Robotic Outcome Assessment in a Non-Human Primate Model of Middle Cerebral Artery Stroke

Stroke is a prevalent disorder with immense socioeconomic impact. A variety of chronic neurological deficits result from stroke. In particular, sensorimotor deficits are a significant barrier to achieving post-stroke independence. Unfortunately, the majority of pre-clinical studies that show improved outcomes in animal stroke models have failed in clinical trials. Pre-clinical studies using non-human primate (NHP) stroke models prior to initiating human trials are a potential step to improving translation from animal studies to clinical trials. Robotic assessment tools represent a quantitative, reliable, and reproducible means to assess reaching behaviour following stroke in both humans and NHPs. We investigated the use of robotic technology to assess sensorimotor impairments in NHPs following middle cerebral artery occlusion (MCAO). Two cynomolgus macaques underwent transient MCAO for 90 minutes. Approximately 1.5 years following the procedure these NHPs and two non-stroke control monkeys were trained in a reaching task with both arms in the KINARM exoskeleton. This robot permits elbow and shoulder movements in the horizontal plane. The task required NHPs to make reaching movements from a centrally positioned start target to 1 of 8 peripheral targets uniformly distributed around the first target. We analyzed four movement parameters: reaction time, movement time (MT), initial direction error (IDE), and number of speed maxima to characterize sensorimotor deficiencies. We hypothesized reduced performance in these attributes during a neurobehavioural task with the paretic limb of NHPs following MCAO compared to controls. Reaching movements in the non-affected limbs of control and experimental NHPs showed bell-shaped velocity profiles. In contrast, the reaching movements with the affected limbs were highly variable. We found distinctive patterns in MT, IDE, and number of speed peaks between control and experimental monkeys and between limbs of NHPs with MCAO. NHPs with MCAO demonstrated more speed peaks, longer MTs, and greater IDE in their paretic limb compared to controls. These initial results qualitatively match human stroke subjects’ performance, suggesting that robotic neurobehavioural assessment in NHPs with stroke is feasible and could have translational relevance in subsequent human studies. Further studies will be necessary to replicate and expand on these preliminary findings.

An Interactive Model to Teach Motor Skills

There has been a tremendous increase in our knowledge of hum motor performance over the last few decades. Our theoretical understanding of how an individual learns to move is sophisticated and complex. It is difficult however to relate much of this information in practical terms to physical educators, coaches, and therapists concerned with the learning of motor skills (Shumway-Cook & Woolcott, 1995). Much of our knowledge stems from lab testing which often appears to bear little relation to real-life situations. This lack of ecological validity has slowed the flow of information from the theorists and researchers to the practitioners. This paper is concerned with taking some small aspects of motor learning theory, unifying them, and presenting them in a usable fashion. The intention is not to present a recipe for teaching motor skills, but to present a framework from which solutions can be found. If motor performance research has taught us anything, it is that every individual and situation presents unique challenges. By increasing our ability to conceptualize the learning situation we should be able to develop more flexible and adaptive responses to the challege of teaching motor skills. The model presented here allows a teacher, coach, or therapist to use readily available observations and known characteristics about a motor task and to conceptualize them in a manner which allows them to make appropriate teaching/learning decisions.