KINARM

Description

Kinesiological Instrument for Normal and Altered Reaching Movements (KINARM) is a robotics research tool designed to make quantitative neurological assessments of sensorimotor, proprioceptive, and cognitive brain function. It consists of a wheelchair and upper extremity exoskeleton that the subject is fitted to based on their body specifications. The KINARM allows the researcher to assess coordination of limbs at multiple joints while also precisely measuring the joint-specific force applied by the subject as they perform individual tasks. The precision of the instrument removes the subjectivity that is currently inherent in most physiotherapy assessments of neurological status (e.g. muscle tone, spasticity, proprioception, etc.)

The creators of the KINARM, BKIN Technologies, have also developed a proprietary software named Dexterit-E.

The robotic assessment device combined with an augmented reality system creates a virtual environment where subjects perform tasks, such as directing a hand to a target, or interacting with an object in the environment

Using BKIN’s proprietary software Dexterit-E, a detailed report of measurements is produced and compared to age-matched controls. Other technologies such as gaze-tracking and force plates are also available to capture more behavioral information.

Nick will do above

Utilizing the KINARM in augmented reality, it is also possible for researchers to assess and quantify interactions between motor, visual, and proprioceptive systems during objective tasks. Some specific motor and/or visual tasks have been designed (KINARM Standard Tests) that incorporate cognitive functions such as learning, problem solving, and perception. These tests can give researchers insight into the cognitive, motor, and sensory brain function of normal and impaired subjects. (reference KST Summary and BKIN website relevant pages)

KINARM Standard Tests (KST)

A series of objective tasks has been developed using two different types of KINARM instruments (End-Point and Exoskeleton). These objective tasks were standardized and normal values for individuals aged between 18-85 have been statistically analyzed. These tests are objective, quantitative and sensitive to change (Table 1).

Table 1: KINARM Standard Tests and the brain functions measured

KINARM Standard Tests	Measure(s) of Brain Function
Arm Position Matching	Joint position sense
Ball on Bar	Bilateral coordination, visuomotor skills
Elbow Stretch	Muscle tone and/or Spasticity
Object Hit	Goal-directed movement, Rapid visuomotor action, Spatial attention
Object HIt and Avoid	Goal-directed movement, Rapid visuomotor action, Spatial attention, Inhibitory control, Executive function.
Reverse Visually Guided Reaching	Visuomotor skill, Inhibition of automatic motor responses
Spatial Span	Visuospatial working memory
Trail Making	Executive function of switching between tasks
Visually Guided Reaching	Goal-directed voluntary control, Postural control, Visuomotor response time, Arm motor coordination

A complete description of the KINARM Standard Tests (KST), including how they are quantified and their statistical analyses can be found in the KST Summary document provided on the manufacturer's website (reference KST Summary).

KINARM and Stroke

The KINARM is a tool that can reliably and quantitatively assess deficits in limb position sense (proprioception) following stroke which significantly impedes activities of daily living. It is known that approximately ⅓ to ½ of stroke patients have impaired position sense. Intact position sense strongly correlates with extent of long-term motor recovery. Current clinical tools used for assessing position sense have very poor interrater reliability and sensitive and are absent of normative data (Dukelow et al., 2010).

Research Studies Undergoing in the Current Settings

Stroke Spinal cord injury Parkinson’s Disease Multiple Sclerosis Cardiac arrest Transient ischemic attack Sport concussion. Pediatric brain injury Neurodegenerative disease Brain Diseases Health Aging Cerebral Palsy All from Bkin website

Types of KINARM

Exoskeleton Robot

Allows planar movements of the arm in horizontal plane for flexion and extension at the shoulder and elbow Provides feedback from the control of the shoulder and elbow joints Exoskeleton robot provides gravity support for subjects with upper arm weakness such as in subjects with stroke, spinal cord injury, Parkinson’s, or multiple sclerosis https://www.youtube.com/watch?time_continue=7&v=M7psCB0ZOx0

End-Point Robot

Does not provide feedback about the control of the shoulder and elbow joints Stiffer than the Exoskeleton Robot which allows for greater feedback More time efficient than the Exoskeleton Robot because the gravity support of the upper limb is not required Force Channel (KINARM End-Point only)

Contraindications

KINARM Standard Tests are not indicated for research subjects who are unable to read at a fifth grade level, who do not have adequate cognitive function to understand task instructions, who do not have visual and/or auditory acuity to permit adequate perception of instructions or task stimuli, and/or who are of an age falling outside of 18-85. (manual pdf)

Patient Positioning and Technique

Subjects are seated in a wheelchair base with each arm fit comfortably within an exoskeleton arm, with adjustments made to fit the dimensions of the subject’s body. One arm is relaxed (passive arm) in order to allow the robot to move it into 1 of 9 different spatial locations. The examiner then instructs the subject to move their opposite arm (active arm) in order to mirror the passive arm. When the subject was at rest, the arm is relaxed at the central target (shoulder in 30d horizontal abduction and the elbow in 90d of flexion). (Dukelow et al., 2010)

Videos

KINARM Robot: https://www.youtube.com/watch?v=OpOKVEHOga0

KINARM Kids: https://www.youtube.com/watch?v=Fm0lYHMp1xI

References

Dukelow, S. P., Herter, T. M., Moore, K. D., Demers, M. J., Glasgow, J. I., Bagg, S. D., Norman, K. E., & Scott, S. H. (2010). Quantitative Assessment of Limb Position Sense Following Stroke, Neurorehabilitation and Neural Repair, 24(2), 178-187. http://dx.doi.org/10.1177/1545968309345267