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Caine S, Alaverdashvili M, Colbourne F, Muir GD, Paterson PG. A modified rehabilitation paradigm bilaterally increased rat extensor digitorum communis muscle size but did not improve forelimb function after stroke. PLoS One 2024; 19:e0302008. [PMID: 38603768 PMCID: PMC11008896 DOI: 10.1371/journal.pone.0302008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Malnutrition after stroke may lessen the beneficial effects of rehabilitation on motor recovery through influences on both brain and skeletal muscle. Enriched rehabilitation (ER), a combination of environmental enrichment and forelimb reaching practice, is used preclinically to study recovery of skilled reaching after stroke. However, the chronic food restriction typically used to motivate engagement in reaching practice is a barrier to using ER to investigate interactions between nutritional status and rehabilitation. Thus, our objectives were to determine if a modified ER program comprised of environmental enrichment and skilled reaching practice motivated by a short fast would enhance post-stroke forelimb motor recovery and preserve forelimb muscle size and metabolic fiber type, relative to a group exposed to stroke without ER. At one week after photothrombotic cortical stroke, male, Sprague-Dawley rats were assigned to modified ER or standard care for 2 weeks. Forelimb recovery was assessed in the Montoya staircase and cylinder task before stroke and on days 5-6, 22-23, and 33-34 after stroke. ER failed to improve forelimb function in either task (p > 0.05). Atrophy of extensor digitorum communis (EDC) and triceps brachii long head (TBL) muscles was not evident in the stroke-targeted forelimb on day 35, but the area occupied by hybrid fibers was increased in the EDC muscle (p = 0.038). ER bilaterally increased EDC (p = 0.046), but not TBL, muscle size; EDC muscle fiber type was unchanged by ER. While the modified ER did not promote forelimb motor recovery, it does appear to have utility for studying the role of skeletal muscle plasticity in post-stroke recovery.
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Affiliation(s)
- Sally Caine
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | | | - Frederick Colbourne
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Gillian D. Muir
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Phyllis G. Paterson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Dunn JA, Wong B, Sinclair SK, Henninger HB, Bachus KN, Foreman KB. Extended physiological proprioception is affected by transhumeral Socket-Suspended prosthesis use. J Biomech 2024; 166:112054. [PMID: 38513398 DOI: 10.1016/j.jbiomech.2024.112054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
The objective of this study was to define targeted reaching performance without visual information for transhumeral (TH) prosthesis users, establishing baseline information about extended physiological proprioception (EPP) in this population. Subjects completed a seated proprioceptive targeting task under simultaneous motion capture, using their prosthesis and intact limb. Eight male subjects, median age of 58 years (range 29-77 years), were selected from an ongoing screening study to participate. Five subjects had a left-side TH amputation, and three a right-side TH amputation. Median time since amputation was 9 years (range 3-54 years). Four subjects used a body-powered prosthetic hook, three a myoelectric hand, and one a myoelectric hook. The outcome measures were precision and accuracy, motion of the targeting hand, and joint angular displacement. Subjects demonstrated better precision when targeting with their intact limb compared to targeting with their prosthesis, 1.9 cm2 (0.8-3.0) v. 7.1 cm2 (1.3-12.8), respectively, p = 0.008. Subjects achieved a more direct reach path ratio when targeting with the intact limb compared to with the prosthesis, 1.2 (1.1-1.3) v. 1.3 (1.3-1.4), respectively, p = 0.039 The acceleration, deceleration, and corrective phase durations were consistent between conditions. Trunk angular displacement increased in flexion, lateral flexion, and axial rotation while shoulder flexion decreased when subjects targeted with their prosthesis compared to the intact limb. The differences in targeting precision, reach patio ratio, and joint angular displacements while completing the targeting task indicate diminished EPP. These findings establish baseline information about EPP in TH prosthesis users for comparison as novel prosthesis suspension systems become more available to be tested.
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Affiliation(s)
- Julia A Dunn
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States
| | - Bob Wong
- College of Nursing University of Utah, United States
| | - Sarina K Sinclair
- Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States
| | - Heath B Henninger
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States
| | - Kent N Bachus
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States
| | - K Bo Foreman
- Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training University of Utah, United States.
