely on the bar.
Citation: Lowrey et al. 2014 documents the development of the task. The study found that the task provides a quantitative measure of bimanual coordination and can sensitively identify impairments in a population of subjects with stroke.
Healthy Behaviour
Unhealthy Behaviour
Arm Posture Perturbation*
The Arm Posture Perturbation task is meant to assess the subject’s ability to respond to unexpected disturbances to the arm when maintaining their hand at a target. During the task, the subject is shown a target to move to and once the subject moves a cursor representing their hand position into the target, a background load in one of 4 directions turns on slowly. After a random wait, the background load ramps off quickly. Good performance requires the ability to generate rapid corrective responses to these disturbances. *This task is only available with the Kinarm Exoskeleton Lab.
Citations: Bourke et al. 2015‘ s study found that subjects with stroke often have difficulties responding to the task’s mechanical disturbances, which may have important implications for performing daily abilities. Lowrey et al. 2019 concludes that the task provides an improved approach to assess rapid corrective responses of the arm in subjects with stroke where they found impairment is often equally felt in both arms.
Healthy Behaviour
Unhealthy Behaviour
Elbow Stretch*
During the Elbow Stretch task the robot attempts to rotate a subject’s elbow over a known angular range within a specified duration. It assesses the subject’s response to the passive stretch in order to quantify any increase in muscle tone or an uncontrollable increase in muscle activity due to joint position or motion. *This task is only available with the Kinarm Exoskeleton Lab.
Citation: Centen et al. 2017 concludes that the task can provide a sensitive and reliable assessment of post-stroke elbow spasticity while identifying characteristics of spasticity not attainable through coarse traditional scales.
Sensory Tests
Arm Position Matching
The purpose of the Arm Position Matching task is to provide measures of a subject’s proprioceptive capabilities, specifically position sense in the upper limb. During the task the Kinarm robot will move one of the subject’s arms to a given position, and the subject is instructed to move their other arm to a mirror-matched position. Vision of the subject’s arms is blocked so that the subject can only use somatosensation from the arm to perceive arm position.
Citation: Dukelow et al. 2010 is the first publication indicating that Kinarm robots can provide a reliable quantitative means to assess deficits in limb position sense following stroke. It found that fifty percent of stroke subjects had some element of position sense impairment, indicating that this is a common problem.
U.S. Patent No. 8,277,396; CN Patent No. ZL200780047665.6; JP Patent No. 5368311; CA Patent No. 2,668,364
Healthy Behaviour
Unhealthy Behaviour
Arm Movement Matching
The Arm Movement Matching task, also known as the ‘Kines’ task, is meant to assess the ability of a subject to perceive limb motion or kinesthesia in a workspace, which is an another aspect of proprioception. During the task the Kinarm robot will move the subject’s arm via a controlled trajectory to a given position. The subject is then instructed to move their other arm to match the speed and direction of the movement. Vision of both arms are blocked so that the subject can only rely on somatosensation from the arm to perceive arm position.
Citations: Semrau et al. 2013’s study utilizes the task to identity kinesthetic deficits in subjects with stroke and found that the robotic approach allows for more sensitive, accurate, and objective identification. Semrau et al. 2017 concludes that the task exhibits good inter-rater reliability, which validates it as a reliable, objective method for quantifying kinesthesia after stroke.
To learn more about the task’s development and utility, hear more from its developers here.
Healthy Behaviour
Unhealthy Behaviour
Disclaimer
Kinarm Standard Tests™ are currently in research and development and are currently only available to researchers with an IRB/REB approved protocol. *Intended Use* Kinarm Standard Tests are intended as research tools to contribute to the understanding of brain function and dysfunction. Kinarm Standard Tests are intended to be used on a Kinarm Exoskeleton Lab and/or a Kinarm End-Point Lab. Kinarm Standard Tests do not directly offer a medical diagnosis of any type, nor are Kinarm Standard Tests to be used as an assessment tool to assist with diagnosis. A diagnosis of any brain injury or disease can be made only by a qualified physician or psychologist. *Contraindications* Kinarm Standard Tests are not indicated for research subjects who do not have adequate cognitive functioning to understand the task instructions, who do not have visual and/or auditory acuity to permit adequate perception of instructions or task stimuli, and/or who are of an age falling outside of 18-85.
Documents
This marketing brief summarizes the suite of standardized protocols, analysis and reports available as of Dexterit-E 3.7 (released Jul-18).
Last Updated: October 30, 2019
1.26 MB
Best Used by
Basic Researchers
- Even if you’re an expert programmer, developing a new behavioural task takes time. KST allow you to achieve a “fast start” by allowing you to start collecting data right out of the box. We want to help you publish faster.
- KST can easily be integrated into undergraduate labs or graduate labs in motor control or neurological assessment. Use of the tests requires limited training and provide a robust lab experiment for students to explore and deliver analyses without expert skills.
- KST removes the ‘analysis burden’ from basic researchers supporting clinical researchers in collaborative translational research.
Clinical Researchers
- KST ensures you don’t need a highly skilled programmer or data analysis expert to obtain biomarkers/outcome measures for your clinical study.
- Access to KST is flexible. You can turn on/off access to collect assessments with KST in line with your study plan.
Clinical Applications
Exoskeleton Lab helps researchers better their findings in:
Stroke
Identify and quantify underlying impairments
Parkinson’s Disease
Measure the impact of DRT therapy on inhibitory control
Multiple Sclerosis
Monitor disease progression and response to therapy with high resolution
mTBI
Discrimination of subtle, but statistically significant impairments not detectable by manual observation
Cerebral Palsy
Identify therapeutic targets for rehabilitation
TIA
Identify non-transient impairments and monitor recovery
Neuromodulation therapy
Quantify the behavioural effects of therapeutic interventions such as neuromodulation
