Proprioceptive Function Varies With Neural Circuits Used To Measure Error In Patients With Recent Stroke

Research Objectives: To investigate the prevalence of wrist proprioception deficits early after stroke and examine differences across three methods of assessing proprioception.

Design: Observational survey comparing criterion standard with two alternative variations.

Setting: The California Rehabilitation Institute is an inpatient rehabilitation facility (IRF).

Participants: Convenience sample of 26 patients who were tested 14±7 days post-stroke.

Interventions: None.

Main Outcome Measures: [1] Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception that passively moves the tested wrist to a target position and asks the subject to indicate this position by manipulating a pointer with the untested hand. WPST is the criterion standard for identifying abnormal wrist proprioception. [2] An Active (A-WPST) variant requiring active flexion/extension of the tested wrist to match a target position. [3] A Passive (P-WPST) variant requiring the subject to verbally indicate when a target position has been matched during continuous passive movement. A-WPST and P-WPST increase demands on working memory but do not require vision or use of the untested upper extremity.

Results: WPST error was 18+/-9deg in the more-affected wrist, abnormal in 88% of patients; and 11+/-6deg in the less-affected wrist, abnormal in 73% of patients. Error in the more-affected wrist was higher than the less-affected wrist (p < 0.001). A-WPST and P-WPST scores were approximately one-third lower than standard WPST scores (p < 0.01) but were not significantly different from each other. Standard WPST error correlated with A-WPST error (r=0.627, p< 0.01) and P-WPST error (r=0.543, p< 0.01). A-WPST and P-WPST error correlated with each other (r=0.814, p< 0.001).

Conclusions: Deficits in wrist proprioception are common after stroke and may be present bilaterally. WPST variants assess proprioception using different cognitive circuits; error is larger when proprioceptive information must be transferred between hemispheres. Assessment method influences the degree of proprioceptive error appreciated in the early days post-stroke.

Author(s) Disclosures: Dr. Cramer serves as a consultant for Abbvie, Constant Therapeutics, MicroTransponder, Neurolutions, Panaxium, Elevian, Medtronic, Helius, Omniscient, Brainsgate, and TRCare.