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Ateş Sari Y, Aldeges W, Ünlüer NÖ. An investigation of upper extremity function, sleep quality, and functional independence in patients with poststroke shoulder pain: a cross-sectional study. Physiother Theory Pract 2023:1-8. [PMID: 37651602 DOI: 10.1080/09593985.2023.2253313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient's life. OBJECTIVE To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP. METHODS This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression. RESULTS Upper extremity function decreased (p < .05), only the sleep disturbance sub-parameter of sleep quality increased (p = .01), and functional independence increased in patients with PSSP (p < .001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) (p < .05). CONCLUSIONS PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke.
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Affiliation(s)
- Yasemin Ateş Sari
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Çubuk/Ankara, Turkey
| | - Wala'a Aldeges
- Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Etlik/Ankara, Turkey
| | - Nezehat Özgül Ünlüer
- Gülhane Faculty of Physiotherapy and Rehabilitation, Health Sciences University, Keçiören/Ankara, Turkey
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Scano A, Guanziroli E, Brambilla C, Amendola C, Pirovano I, Gasperini G, Molteni F, Spinelli L, Molinari Tosatti L, Rizzo G, Re R, Mastropietro A. A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation. Healthcare (Basel) 2023; 11:2282. [PMID: 37628480 PMCID: PMC10454517 DOI: 10.3390/healthcare11162282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Caterina Amendola
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
| | - Ileana Pirovano
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Lorenzo Spinelli
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Giovanna Rizzo
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Rebecca Re
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Alfonso Mastropietro
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
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Kim D, Baghi R, Koh K, Zhang LQ. MCP extensors respond faster than flexors in individuals with severe-to-moderate stroke-caused impairment: Evidence of uncoupled neural pathways. Front Neurol 2023; 14:1119761. [PMID: 37034096 PMCID: PMC10075324 DOI: 10.3389/fneur.2023.1119761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Damage in the corticospinal system following stroke produces imbalance between flexors and extensors in the upper extremity, eventually leading to flexion-favored postures. The substitution of alternative tracts for the damaged corticospinal tract is known to excessively activate flexors of the fingers while the fingers are voluntarily being extended. Here, we questioned whether the cortical source or/and neural pathways of the flexors and extensors of the fingers are coupled and what factor of impairment influences finger movement. In this study, a total of seven male participants with severe-to-moderate impairment by a hemiplegic stroke conducted flexion and extension at the metacarpophalangeal (MCP) joints in response to auditory tones. We measured activation and de-activation delays of the flexor and extensor of the MCP joints on the paretic side, and force generation. All participants generated greater torque in the direction of flexion (p = 0.017). Regarding co-contraction, coupled activation of the extensor is also made during flexion in the similar way to coupled activation of the flexor made during extension. As opposite to our expectation, we observed that during extension, the extensor showed marginally significantly faster activation (p = 0.66) while it showed faster de-activation (p = 0.038), in comparison to activation and de-activation of the flexor during flexion. But movement smoothness was not affected by those factors. Our results imply that the cortical source and neural pathway for the extensors of the MCP joints are not coupled with those for the flexors of the MCP joints.
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Affiliation(s)
- Dongwon Kim
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
- Department of Bioengineering, School of Engineering, University of Maryland, College Park, MD, United States
| | - Raziyeh Baghi
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Kyung Koh
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
- Department of Bioengineering, School of Engineering, University of Maryland, College Park, MD, United States
- Department of Orthopedics, University of Maryland, Baltimore, MD, United States
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Lapresa M, Zollo L, Cordella F. A user-friendly automatic toolbox for hand kinematic analysis, clinical assessment and postural synergies extraction. Front Bioeng Biotechnol 2022; 10:1010073. [PMID: 36440447 PMCID: PMC9686293 DOI: 10.3389/fbioe.2022.1010073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2022] [Indexed: 12/07/2023] Open
Abstract
