ROBot-aided system Identification: a novel tool for diagnosis and assessment in Neurological rehabilitation: *ROBIN*

Therapy for spastic paresis in patients with brain damageis focused on either
neural or non-neural causes of increased joint impedance, or both. The clinical
community is in great need of quantitative and valid assessment of
neuromechanical parameters, i.e. the quantitative description of the neural and
non-neural contributors to joint impedance to guide therapy selection.
Nonlinear SIPE techniques allow for capturing the neuromechanical system during
functional movement, i.e. large angular displacements and joint torques. SIPE
is based on haptic robotic manipulators to impose displacements or torques on
joints during simulated functional movements.

Primary objective of this study is to assess the reliability, validity, and
diagnostic value of the neuromechanical parameters of joint impedance estimated
by nonlinear SIPE technology in patients with a spastic paresis.

Observational cohort study. Initial phase (reliability): 1) test- retest and
inter-examiner reliability. Potential phase (validity): 2) comparison of stroke
patients to healthy controls; 3) comparison of neuromechanical parameters to
current clinical tests; 4) and 5) comparison of single joint approach to gait
characteristics and neuromechanical parameters assessed during gait; 6)
comparison of neuromechanical parameters to clinical phenotype expressed by a
gross motor function assessment scale. Quantitative phase (pre-post
comparison): 7) sensitivity of neuromechanical parameters to interventions,
i.e. botulinum toxin and splinting; 8) understanding of underlying
pathophysiological mechanisms. Diagnostic phase (predictive value): 9)
assessment of the predictive value of SIPE

The ROBIN protocol will align with current clinical practice, i.e. will not
interfere with clinical decision making. ROBIN will add extra measurements,
i.e. assessment of impedance around the ankle- or wrist joint using a single
axis robot manipulator and assessment of joint impedance around the ankle joint
using short, fast treadmill perturbations during regular gait analysis for a
selection of patients. Measurements are performed during regular visits to the
outpatient clinic. No extra visits of the patients are required, except during
the initial phase when reliability is assessed for n=15 stroke subjects and
n=15 control subjects. Measurements are non-invasive and bear minimal risks.
During a short time, active participation of patients and subjects is required.
Measurement time per session does not exceed 20 minutes for the single axis
robot manipulator and 60 minutes for the treadmill. Maximal number of sessions
per subject/patients is four.