Lower Extremity Position Test: A new clinical quantitative assessment tool of proprioception post stroke.

OBJECTIVE: To develop a quantitative, inexpensive and easy to use tool, for assessing proprioception of the lower extremity of individuals post-stroke, and examine its test-retest reliability and known-groups validity. METHODS: The Lower Extremity Position Test was developed. Testing procedure: seated subjects were asked to reproduce 12 cm or 22 cm distances on a plastic surface, by verbally stopping passive movement of the foot produced by the tester. The deviation from the target point was measured as the mismatch score. Fifty one subjects post-stroke (n = 51) participated in prospective test-retest assessment. The tests were performed one week apart by a single assessor, in physical therapy out-patient clinics. The t-test, ICC and Bland-Altman tests were used to determine known-groups validity by determining leg differences and test-retest reliability. RESULTS: Post-stroke involved foot demonstrated significantly higher mismatch scores then the uninvolved foot did (p < 0.0001). Good test-retest reliability was demonstrated for the involved leg for both 12 cm and 22 cm distances (ICC = 0.79 and 0.85, respectively). The 95% repeatability ranges were leg related. CONCLUSIONS: The Lower Extremity Position Test (LEPT) is a newly-developed testing tool with good clinical utility, reliable in post-stroke population and has known-group validity (involved versus uninvolved foot).

Assessment of texture discrimination ability at the sole of the foot in subjects with chronic stroke compared with young and elderly subjects with no neurological deficits: a reliability and validity study.

PURPOSE: To examine validity and test-retest reliability of a sensory test developed to evaluate ability of elderly subjects with/out a stroke to discriminate between textures with the sole of their foot. METHODS: Subjects poststroke, old adults and young subjects were tested twice. Twelve materials relevant to foot function (e.g., gravel, sand) were used. Blindfolded subjects were requested to discriminate with the sole of each foot one outstanding texture among three textures presented in each of 12 subtests. ANOVA, ICC and Bland-Altman tests were used to determine group/leg differences and test-retest reliability. RESULTS: Discrimination ability of the involved lower extremity poststroke is significantly reduced. Ability in individuals with no neurological impairment is age related. Good test-retest (ICC = 0.81) reliability was demonstrated for the impaired foot of subjects poststroke. The 95% repeatability ranges were age related with the highest range demonstrated for the involved foot poststroke. A significant fair negative correlation was demonstrated between texture discrimination ability and tactile detection threshold measured by Semmes-Weinstein monofilaments for the involved foot in poststroke subjects. CONCLUSION: This newly developed assessment tool demonstrates concurrent and known-groups validity and is reliable for determining texture discriminative ability of the foot in individuals post-stroke and in older adults with no neurological impairment. Implications for rehabilitation The texture discrimination test presented here is a valid and reliable tool, providing quantitative assessment of sensory function at the sole of the foot in older adults with no neurologic deficits and in subjects poststroke. Lower extremity texture discrimination test is easy to administer in the clinic and might suggest directions for individually tailored, lower extremity, sensory retraining protocols.

The reliability of hand-held dynamometry for strength assessment during electrically induced muscle contractions.

OBJECTIVES: To determine inter- and intra-tester reliability of strength measurements during maximal electrically induced contractions (MEIC) using a hand-held dynamometer (HHD). METHODS: Thirty-seven healthy young female adults, mean age (SD) 23.4 (2.4) years, were tested by two examiners during two sessions, with order of examiners randomized. Biphasic pulses (phase duration--300 µs; pulse frequency--75 Hz) were employed in order to induce contractions of the quadriceps femoris muscle at a maximally tolerated current level. Strength of maximal voluntary isometric contractions (MVIC) and of MEIC was recorded with a HHD utilizing a stabilization belt. RESULTS: Good to excellent inter- and intra-tester reliability were determined with intra-class correlation coefficients ranging between 0.8 and 0.9, and no bias in the Bland-Altman plots. The 95% repeatability ranged between 8.7 and 13.0 kg for the MVIC and MEIC, and between 20.7 and 25.6% for the % MVIC. CONCLUSION: Our results confirm previous findings indicating good to excellent reliability of quadriceps femoris muscle MVIC assessment with a HHD. However, a high 95% repeatability range indicates the HHD is not sufficiently reliable as an indicator of the force level attained during electrically induced contractions. Other methods need to be investigated to assist in determining whether MEIC have reached therapeutic levels.

Low-cost virtual reality intervention program for children with developmental coordination disorder: a pilot feasibility study.