The clinical assessment of the human hand is typically conducted through questionnaires or tests that include objective (e.g., time) and subjective (e.g., grasp quality) outcome measures. However, there are other important indicators that should be considered to quantify grasp and movement quality in addition to the time needed by a subject to execute a task, and this is essential for human and artificial hands that attempt to replicate the human hand properties. The correct estimation of hand kinematics is fundamental for computing these indicators with high fidelity, and a technical background is typically required to perform this analysis. In addition, to understand human motor control strategies as well as to replicate them on artificial devices, postural synergies were widely explored in recent years. Synergies should be analyzed not only to investigate possible modifications due to musculoskeletal and/or neuromuscular disorders, but also to test biomimetic hands. The aim of this work is to present an open source toolbox to perform all-in-one kinematic analysis and clinical assessment of the hand, as well as to perform postural synergies extraction. In the example provided in this work, the tool takes as input the position of 28 retroreflective markers with a diameter of 6 mm, positioned on specific anatomical landmarks of the hand and recorded with an optoelectronic motion capture system, and automatically performs 1) hand kinematic analysis (i.e., computation of 23 joint angles); 2) clinical assessment, by computing indicators that allow quantifying movement efficiency (Peak Grip Aperture), smoothness (Normalized Dimensionless Jerk Grasp Aperture) and speed (Peak Velocity of Grasp Aperture), planning capabilities (Time to Peak Grip Aperture), spatial posture (Wrist and Finger Joint Angles) and grasp stability (Posture of Hand Finger Joints), and 3) postural synergies extraction and analysis through the Pareto, Scree and Loadings plots. Two examples are described to demonstrate the applicability of the toolbox: the first one aiming at performing a clinical assessment of a volunteer and the second one aiming at extracting and analyzing the volunteer's postural synergies. The tool allows calculating joint angles with high accuracy (reconstruction errors below 4 mm and 3.2 mm for the fingers and wrist respectively) and automatically performing clinical assessment and postural synergies extraction. Results can be visually inspected, and data can be saved for any desired post processing analysis. Custom-made protocols to extract joint angles, based on different markersets, could be also integrated in the toolbox. The tool can be easily exploitable in clinical contexts, as it does not require any particular technical knowledge to be used, as confirmed by the usability evaluation conducted (perceived usability = 94.2 ± 5.4). In addition, it can be integrated with the SynGrasp toolbox to perform grasp analysis of underactuated virtual hands based on postural synergies.
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Affiliation(s)
- Martina Lapresa
- Department of Engineering, Research Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, Roma, Italy
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Isenstein EL, Waz T, LoPrete A, Hernandez Y, Knight EJ, Busza A, Tadin D. Rapid assessment of hand reaching using virtual reality and application in cerebellar stroke. PLoS One 2022; 17:e0275220. [PMID: 36174027 PMCID: PMC9522266 DOI: 10.1371/journal.pone.0275220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
The acquisition of sensory information about the world is a dynamic and interactive experience, yet the majority of sensory research focuses on perception without action and is conducted with participants who are passive observers with very limited control over their environment. This approach allows for highly controlled, repeatable experiments and has led to major advances in our understanding of basic sensory processing. Typical human perceptual experiences, however, are far more complex than conventional action-perception experiments and often involve bi-directional interactions between perception and action. Innovations in virtual reality (VR) technology offer an approach to close this notable disconnect between perceptual experiences and experiments. VR experiments can be conducted with a high level of empirical control while also allowing for movement and agency as well as controlled naturalistic environments. New VR technology also permits tracking of fine hand movements, allowing for seamless empirical integration of perception and action. Here, we used VR to assess how multisensory information and cognitive demands affect hand movements while reaching for virtual targets. First, we manipulated the visibility of the reaching hand to uncouple vision and proprioception in a task measuring accuracy while reaching toward a virtual target (n = 20, healthy young adults). The results, which as expected revealed multisensory facilitation, provided a rapid and a highly sensitive measure of isolated proprioceptive accuracy. In the second experiment, we presented the virtual target only briefly and showed that VR can be used as an efficient and robust measurement of spatial memory (n = 18, healthy young adults). Finally, to assess the feasibility of using VR to study perception and action in populations with physical disabilities, we showed that the results from the visual-proprioceptive task generalize to two patients with recent cerebellar stroke. Overall, we show that VR coupled with hand-tracking offers an efficient and adaptable way to study human perception and action.
