Robot-aided Proprioceptive Rehabilitation Training

This protocol seeks to improve proprioceptive-motor function. Proprioception refers to the
perception of limb position or motion and the orientation of one's body in space. Numerous
medical conditions with motor symptoms are also associated with proprioceptive loss, such as
osteoarthritis, Parkinson's disease, peripheral sensory neuropathy, stroke, and developmental
coordination disorder.

However, therapies to improve proprioceptive function in these populations are either
non-existent or very limited in scope although it is established that proprioceptive
impairments severely degrade motor function. The proposed protocol focuses on proprioception
for fine motor function of the hand/wrist joint complex, because hand/wrist motor control is
highly important for activities of daily living.

The specific aims are to determine if a 2-day wrist proprioceptive training:

1. improves limb position sense acuity,

2. improves the spatial precision of wrist/hand motor tasks,

3. increases the efficiency of performing such motor tasks,

4. is associated with neural changes in cortical processing as measured by short-latency
somatosensory evoke potentials (SEP) and motor evoked potentials (MEP) using
transcranial magnetic stimulation.

The study follows a crossover design with two arms and two groups. Time frame for the
completion of the study is up to 7 days depending on the start day of the week (Monday
through Friday). No testing will occur on the weekend.

Group 1 will have the following time frame: Day 1: pre-test (approx. 3 hrs.) and training
intervention (approx. 30 min.). Day 2: training intervention (approx. 30 min.) and post-test
1 (approx. 3 hrs.). Days 3-6: Usual care (min. of 2 days required). Days 5-7: Post-test 2
(depending on the start day of the week, it is either Day 5,6, or 7).

Group 2 will have the following time frame: Day 1: pre-test 1 (approx. 3 hrs.). Days 2-4:
Usual care (min. of 2 days required). Days 4-6: pre-test 2 (approx. 3 hrs.) and training
intervention (approx. 30 min.). Days 5-7: Training intervention and post-test 1 (depending on
the start day of the week, it is either Day 5,6, or 7).

For all participants (both healthy and patient populations)

Inclusion Criteria:

1. wrist passive range of motion (ROM) more than 22.5° in flexion/extension

2. sense the vibro-tactile cues on either forearms in order to effectively receive the
movement-related feedback

3. resist minimal resistance in gravity-eliminated position (score at least 2+/5 with the
physical examination of manual muscle testing (Hislop, Avers, & Brown, 2013)) ) in all
wrist movement directions.

Exclusion Criteria:

1. Regular intake of benzodiazepines.

2. Cognitive impairment: score ≥ 23 on Mini-mental state examination (Folstein, Robins &
Helzer, 1983)

3. Depressive symptoms: score ≤ 19 on Beck depression inventory (Beck, Steer, &
Carbin,1988).

Inclusion Criteria for Stroke Subjects

1. at least 3 months after stroke

2. whose age are between 30 to 75 years old.

Exclusion Criteria for Subjects undergoing the TMS procedure (Rossi, Hallett, Rossini, &
Pascual-Leone, 2009)

- Has implanted metal in the body.

- Diagnosed with multiple sclerosis, major psychiatric conditions, epilepsy, history of
seizures in the past 2 years, sleep deprivation, pregnancy, uncontrolled migraine,
major traumatic head injury, severe heart disease, increased intracranial pressure,
high consumption of alcohol, any conditions that predispose one to seizures

- Is currently taking any pro-epileptic medication (e.g. epileptogenic drugs such as
tricyclic antidepressants)

- When no electromyography response can be elicited within the range of the TMS
stimulator

- Pregnant at the time of data collection .