Sean P Dukelow

The University of Calgary | HBI · Department of Clinical Neurosciences

Background Proprioception is commonly impaired after stroke. Robotic tools precisely measure multiple attributes of position sense and create large datasets. Previously, we quantified individual performance based on single measured robotic parameters and an overall task score in an arm position matching (APM) task. In the present manuscript, we use...

Background While higher therapeutic intensity improves motor recovery after stroke, translating findings from successful studies is challenging without clear exercise intensity targets. We show in the DOSE trial ¹ more than double the steps and aerobic minutes within a session can be achieved compared with usual care and translates to improved long...

Background Analysis of fluid metabolites has the potential to provide insight into the neuropathophysiology of injury in patients with traumatic brain injury (TBI). Objective Using a ¹H nuclear magnetic resonance (NMR)-based quantitative metabolic profiling approach, this study determined (1) if urinary metabolites change during recovery in patien...

Perception of limb position and motion combines sensory information from spindles in muscles that span one joint (monoarticulars) and two joints (biarticulars). This anatomical organization should create interactions in estimating limb position. We developed two models, one with only monoarticulars (MO Model) and one with monoarticulars and biartic...

Background Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted the...

Background Numerous studies have found associations when change scores are regressed onto initial impairments in people with stroke (slopes ≈ 0.7). However, there are important statistical considerations that limit the conclusions we can draw about recovery from these studies. Objective To provide an accessible checklist of conceptual and analytic...

Sensory phenomena (premonitory sensations/urges) are associated with tics. Noisier afferent signals may underlie tic disorders, possibly affecting proprioception. We compared 64 children with Tourette syndrome or chronic motor tic disorder with 155 typically developing controls in arm‐position matching using a robotic exoskeleton (Kinarm). Passive...

Objective: To develop consensus recommendations for the use of repetitive transcranial magnetic stimulation as an adjunct intervention for upper extremity motor recovery in stroke rehabilitation clinical trials. Methods: The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) convened a multidisciplinary team of clinicians and...

Context Sport-related concussion (SRC) often presents with multidimensional and subtle neurologic deficits that are difficult to detect with standard clinical tests. New assessment approaches that efficiently quantify deficits across multiple neurologic domains are needed. Objective To quantify impairments in postural movements during an assessmen...

Background and Purpose We investigated the effect of higher therapeutic exercise doses on walking during inpatient rehabilitation, typically commencing 1 to 4 weeks poststroke. Methods This phase II, blinded-assessor, randomized controlled trial recruited from 6 Canadian inpatient rehabilitation units, between 2014 and 2018. Subjects (n=75; 25/gro...

Background: Voxel-wise lesion-symptom mapping (VLSM) is a statistical technique to infer the structure-function relationship in patients with cerebral strokes. Previous VLSM research suggests that it is important to adjust for various confounders such as lesion size to minimize the inflation of true effects. The aim of this work is to investigate t...

Background: Robotic technologies for neurological assessment provide sensitive, objective measures of behavioural impairments associated with injuries or disease such as stroke. Previous robotic tasks to assess proprioception typically involve single limbs or in some cases both limbs. The challenge with these approaches is that they often rely on...

Background. Understanding potential sex differences in stroke recovery is important for prognosis, ensuring appropriate allocation of health care resources, and for stratification in research studies. Previously, functional measures have shown poorer outcomes for females, however, little is known about sex differences that may exist in specific mot...

Background: Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a roboti...

Accurate predictions of motor impairment after stroke are of cardinal importance for the patient, clinician, and healthcare system. More than 10 years ago, the proportional recovery rule was introduced by promising that high-fidelity predictions of recovery following stroke were based only on the initially lost motor function, at least for a specif...

Practical Guidance for Outpatient Spasticity Management during the Coronavirus (COVID-19) Pandemic: Canadian Spasticity COVID-19 Task Force - Rajiv Reebye, Heather Finlayson, Curtis May, Lalith Satkunam, Theodore Wein, Thomas Miller, Chris Boulias, Colleen O’Connell, Anibal Bohorquez, Sean Dukelow, Karen Ethans, Farooq Ismail, Waill Khalil, Omar Kh...

A cross sectional study was performed in a tertiary pediatric movement disorders clinic. Ten consecutive patients with essential tremor(ET) were assessed. Clinical evaluation was performed utilizing the Tremor Rating Scale (TRS). Subsequently, triaxial accelerometers were placed equidistantly at the dorsum of the hands and arms, the recording was d...

Background and purpose Clinical assessment scores in acute ischemic stroke are only moderately correlated with lesion volume since lesion location is an important confounding factor. Many studies have investigated gray matter indicators of stroke severity, but the understanding of white matter tract involvement is limited in the early phase after s...

Background: Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation. Methods: Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), len...