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Affiliation(s)
- E. L. Isenstein
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
| | - T. Waz
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
| | - A. LoPrete
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
- Center for Neuroscience and Behavior, American University, Washington, DC, United States of America
- Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Y. Hernandez
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- The City College of New York, CUNY, New York, NY, United States of America
| | - E. J. Knight
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - A. Busza
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - D. Tadin
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
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The Effect of Task-Oriented Training on Upper-Limb Function, Visual Perception, and Activities of Daily Living in Acute Stroke Patients: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063186. [PMID: 35328874 PMCID: PMC8954660 DOI: 10.3390/ijerph19063186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
This pilot study aimed to investigate the effects of task-oriented training on upper-limb functioning, visual perception, and activities of daily living (ADL) in acute stroke patients. Of 20 participants, 10 were randomly assigned in a 1:1 ratio to experimental and control groups. Task-oriented training and table-top activity training were implemented for 6 weeks. Change in upper-limb functioning was assessed with the Manual Function Test (MFT); visual perceptual skill and ADL performance were evaluated using the Motor-Free Visual Perception Test—Vertical (MVPT-V) and Korean Modified Barthel Index (K-MBI), respectively. There was a significant interaction in the MFT and MBI score between the group and time (p < 0.05), but the group effect was not significant (p > 0.05). The MFT and MBI score significantly increased in both groups after the intervention (p < 0.001), but the effect size was greater in the task-oriented training group than the table-top activity training group. No significant interaction with MVPT-V score was found between the group and time (p > 0.05), and no statistical group difference was found either (p > 0.05). Both groups showed significant improvement in their MVPT-V score after the intervention (p < 0.001). The pilot study findings demonstrate that both task-oriented training and table-top activity training are effective in recovering upper-limb function, visual perception, and ADL in acute stroke patients.
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Alabdulaali L, Hickman L, Punt TD, Jenkinson N. Effectiveness of transcranial direct current stimulation on hand dexterity in stroke patients: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e056064. [PMID: 35173006 PMCID: PMC8852708 DOI: 10.1136/bmjopen-2021-056064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Hand dexterity is the ability to execute the skilful movements using the hand and fingers. It is commonly impaired poststroke resulting in a profound deterioration in the quality of life for patients with stroke. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation, which has gained a popularity as an adjunct therapy in recovering motor dysfunction poststroke. Promising results have been gained from applying tDCS in combination with motor rehabilitation, however, the outcome of tDCS on the upper limb motor function poststroke has been varied. Different results are potentially related to the discrepancy of the area of brain stimulation. Therefore, we aim to enhance the application of tDCS to improve its effectiveness in recovering hand dexterity through testing our hypothesis that stimulating the primary motor cortex could improve fine dexterity more than gross dexterity. METHODS AND ANALYSIS This protocol has been reported according to Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. CENTRAL, MEDLINE, EMBASE, SCOPUS, Web of Science and CINAHL databases will be searched with no restriction in language and publication date. The selected studies will be randomised controlled trial investigating the effect of tDCS alone or in combination with motor rehabilitation in improving hand dexterity of patients with stroke with upper limb hemiparesis. The outcomes of interest are fine and gross hand dexterity measures. Two independent reviewers will assess the eligibility of the study, extract data and appraise the methodological quality. The data will be pooled in a meta-analysis if applicable or interpreted narratively. Grading of Recommendations, Assessment, Development and Evaluation approach will be used to assess the overall quality of evidence for the fine and gross dexterity measures. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The dissemination plan is to publish the results in a peer-review journal and presenting results in a conference. PROSPERO REGISTRATION NUMBER CRD42021262186.
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Affiliation(s)
- Lulwa Alabdulaali
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lydia Hickman
- School of Psychology, University of Birmingham, Birmingham, UK
| | - T David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ned Jenkinson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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Rätz R, Conti F, Müri RM, Marchal-Crespo L. A Novel Clinical-Driven Design for Robotic Hand Rehabilitation: Combining Sensory Training, Effortless Setup, and Large Range of Motion in a Palmar Device. Front Neurorobot 2021; 15:748196. [PMID: 34987371 PMCID: PMC8721892 DOI: 10.3389/fnbot.2021.748196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/12/2021] [Indexed: 01/19/2023] Open
Abstract
Neurorehabilitation research suggests that not only high training intensity, but also somatosensory information plays a fundamental role in the recovery of stroke patients. Yet, there is currently a lack of easy-to-use robotic solutions for sensorimotor hand rehabilitation. We addressed this shortcoming by developing a novel clinical-driven robotic hand rehabilitation device, which is capable of fine haptic rendering, and that supports physiological full flexion/extension of the fingers while offering an effortless setup. Our palmar design, based on a parallelogram coupled to a principal revolute joint, introduces the following novelties: (1) While allowing for an effortless installation of the user's hand, it offers large range of motion of the fingers (full extension to 180° flexion). (2) The kinematic design ensures that all fingers are supported through the full range of motion and that the little finger does not lose contact with the finger support in extension. (3) We took into consideration that a handle is usually comfortably grasped such that its longitudinal axis runs obliquely from the metacarpophalangeal joint of the index finger to the base of the hypothenar eminence. (4) The fingertip path was optimized to guarantee physiologically correct finger movements for a large variety of hand sizes. Moreover, the device possesses a high mechanical transparency, which was achieved using a backdrivable cable transmission. The transparency was further improved with the implementation of friction and gravity compensation. In a test with six healthy participants, the root mean square of the human-robot interaction force was found to remain as low as 1.37 N in a dynamic task. With its clinical-driven design and easy-to-use setup, our robotic device for hand sensorimotor rehabilitation has the potential for high clinical acceptance, applicability and effectiveness.
