Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton

Background Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton. Methods Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity. Results Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures. Conclusions The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.York University Librarie

Sustainability of an HIV PEP Program for Sexual Assault Survivors: “Lessons Learned” from Health Care Providers

This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program. All focus groups were audio-recorded and the recordings transcribed. The transcriptions and open-ended survey responses were analyzed using content analysis. Administrator, nurse, physician, social worker, and pharmacist respondents perceived important barriers to sustainability of the HIV PEP Program. Eight constructs were identified within four broad themes: resources (inadequate funds, overworked and unacknowledged staff), expertise (insufficient external supports, insufficiently trained and knowledgeable staff), commitment (lack of institutional support, physician resistance to offering HIV PEP), and accommodation (lack of flexibility in addressing specific client and community needs, inaccessibility and lack of clarity of tools). We discuss the implications of these findings and the actions that were taken to address the challenges

Assessing Velocity-Dependent Features of Post-Stroke Spasticity Using Robotic Assessment Methods

Spasticity is typically assessed by examining the velocity-dependence of resistance to passive movement; however, velocity-independent features may present in tandem. This thesis examined whether velocity-dependent and velocity-independent components were distinguishable in individuals with post-stroke spasticity. A retrospective analysis was conducted in which thirty individuals with stroke (13 with spasticity, 17 without) and 98 healthy controls were recruited. Using the KINARM Robotic Exoskeleton, each participants’ upper-limb was moved through range at two speeds. Velocity-reduction angle (kinematically-detected spastic catch), between-limb final angle, and between-limb peak velocity were the primary outcomes. Individuals with spasticity displayed a velocity-reduction angle, decreased range of motion, and increased tone. While a velocity-reduction angle was detected more frequently during fast stretch, final angle and peak velocity did not differ significantly across speeds. Individuals with stroke (with and without spasticity) were also characterized based on kinematic properties. These findings suggest velocity-dependent and velocity-independent impairments are detectable in individuals post-stroke.M.Sc