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  • Semrau, Jennifer A.  (6)
  • 1
    Online Resource
    Online Resource
    SAGE Publications ; 2016
    In:  Neurorehabilitation and Neural Repair Vol. 30, No. 8 ( 2016-09), p. 762-772
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 30, No. 8 ( 2016-09), p. 762-772
    Abstract: Background. Perinatal stroke is the leading cause of hemiparetic cerebral palsy. Motor deficits and their treatment are commonly emphasized in the literature. Sensory dysfunction may be an important contributor to disability, but it is difficult to measure accurately clinically. Objective. Use robotics to quantify position sense deficits in hemiparetic children with perinatal stroke and determine their association with common clinical measures. Methods. Case-control study. Participants were children aged 6 to 19 years with magnetic resonance imaging–confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction and symptomatic hemiparetic cerebral palsy. Participants completed a position matching task using an exoskeleton robotic device (KINARM). Position matching variability, shift, and expansion/contraction area were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of disability (Assisting Hand Assessment) and sensory function. Results. Forty stroke participants (22 arterial, 18 venous, median age 12 years, 43% female) were compared with 60 healthy controls. Position sense variability was impaired in arterial (6.01 ± 1.8 cm) and venous (5.42 ± 1.8 cm) stroke compared to controls (3.54 ± 0.9 cm, P 〈 .001) with vision occluded. Impairment remained when vision was restored. Robotic measures correlated with functional disability. Sensitivity and specificity of clinical sensory tests were modest. Conclusions. Robotic assessment of position sense is feasible in children with perinatal stroke. Impairment is common and worse in arterial lesions. Limited correction with vision suggests cortical sensory network dysfunction. Disordered position sense may represent a therapeutic target in hemiparetic cerebral palsy.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2100545-X
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  • 2
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2021
    In:  Journal of NeuroEngineering and Rehabilitation Vol. 18, No. 1 ( 2021-12)
    In: Journal of NeuroEngineering and Rehabilitation, Springer Science and Business Media LLC, Vol. 18, No. 1 ( 2021-12)
    Abstract: Studies using clinical measures have suggested that proprioceptive dysfunction is related to motor impairment of the upper extremity following adult stroke. We used robotic technology and clinical measures to assess the relationship between position sense and reaching with the hemiparetic upper limb in children with perinatal stroke. Methods Prospective term-born children with magnetic resonance imaging-confirmed perinatal ischemic stroke and upper extremity deficits were recruited from a population-based cohort. Neurotypical controls were recruited from the community. Participants completed two tasks in the Kinarm robot: arm position-matching (three parameters: variability [Var xy ], contraction/expansion [Area xy ], systematic spatial shift [Shift xy ]) and visually guided reaching (five parameters: posture speed [PS] , reaction time [RT], initial direction error [IDE] , speed maxima count [SMC], movement time [MT] ). Additional clinical assessments of sensory (thumb localization test) and motor impairment (Assisting Hand Assessment, Chedoke-McMaster Stroke Assessment) were completed and compared to robotic measures. Results Forty-eight children with stroke (26 arterial, 22 venous, mean age: 12.0 ± 4.0 years) and 145 controls (mean age: 12.8 ± 3.9 years) completed both tasks. Position-matching performance in children with stroke did not correlate with performance on the visually guided reaching task. Robotic sensory and motor measures correlated with only some clinical tests. For example, AHA scores correlated with reaction time (R = − 0.61, p  〈  0.001), initial direction error (R = − 0.64, p  〈  0.001), and movement time (R = − 0.62, p  〈  0.001). Conclusions Robotic technology can quantify complex, discrete aspects of upper limb sensory and motor function in hemiparetic children. Robot-measured deficits in position sense and reaching with the contralesional limb appear to be relatively independent of each other and correlations for both with clinical measures are modest. Knowledge of the relationship between sensory and motor impairment may inform future rehabilitation strategies and improve outcomes for children with hemiparetic cerebral palsy.
