The Clinical Need
BKIN developed KINARM Standard Tests to address one of the most urgent issues in the management of brain injury and disease: the lack of objective assessment.
Clinician scientists have always used their keen perception of human behavior to identify neurological impairments, and help diagnose brain disorders. A clinician will look at how a patient moves and interacts with them during a standard neurological exam. However to assess these functions, the clinician must rely heavily on their subjective estimate of the patient’s ability to perform behaviors that represent various functions. For example, to test visuomotor coordination, the clinician assesses the ability of a patient to touch their nose and then the clinician’s finger. The test is scored on a three point scale ( 0, 1 or 2) – a necessarily coarse ordinal score to ensure reliability. Unfortunately, such coarseness makes it difficult to identify subtle changes in sensorimotor function, such as small delays in reaction or increases in movement variability. This coarseness leads to floor and ceiling effects in the scoring system. It is widely recognized in the literature that ineffective scoring systems represent a significant barrier to the development of new therapies.
The result is a vicious circle between neurological assessment and neurorehabilitation: the lack of sensitive tools to quantify dysfunction makes demonstrating the effectiveness of novel therapeutic approaches difficult. Similarly, limited improvement by existing treatments, as measured by current assessment tools, implies no need for better assessment tools (Scott and Dukelow, 2011).
BKIN has addressed this need by developing KINARM Labs that are objective, quantitative and sensitive to change. Driven by our suite of standardized protocols and analyses called KINARM Standard Tests, KINARM Labs are providing clinician scientists around the world with advanced instrumentation to explore a range of issues on brain injuries and disease. We are fortunate to be able to profile here some of the research questions being addressed.
Stroke/Acquired Brain Injury
KINARM Labs have enabled dozens of publications conducting research into the identification and quantification of neurological impairments arising from stroke and traumatic brain injury. These have been recently recognized by the 2016 AHA Guidelines for Stroke Recovery (Winstein et al, 2016). Studies are also underway in stroke drug development, quantifying impairments in cardiac arrest, identification of deficits in transient ischemic attack and sport concussion.
Pediatric Brain Injury
Application of KINARM Labs range from identification of sensorimotor deficits in Fetal Alcohol Disorder, to return to play decisions in sport concussion, to quantification of deficits for subjects with cerebral palsy. Recently, Dr. Adam Kirton of Alberta Children’s Hospital released this video report on his work with proprioceptive deficits in children with CP.
KINARM Exoskeleton Lab has enabled significant research on cerebellar disorders. New applications for KINARM Labs are emerging in the identification of pre-symptomatic deficits related to Alzheimer’s, quantification of sensorimotor deficits in ALS and development of new drug therapies for Parkinson’s.
Dr. Catherine Mercier (CIRRIS, l’Université Laval) is using the KINARM in various populations suffering from chronic pain (complex regional pain syndrome, fibromyalgia, spinal cord injury) to study how pain affects body perception and sensorimotor performance.
More information coming soon!
Clinical Research Sites
KINARM Labs have been used at top-tier clinical research sites for over a decade.