Developing an Ankle Assessment and Rehabilitation System for Improving Proprioception and Coordination Performances of Paretic Ankle Joint Following Chronic Stroke

Proprioception feedback in multiple axis movements for the motor performance of the ankle joint is very critical for daily activities. Stroke leads to impaired proprioception of the paretic ankle joint, affecting coordination performance of bilateral ankle joints and decreasing ambulatory ability. However, there is little known about the proprioception performance in multiple axis movements of the paretic ankle joint and bilateral feet coordination for stroke patients. There are few studies that have developed the appropriate rehabilitation program combining bilateral movement and visual feedback to improve impaired proprioception, coordination and functional activities of the paretic ankle joint. Objectives: The specific aims of this proposal are the following: 1) to develop an ankle proprioception assessment system for multiple axis movements of the ankle joint by analyzing the differences between affected and unaffected ankle joints and investigating the relationships between proprioception deficits, daily activities and clinical assessments in stroke patients; 2) to establish an ankle coordination performance assessment system of bilateral ankle joints by analyzing the difference and gait performances between healthy young people, elderly adults and stroke subjects; 3) to develop a rehabilitation system by investigating the effects of this system on the proprioception recovery and coordination performance of paretic ankle joints in chronic stroke patients. Methods: The first year of this proposal will establish an ankle proprioception assessment system for measuring ankle movements and proprioception performances in multiple axes and one lower extremity supporter for preventing potential measurement bias from compensatory movement of the lower extremity. We will also recruit 31 stroke subjects and evaluate the stroke-related changes in proprioception in multiple axes, including joint position sense direction error, absolute error and variable error. Clinical motor and functional assessments in the paretic lower limb include Fugl-Meyer Assessment, Motor Assessment Score, Berg Balance Scale, Time Up and Go and Barthel Index. The second year of this proposal will establish a bilateral ankle coordination assessment system by adding the same equipment with load cell and an assessment interface written in LabVIEW. We will also recruit 51 stroke adults and age-matched 51 healthy people, analyzing the differences in the coordination control of the bilateral ankle joints and gait performance. The third year of this proposal will establish a rehabilitation system by combining the visual feedback game-based and bilateral movement rehabilitation programs written in LabVIEW. Forty-two stroke subjects will be recruited and randomized to visual feedback game-based group and traditional rehabilitation group, and the visual feedback game-based training effects of using this rehabilitation system for 4 weeks on the proprioception recovery and coordination improvement of paretic ankle joint in stroke patients will be investigated. Significant contributions: The information from these results in this proposal would be very useful for understanding the real proprioception and coordination deficits in multiple axis movements and limitations in daily activities of paretic ankle joint and investigating the intervention effects of combining bilateral movement and visual feedback training for improving proprioception, coordination control and daily activities following stroke.