Assessment and therapy of proprioceptive function after stroke and its link to motor recovery

• Applicant: Professor Joachim Liepert
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology
• Term: from 2018 to 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 323579831

There is growing evidence that somatosensory impairment - in particular proprioceptive dysfunction - results in a poor prognosis for functional recovery after stroke. Nevertheless, proprioceptive impairment has received little attention in research and conventional clinical rehabilitation after stroke, which have a strong focus on motor training. Yet, proprioceptive function plays a critical role in grasping and manipulating objects, and thereby strongly affects the ability to perform activities of daily living and the functional independence of stroke survivors. One major impediment for progress in the field of somatosensory therapy may stem from the limited application and shortcomings of clinical assessments of somatosensory function.The aim of this project is to develop and clinically validate a battery of rapidly administered, quantitative and sensitive robot-assisted assessments of hand function, in order to investigate proprioceptive function and its link to motor and sensorimotor function in stroke survivors. Test-retest reliability and concurrent validity of the developed metrics will be determined through observational studies in subacute stroke patients. Outcome measures will be correlated with clinical scales and neurophysiological assessments, and compared with normative data from age-matched healthy controls.To demonstrate the clinical potential and generate new insights on the co-evolution and interdependence of the recovery of proprioceptive and motor function, the validated assessments will then be employed in a longitudinal observational study in 50 subacute patients. Based on the developed tools and insights from the longitudinal study, we will develop novel adaptive robot-assisted, assessment-driven therapy exercises, to enable an optimally-challenging, intensive proprioceptive therapy to complement conventional motor rehabilitation. The proposed therapy concept will be tested for its feasibility and utility in a pilot study with 15 subacute stroke patients and lay the foundation for a future systematic randomized controlled trial on adaptive assessment-driven somatosensory therapy. We hypothesize that this approach will lead to a faster and more complete functional recovery of hand impairment after stroke - one of the principal causes of disability in adults - by enhancing both somatosensory and motor recovery. This work is important because it will result in a better understanding of the prevalence of proprioceptive deficits and their effect on sensorimotor recovery following stroke, and provide objective tools for the rapid assessment of proprioceptive function. The developed tools may allow for more precise prognoses and improved stratification of patients, and enable novel modes of therapy targeting proprioceptive rehabilitation. This is a first important step towards a therapy focused on proprioceptive deficits, driven by continuous, automated assessments, which could be applied both in the clinic and at home.

• DFG Programme: Research Grants
• International Connection: Switzerland
• Cooperation Partner: Professor Dr.-Ing. Roger Gassert, Ph.D.