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Abstract
Objective To test the hypothesis that, in the context of robotic therapy designed to enhance proprioceptive feedback via a Hebbian model, integrity of both somatosensory and motor systems would be important in understanding interparticipant differences in treatment-related motor gains.
Methods In 30 patients with chronic stroke, behavioral performance, neural injury, and neural function were quantified for somatosensory and motor systems. Patients then received a 3-week robot-based therapy targeting finger movements with enhanced proprioceptive feedback.
Results Hand function improved after treatment (Box and Blocks score increase of 2.8 blocks, p = 0.001) but with substantial variability: 9 patients showed improvement exceeding the minimal clinically important difference (6 blocks), while 8 patients (all of whom had >2-SD greater proprioception deficit compared to 25 healthy controls) showed no improvement. In terms of baseline behavioral assessments, a somatosensory measure (finger proprioception assessed robotically) best predicted treatment gains, outperforming all measures of motor behavior. When the neural basis underlying variability in treatment response was examined, somatosensory-related variables were again the strongest predictors. A multivariate model combining total sensory system injury and sensorimotor cortical connectivity (between ipsilesional primary motor and secondary somatosensory cortices) explained 56% of variance in treatment-induced hand functional gains (p = 0.002).
Conclusions Measures related to the somatosensory network best explained interparticipant differences in treatment-related hand function gains. These results underscore the importance of baseline somatosensory integrity for improving hand function after stroke and provide insights useful for individualizing rehabilitation therapy.
ClinicalTrials.gov identifier: NCT02048826.
Glossary
- B&B=
- Box and Blocks;
- CST=
- corticospinal tract;
- FINGER=
- Finger Individuating Grasp Exercise Robot;
- MNI=
- Montreal Neurological Institute;
- ROI=
- region of interest;
- TST=
- thalamocortical spinal tract
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received July 11, 2018.
- Accepted in final form October 31, 2018.
- © 2019 American Academy of Neurology
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