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Assessing lower limb position sense in stroke using the gradient discrimination test (GradDT™) and step-height
Terry Gorst1, Jenny Freeman1, Kielan Yarrow2
1School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK.
Disability and Rehabilitation
|January 15, 2019
Summary
Two new tests accurately measure lower limb position sense in stroke survivors and the elderly. These reliable and valid tests, GradDT™ and StepDT, offer sensitive clinical assessments for rehabilitation.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Impaired lower limb position sense is common after stroke, affecting balance and mobility.
- Existing clinical tests for position sense may lack sensitivity or practicality for certain populations.
Purpose of the Study:
- To evaluate the psychometric properties of two novel tests designed to assess lower limb position sense: the Gradient Discrimination Test (GradDT™) and the Step Height Discrimination Test (StepDT).
Main Methods:
- The study involved 32 stroke participants and 32 age-matched controls.
- Participants completed the GradDT™ and StepDT, which use a two-alternative forced choice approach to measure discrimination thresholds for under-foot slope and step height.
- Psychometric properties including reliability, agreement, sensitivity, specificity, and validity were assessed.
Main Results:
- Both tests demonstrated excellent intra-rater and inter-rater reliability (ICC ranging from 0.85 to 0.95).
- Discriminant validity was confirmed by significant performance differences between stroke and control groups (p < 0.001).
- The novel tests showed higher sensitivity and specificity in predicting self-reported sensory impairments compared to a standard sensory assessment and correlated well with functional mobility measures.
Conclusions:
- The GradDT™ and StepDT are reliable, valid, and feasible tools for assessing lower limb position sense in ambulatory individuals with chronic stroke and the elderly.
- These novel tests provide clinicians and researchers with sensitive, accurate, and practical measures for use in rehabilitation settings.
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