    Type of Medium: Online Resource
    ISSN: 1743-0003
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2164377-5
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  • 3
    In: Human Brain Mapping, Wiley, Vol. 39, No. 3 ( 2018-03), p. 1130-1144
    Abstract: Perinatal stroke is the leading cause of hemiparetic cerebral palsy (CP), resulting in life‐long disability. In this study, we examined the relationship between robotic upper extremity motor impairment and corticospinal tract (CST) diffusion properties. Thirty‐three children with unilateral perinatal ischemic stroke (17 arterial, 16 venous) and hemiparesis were recruited from a population‐based research cohort. Bilateral CSTs were defined using diffusion tensor imaging (DTI) and four diffusion metrics were quantified: fractional anisotropy (FA), mean (MD), radial (RD), and axial (AD) diffusivities. Participants completed a visually guided reaching task using the KINARM robot to define 10 movement parameters including movement time and maximum speed. Twenty‐six typically developing children underwent the same evaluations. Partial correlations assessed the relationship between robotic reaching and CST diffusion parameters. All diffusion properties of the lesioned CST differed from controls in the arterial group, whereas only FA was reduced in the venous group. Non‐lesioned CST diffusion measures were similar between stroke groups and controls. Both stroke groups demonstrated impaired reaching performance. Multiple reaching parameters of the affected limb correlated with lesioned CST diffusion properties. Lower FA and higher MD were associated with greater movement time. Few correlations were observed between non‐lesioned CST diffusion and unaffected limb function though FA was associated with reaction time ( R  = −0.39, p   〈  .01). Diffusion properties of the lesioned CST are altered after perinatal stroke, the degree of which correlates with specific elements of visually guided reaching performance, suggesting specific relevance of CST structural connectivity to clinical motor function in hemiparetic children.
    Type of Medium: Online Resource
    ISSN: 1065-9471 , 1097-0193
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1492703-2
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  • 4
    In: Human Brain Mapping, Wiley, Vol. 38, No. 5 ( 2017-05), p. 2424-2440
    Abstract: Perinatal stroke causes most hemiparetic cerebral palsy, resulting in lifelong disability. We have demonstrated the ability of robots to quantify sensory dysfunction in hemiparetic children but the relationship between such deficits and sensory tract structural connectivity has not been explored. It was aimed to characterize the relationship between the dorsal column medial lemniscus (DCML) pathway connectivity and proprioceptive dysfunction in children with perinatal stroke. Twenty‐nine participants (6–19 years old) with MRI‐classified, unilateral perinatal ischemic stroke (14 arterial, 15 venous), and upper extremity deficits were recruited from a population‐based cohort and compared with 21 healthy controls. Diffusion tensor imaging (DTI) defined DCML tracts and five diffusion properties were quantified: fractional anisotropy (FA), mean, radial, and axial diffusivities (MD, RD, AD), and fiber count. A robotic exoskeleton (KINARM) tested upper limb proprioception in an augmented reality environment. Correlations between robotic measures and sensory tract diffusion parameters were evaluated. Lesioned hemisphere sensory tracts demonstrated lower FA and higher MD, RD, and AD compared with the non‐dominant hemisphere of controls. Dominant (contralesional) hemisphere tracts were not different from controls. Both arterial and venous stroke groups demonstrated impairments in proprioception that correlated with lesioned hemisphere DCML tract diffusion properties. Sensory tract connectivity is altered in the lesioned hemisphere of hemiparetic children with perinatal stroke. A correlation between lesioned DCML tract diffusion properties and robotic proprioceptive measures suggests clinical relevance and a possible target for therapeutic intervention. Hum Brain Mapp 38:2424–2440, 2017 . © 2017 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 1065-9471 , 1097-0193
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 5
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2018
    In:  Journal of NeuroEngineering and Rehabilitation Vol. 15, No. 1 ( 2018-12)
    In: Journal of NeuroEngineering and Rehabilitation, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2018-12)
    Type of Medium: Online Resource
    ISSN: 1743-0003
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 2164377-5
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  • 6
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2017
    In:  Journal of NeuroEngineering and Rehabilitation Vol. 14, No. 1 ( 2017-12)
    In: Journal of NeuroEngineering and Rehabilitation, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2017-12)
    Type of Medium: Online Resource
    ISSN: 1743-0003
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2164377-5
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