Kinesiological Instrument for Normal and Altered Reaching Movements (KINARM) is a robotics research tool designed to make quantitative neurological assessments of sensorimotor, proprioception, 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 software provides users with a detailed report of measurements, which can be used to compare subjects with age-matched controls. Additionally, other technologies from BKIN Technologies include gaze-tracking and force plates, which are important for capturing behavioural information of the subject. In combination with the robotic device, a virtual reality system can be implemented as an alternative way for subjects to perform tasks. Some examples of tasks include interacting with an object in the environment or directing a hand to a target.
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.
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).
|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|
Table 1: KINARM Standard Tests and the brain functions measured
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.
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.
Research Studies Undergoing in the Current Settings
- Spinal Cord Injury
- Parkinson’s Disease
- Multiple Sclerosis
- Cardiac arrest
- Transient ischemic attack
- Sport concussion
- Pediatric brain injury
- Neurodegenerative disease
- Brain Diseases
- Healthy Aging
- Cerebral Palsy
Types of KINARM
- 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 disease, or multiple sclerosis
- 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 (exists in End-Point only)
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.
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).
===== References =====
BKIN Technologies Ltd. (2017, Nov 2). KINARM Exoskeleton Lab by BKIN Technologies [Video file]. Retrieved from https://www.youtube.com/watch?v=M7psCB0ZOx0
BKIN Technologies. (2018). KINARM Standard Tests Summary [pdf]. Retrieved from https://www.bkintechnologies.com/bkin-products/kinarm-standard-tests/. Accessed May 10, 2018.
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
stephen scott. (2014, Mar 13). KINARM Robot [Video file]. Retrieved from https://www.youtube.com/watch?v=OpOKVEHOga0stephen scott (2016, May 25). KINARM Kids [Video file]. Retrieved from https://www.youtube.com/watch?v=Fm0lYHMp1xI
- BKIN Technologies. (2018). KINARM Standard Tests Summary [pdf]. Retrieved from https://www.bkintechnologies.com/bkin-products/kinarm-standard-tests/. Accessed May 10, 2018.
- 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
- BKIN Technologies Ltd. (2017, Nov 2). KINARM Exoskeleton Lab by BKIN Technologies [Video file]. Retrieved from https://www.youtube.com/watch?v=M7psCB0ZOx0
- stephen scott. (2014, Mar 13). KINARM Robot [Video file]. Retrieved from https://www.youtube.com/watch?v=OpOKVEHOga0
- stephen scott (2016, May 25). KINARM Kids [Video file]. Retrieved from https://www.youtube.com/watch?v=Fm0lYHMp1xI