UD researchers use a robotic exoskeleton to reveal hidden sensory deficits in stroke survivors, enabling more precise rehabilitation.
A new study is using robotics to expose a hidden barrier in stroke recovery : the loss of the body’s internal sense of movement.This sensory ability, called proprioception, is rarely tested in clinics, despite being a crucial factor that determines whether survivors can regain functional independence or not.
Now, a team of researchers at the University of Delaware is offering a way to identify these sensory deficits even when patients cannot move their impaired arm.At the center of their work is a robotic exoskeleton that tracks motion with high precision.Helping them probe this challenge is Don Lewis, who knows firsthand how unpredictable stroke recovery can be.A decade ago, Lewis woke up unable to move his left side.The 55-year-old had suffered a stroke in his sleep, discovered only when a neighbor noticed his truck hadn’t moved in days. Months of therapy helped him regain use of his left leg, but his left arm remains paralyzed.Hidden sensory lossesLewis is now contributing to UD’s work on proprioception, the brain’s ability to sense limb position and movement without looking.“To simplify the concept, in class, I tell my undergraduates to close their eyes and touch their nose; if people can’t do that, it means they likely have impaired proprioception,” said Jennifer Semrau, associate professor of kinesiology and applied physiology.Along with her doctoral candidate, Joanna Hoh, Semrau suggests clinicians can uncover sensory deficits without requiring movement from the affected arm, making assessments far more accessible.Robot-assisted insightsInside the lab, Lewis sits in a KINARM robotic exoskeleton that maps upper-limb movement.The system allows the team to isolate sensory issues from motor ones, which has remained a challenge in stroke science.“We’re trying to determine the lowest level someone can detect their arm moving,” Semrau said.Healthy people can sense as little as half a centimeter of motion. Post-stroke, that sensitivity varies widely.“Some can’t tell their arm was moved 10 centimeters, and that could be the difference between touching a hot stove or a knife in the kitchen,” Semrau said.Strokes disrupt the signals between the brain and muscle receptors.“When you move, the receptors lengthen or shorten, and if the information isn’t getting from the brain to those muscle receptors, you can’t properly coordinate movement,” she said.And crucially, proprioception loss doesn’t necessarily affect pain or touch.“Pain is part of the somatosensory system… Every person is a fingerprint,” Semrau said.Rewriting rehab thinkingFor Hoh, the research fills a blind spot she noticed as a clinician.“We often think about movement through motor function,” she said. “I had a blind spot to the sensory system.”Her dissertation examines how sensory deficits shape real-world recovery.“In one of our studies, we found that just 1 percent of clinicians assess proprioception in people with stroke,” Semrau said. “Without sensory recovery, a person will not gain full recovery of function.”Hoh and Semrau hope their work pushes rehabilitation toward personalized testing and therapy.“The onus is on clinicians and researchers to ensure they’re testing for sensory deficits,” Hoh said.Semrau added, “Understanding the connection between motor and sensory impairments… is key to better targeting therapies.”The study appears in the journal Neurorehabilitation and Neural Repair.
Neuroscience Proprioception Rehabilitation Robotics Sensory Deficits Stroke Recovery University Of Delaware
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