Stroke is the leading cause of neurologic disability not only in adults but perinatal and childhood stroke affect millions of children as well worldwide with deficits that last a lifetime. The rapidly increasing evidence base for how noninvasive neuromodulation may enhance stroke recovery in adults may be applicable to the youngest stroke survivors...

Background: While motor deficits are the hallmark of hemiparetic cerebral palsy, children may also experience impairments in visuospatial attention that interfere with participation in complex activities, including sports or driving. In this study, we used a robotic object hitting task to assess bilateral sensorimotor control and visuospatial skil...

Background: Persistent post-concussive symptoms (PPCS) affect up to 30% of individuals following mild traumatic brain injury. PPCS frequently includes exercise intolerance. Sub-symptom threshold aerobic exercise has been proposed as a treatment option for symptom burden and exercise intolerance in this population. The primary aim of this study is...

Deficits in proprioception, the ability to discriminate the relative position and movement of our limbs, affect ~50% of stroke patients and reduce functional outcomes. Our lack of knowledge of the anatomical correlates of proprioceptive processing limits our understanding of the impact that such deficits have on recovery. This research investigated...

Background. Numerous studies have found large statistical relationships between the amount of recovery and initial impairments in people with stroke. When change scores are regressed onto initial impairments, the resulting slope is approximately 0.7 for a variety of outcomes. These findings have led to the 70% "proportional recovery rule" and the a...

Background: Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. T...

Background: Position sense is commonly impaired after stroke. Traditional rehabilitation methods instruct patients to visualize their limbs to compensate for impaired position sense. Objective: Our goal was to evaluate how the use of vision influences impaired position sense. Methods: We examined 177 stroke survivors, an average of 12.7 days (...

Accurate predictions of motor performance after stroke are of cardinal importance for the patient, clinician, and health care system. More than ten years ago, the proportional recovery rule was introduced by promising just that: high-fidelity predictions of recovery following stroke based only on the initially lost motor performance, at least for a...

Position sense and kinesthesia are thought to be independent sub-modalities of proprioception, based on neuromuscular recordings in the periphery. However, little evidence has demonstrated separation in the central nervous system (CNS). Stroke provides an interesting model to examine this dissociation in the CNS due to the heterogeneity of lesion l...

Persistent post-traumatic headache (PTH) following mild traumatic brain injury (mTBI) is one of the most prominent and highly reported persistent post-concussion symptoms (PPCS). Non-pharmacologic treatments, including non-invasive neurostimulation technologies, have been proposed for use. Our objective was to evaluate headache characteristics at o...

Background. Corticospinal tract (CST) damage is considered a biomarker for stroke recovery. Several methods have been used to define CST damage and examine its relationship to motor performance, but which method is most useful remains unclear. Proprioceptive impairment also affects stroke recovery and may be related to CST damage. Methods. Robotic...

Background: We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination. Methods: Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Function...

Aim: Treatment efficacy is established via controlled research trials, but treatment in real-world clinical environments is typically highly variable and may differ from research protocols by necessity. Here, we examined provision of visual retraining for adults after neurological injury at an outpatient rehabilitation program in Calgary, Canada. M...

Background: The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool known to accurately measure mild cognitive impairment (MCI) in many different neurological populations. Objective: We aimed to determine whether a sport-related concussion (SRC) history and other concussion modifiers influence global cognitive function in high-per...

Background and purpose: The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a compr...

Proprioceptive and motor impairments commonly occur after stroke. Relationships between corticospinal tract (CST) fractional anisotropy (FA) and motor recovery have been identified. However, the relationship between sensory tract microstructure and proprioceptive recovery remains unexplored. Using probabilistic tractography, we examined the relatio...

Proprioception is our sense of limb position and movement without vision. Impaired proprioception leads to difficulty performing activities of daily living. While proprioceptive deficits are common after stroke, the neural correlates underlying them are relatively unknown. Recent voxel based lesion analysis evidence suggests that a cluster of regio...

Background and Purpose: The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial inter-observer variability impairs outcome assessment and reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health (ICF), we developed a compre...

Background Robotic technologies to measure human behavior are emerging as a new approach to assess brain function. Recently, we developed a robot-based postural Load Task to assess corrective responses to mechanical disturbances to the arm and found impairments in many participants with stroke compared to a healthy cohort (Bourke et al, J NeuroEngi...

Introduction Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might...

RecoverNow application list. (DOCX)

Transcranial direct-current stimulation (tDCS) enhances motor learning in adults. We have demonstrated that anodal tDCS and high-definition (HD) tDCS of the motor cortex can enhance motor skill acquisition in children, but behavioral mechanisms remain unknown. Robotics can objectively quantify complex sensorimotor functions to better understand mec...