PURPOSE: To explore the feasibility of using a low-cost, off-the-shelf virtual reality (VR) game to treat young children with developmental coordination disorder (DCD) and to determine the effect of this intervention on motor function. METHODS: Nine children, aged 4 to 6 years, referred to physical therapy because of suspected DCD participated in 10 game-based intervention sessions. OUTCOME MEASURES: Outcome measures included Movement Assessment Battery for Children-2 (M-ABC-2), the DCD Questionnaire (DCD-Q), the 6-minute walk test, and 10-m walk test. RESULTS: Statistically significant changes were observed in the total standard score (P = .024) and the balance subscore (P = .012) of the M-ABC-2 and in the DCD-Q (P < .05). The children seemed to be motivated and to enjoy the interaction with the VR environment. CONCLUSION: VR games seemed to be beneficial in improving the children's motor function.

Neck pain assessment in a virtual environment.

STUDY DESIGN: Neck-pain and control group comparative analysis of conventional and virtual reality (VR)-based assessment of cervical range of motion (CROM). OBJECTIVES: To use a tracker-based VR system to compare CROM of individuals suffering from chronic neck pain with CROM of asymptomatic individuals; to compare VR system results with those obtained during conventional assessment; to present the diagnostic value of CROM measures obtained by both assessments; and to demonstrate the effect of a single VR session on CROM. SUMMARY OF BACKGROUND DATA: Neck pain is a common musculoskeletal complaint with a reported annual prevalence of 30% to 50%. In the absence of a gold standard for CROM assessment, a variety of assessment devices and methodologies exist. Common to these methodologies, assessment of CROM is carried out by instructing subjects to move their head as far as possible. However, these elicited movements do not necessarily replicate functional movements which occur spontaneously in response to multiple stimuli. To achieve a more functional approach to cervical motion assessment, we have recently developed a VR environment in which electromagnetic tracking is used to monitor cervical motion while participants are involved in a simple yet engaging gaming scenario. METHODS: CROM measures were collected from 25 symptomatic and 42 asymptomatic individuals using VR and conventional assessments. Analysis of variance was used to determine differences between groups and assessment methods. Logistic regression analysis, using a single predictor, compared the diagnostic ability of both methods. RESULTS: Results obtained by both methods demonstrated significant CROM limitations in the symptomatic group. The VR measures showed greater CROM and sensitivity while conventional measures showed greater specificity. A single session exposure to VR resulted in a significant increase in CROM. CONCLUSION: Neck pain is significantly associated with reduced CROM as demonstrated by both VR and conventional assessment methods. The VR method provides assessment of functional CROM and can be used for CROM enhancement. Assessment by VR has greater sensitivity than conventional assessment and can be used for the detection of true symptomatic individuals.

Cervical motion assessment using virtual reality.

STUDY DESIGN: Repeated measures of cervical motion in asymptomatic subjects. OBJECTIVES: To introduce a virtual reality (VR)-based assessment of cervical range of motion (ROM); to establish inter and intratester reliability of the VR-based assessment in comparison with conventional assessment in asymptomatic individuals; and to evaluate the effect of a single VR session on cervical ROM. SUMMARY OF BACKGROUND DATA: Cervical ROM and clinical issues related to neck pain is frequently studied. A wide variety of methods is available for evaluation of cervical motion. To date, most methods rely on voluntary responses to an assessor's instructions. However, in day-to-day life, head movement is generally an involuntary response to multiple stimuli. Therefore, there is a need for a more functional assessment method, using sensory stimuli to elicit spontaneous neck motion. VR attributes may provide a methodology for achieving this goal. METHODS: A novel method was developed for cervical motion assessment utilizing an electromagnetic tracking system and a VR game scenario displayed via a head mounted device. Thirty asymptomatic participants were assessed by both conventional and VR-based methods. Inter and intratester repeatability analyses were performed. The effect of a single VR session on ROM was evaluated. RESULTS: Both assessments showed non-biased results between tests and between testers (P > 0.1). Full-cycle repeatability coefficients ranged between 15.0 degrees and 29.2 degrees with smaller values for rotation and for the VR assessment. A single VR session significantly increased ROM, with largest effect found in the rotation direction. CONCLUSION: Inter and intratester reliability was supported for both the VR-based and the conventional methods. Results suggest better repeatability for the VR method, with rotation being more precise than flexion/extension. A single VR session was found to be effective in increasing cervical motion, possibly due to its motivating effect.