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).
FlansbjerU., HolmbäckA., DownhamD., PattenC. & LexellJ. (2005). . Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of rehabilitation medicine: Official journal of the UEMS European Board of Physical and Rehabilitation Medicine, 37(2),
75–82.
6.
FranchignoniF., HorakF., GodiM., NardoneA. & GiordanoA. (2010). Using psychometric techniques to improve the Balance Evaluation Systems Test: The mini-BESTest. Journal of Rehabilitation Medicine, 42(4), 323–331.
7.
GiavarinaD. (2015). Understanding bland Altman analysis. Bio-chemia Medica, 25(2), 141–151.
8.
HanJ., WaddingtonG., AdamsR., AnsonJ. & LiuY. (2016). Assessing proprioception: A critical review of methods. Journal of Sport and Health Science, 5(1), 80–90. https://doi.org/10.1016/j.jshs.2014.10.004.
9.
HillierS., ImminkM. & ThewlisD., (2015). Assessing Proprioception: A Systematic Review of Possibilities. Neurorehabil Neural Repair, 29(10),
933–949.
10.
KimJ. S. & Choi-KwonS. (1996). Discriminative sensory dysfunction after unilateral stroke. Stroke, 27(4), 677–682.
11.
KrewerC., Van de WinckelA., ElangovanN., AmanJ. E. & KonczakJ., (2016). Commentary on: “Assessing proprioception: A critical review of methods” by Han et al. Journal of Sport and Health Science, 5(1), 91–92. https://doi.org/10.1016/j.jshs.2015.11.001.
12.
LinJ. H., HsuehI. P., SheuC. F. & HsiehC. L. (2004). Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients. Clin Rehabil, 18(4), 391–397.
13.
MoloneyN. A., HallT. M., O’SullivanT. C. & DoodyC. M. (2011). Reliability of thermal quantitative sensory testing of the hand in a cohort of young, healthy adults, Muscle & nerve, 44(4), 547–552. doi:10.1002/mus.22121
.
14.
MulderT. (1991). A process-oriented model of human motor behavior: Toward a theory-based rehabilitation approach. [Review]. Phys Ther, 71(2), 157–164.
15.
MyersA. M. (1998). . Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 53A(4), 287–294.
16.
OfekH., AlperinM., KnollT., LivneD. & LauferY., (2018) 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. Disability and Rehabilitation, 40(16), 1960–1966. doi:10.1080/09638288.2017.1323019
.
17.
OliveiraC., MedeirosA.R. T., GretersM. G., FrotaN. A. F., LucatoL. T, ScaffM. & ConfortoA. (2011). Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke. Clinics, 66(12), 2043–2048.
18.
PortneyL. G. & WatkinsM. P. (2000). Foundations of clinical research: Applications to practice (2nd Eds ed.).Upper Saddle River, NJ, Prentice Hall, Inc.: Prentice Hall, Inc.
19.
ProskeU. & GandeviaS. C. (2012). The Proprioceptive Senses: Their Roles in Signaling Body Shape, Body Position and Movement, and Muscle Force. Physiological Reviews, 92, (4), 1651–1697. doi:10.1152/physrev.00048.2011
.
20.
RossierP. & WadeD. T. (2001). Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Archives of Physical Medicine and Rehabilitation, 82(1), 9–13.
21.
SaeysW., VereeckL., TruijenS., LafosseC., WuytsF. P. & Van de HeyningP. (2012). Influence of sensory loss on the perception of verticality in stroke patients. [Research Support, Non-U S Gov’t]. Disabil Rehabil, 34(23), 1965–1970.
22.
Shumway-CookA. & A., WoollacottM. (2010). Motor Control: Translating Research Into Clinical Practice (4th ed. ed.). Philadelphia, PA: Lippincott Williams & Wilkins;.
23.
SpoonerD. M. & PachanaN. A. (2006). Ecological validity in neuropsychological assessment: A case for greater consideration in research with neurologically intact populations. [Review]. Arch Clin Neuropsychol, 21(4), 327–337.
24.
SullivanJ. E. & HedmanL. D. (2008). Sensory dysfunction following stroke: Incidence, significance, examination, and intervention. Topics in Stroke Rehabilitation, 15(3), 200–217.
25.
ToledoD. R. & BarelaJ. A. (2010). Diferenças sensoriais e motoras entre jovens e idosos: Contribuição somatossensorial no controle postural. Brazilian Journal of Physical Therapy, 14, 267–275.
26.
TysonS. (2008). Sensory loss in hospital-admitted people with stroke: Characteristics, associated factors, and relationship with function, Neurorehabilitation and Neural Repair, 22(2), 166–172.
27.
TysonS., CrowJ. L., ConnellL., WinwardC. & HillierS. (2013) Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data. Topics in Stroke Rehabilitation, 20(5), 441–449.
28.
WeirJ. P. (2005). Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. The Journal of Strength & Conditioning Research, 19(1), 231–240.
29.
WutzkeC., MercerV. & LewekM. (2013). Influence of lower extremity sensory function on locomotor adaptation following stroke: A review. Topics in Stroke Rehabilitation, 20(3), 233–240.