Proprioception encompasses our sense of position and movement of our limbs, as well as the effort with which we engage in voluntary actions. Historically, sense of effort has been linked to centrally generated signals that elicit voluntary movements. We were interested in determining the effect of differences in limb geometry and personal control o...

Proprioceptive deficits are common after stroke and have been associated with poorer recovery. Relatively little is known about the brain regions beyond primary somatosensory cortex that contribute to the percept of proprioception in humans. We examined a large sample (n = 153) of stroke survivors longitudinally to determine which brain regions wer...

Kinesthesia is an essential component of proprioception allowing for perception of movement. Due to neural injury, such as stroke, kinesthesia can be significantly impaired. Throughout neurorehabilitation, clinicians may encourage use of vision to guide limb movement to retrain impaired kinesthesia. However, little evidence exists that vision impro...

Background Understanding how the size of acute lesions and white matter hyperintensities (WMH) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and WMH volume on longitudinal recovery of specific sensory, motor, and cognitiv...

Background: Detailed kinematics of motor impairment of the contralesional ("affected") and ipsilesional ("unaffected") limbs in children with hemiparetic cerebral palsy are not well understood. We aimed to 1) quantify the kinematics of reaching in both arms of hemiparetic children with perinatal stroke using a robotic exoskeleton, and 2) assess th...

Proprioceptive information allows us to perform smooth coordinated movements by constantly updating us with knowledge of the position of our limbs in space. How this information is combined and processed to form conscious perceptions of limb position is still relatively unknown. Several functional neuroimaging studies have attempted to tease out th...

Introduction An important problem in the field of sport-related concussion is the lack of a ‘gold-standard’ clinical assessment tool. Currently, the diagnosis relies heavily on self-reporting of symptoms and observation of clinical signs by medical professionals. To address this, our group has been motivated to develop objective measures of neurolo...

There is a need for better tools to objectively, reliably and precisely assess neurologic function after sport-related concussion (SRC). The purpose of this study was to use a robotic device (Kinesiological Instrument for Normal and Altered Reaching Movements, KINARM) to quantify neurologic impairments in athletes acutely and when clinically asympt...

Background/aim: We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets. Methods: Spee...

Rationale: A top priority in stroke rehabilitation research is determining the appropriate exercise dose to optimize recovery. Although more intensive rehabilitation very early after stroke may be deleterious to recovery, inpatient rehabilitation, occurring after acute care, may be a more appropriate setting to assess therapeutic dose on neurologi...

Background: Stroke is a leading cause of perinatal brain injury with variable outcomes including cerebral palsy and epilepsy. The biological processes that underlie these heterogeneous outcomes are poorly understood. Alterations in developmental myelination are recognized as a major determinant of outcome in preterm brain injury but have not been...

Background: Current assessment tools for sport-related concussion are limited by a reliance on subjective interpretation and patient symptom reporting. Robotic assessments may provide more objective and precise measures of neurological function than traditional clinical tests. Objective: To determine the reliability of assessments of sensory, mo...

Data for test-retest reliability studies. (XLSX)

Perinatal stroke is the leading cause of hemiparetic cerebral palsy (CP), resulting in life-long disability. In this study, we examined the relationship between robotic upper extremity motor impairment and corticospinal tract (CST) diffusion properties. Thirty-three children with unilateral perinatal ischemic stroke (17 arterial, 16 venous) and hem...

Background Proprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements. Proprioceptive disorders are common following stroke, but clinical tests for measuring impairments in proprioception are simple ordinal scales that are unreliable and relatively crude. We developed and validated specif...

Objective: To investigate the use of a robotic assessment tool to quantify sensorimotor, visuospatial attention, and executive function impairments in individuals with traumatic brain injury (TBI). Setting: Foothills Hospital (Calgary, Canada). Participants: Twenty-three subjects with first-time TBI in the subacute to chronic phase participate...

Background and purpose: Identifying practical ways to accurately measure exercise intensity and dose in clinical environments is essential to advancing stroke rehabilitation. This is especially relevant in monitoring walking activity during inpatient rehabilitation where recovery is greatest. This study evaluated the accuracy of a readily availabl...

Objective To determine the reliability of the KINARM robot in assessing sensorimotor and neurocognitive function in athletes. Design Test-retest reliability. Setting Sport Medicine Clinic. Participants Thirty-nine randomly selected athletes (mean age: 18±3 years) over 2011–2012 and 2014–2015 seasons. Outcome measures Sixty-three parameters fro...

Objective To evaluate brain adaptation following concussion. Do youth with a history of previous or acute concussion require more ball throws to land on or near a target, when wearing prism glasses (bend light to the left by 15˚), than youth with none? Design Cross-sectional study. Setting Sport Injury Prevention Research Centre, Alberta, Ca...