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Affiliation(s)
- Raphael Rätz
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - René M. Müri
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
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Hwang D, Shin JH, Kwon S. Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke. SENSORS 2021; 21:s21217055. [PMID: 34770362 PMCID: PMC8587557 DOI: 10.3390/s21217055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.
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Affiliation(s)
- Donghwan Hwang
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
| | - Joon-Ho Shin
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
| | - Suncheol Kwon
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
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12
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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13
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Plantin J, Verneau M, Godbolt AK, Pennati GV, Laurencikas E, Johansson B, Krumlinde-Sundholm L, Baron JC, Borg J, Lindberg PG. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology 2021; 97:e706-e719. [PMID: 34400568 PMCID: PMC8377875 DOI: 10.1212/wnl.0000000000012366] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 05/20/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. METHOD In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). RESULTS Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point (r > 0.88, p < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery. CONCLUSION Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery. CLINICALTRIALSGOV IDENTIFIER NCT02878304. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
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Affiliation(s)
- Jeanette Plantin
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France.
| | - Marion Verneau
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Alison K Godbolt
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Gaia Valentina Pennati
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Evaldas Laurencikas
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Birgitta Johansson
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Lena Krumlinde-Sundholm
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jean-Claude Baron
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jörgen Borg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Påvel G Lindberg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
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14
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Russo C, Veronelli L, Casati C, Monti A, Perucca L, Ferraro F, Corbo M, Vallar G, Bolognini N. Explicit motor sequence learning after stroke: a neuropsychological study. Exp Brain Res 2021; 239:2303-2316. [PMID: 34091696 PMCID: PMC8282572 DOI: 10.1007/s00221-021-06141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Motor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.
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Affiliation(s)
- Cristina Russo
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.
| | - Laura Veronelli
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Francesco Ferraro
- Riabilitazione Specialistica Neuromotoria - Dipartimento di Neuroscienze, ASST "Carlo Poma" di Mantova - Presidio di Riabilitazione Multifunzionale di Bozzolo, Mantua, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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15
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Stewart JC, Handlery K, Baird JF, Blanck EL, Pathak G, Fritz SL. Targeted Engagement of the Action Selection Network during Task-Oriented Arm Training after Stroke. Neural Plast 2020; 2020:8814158. [PMID: 33029117 PMCID: PMC7530513 DOI: 10.1155/2020/8814158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Action selection (AS), or selection of an action from a set of alternatives, is an important movement preparation process that engages a frontal-parietal network. The addition of AS demands to arm training after stroke could be used to engage this motor planning process and the neural network that supports it. The purpose of this case series is to describe the feasibility and outcomes associated with task-oriented arm training aimed at engaging the AS behavioral process and the related neural network in three individuals with chronic stroke. Three participants with mild to moderate motor deficits completed 13 to 15 sessions of task-oriented arm training that included AS cues for each movement repetition; cues dictated movement direction, height, or distance. Before and after training, individuals completed an AS brain-behavior probe during functional MRI. AS behavioral performance improved after training (increased accuracy, decreased reaction time) in all participants while brain activation in the AS network (dorsal premotor, parietal, dorsolateral prefrontal cortices) decreased in two participants. Gains in motor function were also found in all three participants, especially on patient-reported measures of perceived difficulty and confidence to complete upper extremity functional tasks. It was feasible to target the AS behavioral process and the related neural network through the addition of AS demands to functional, task-oriented arm training in three individuals with mild to moderate motor dysfunction poststroke.
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Affiliation(s)
- Jill Campbell Stewart
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Jessica F. Baird
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Erika L. Blanck
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
| | - Geetanjali Pathak
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Stacy L. Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
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16
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Mesquita IA, Fonseca PFPD, Borgonovo-Santos M, Ribeiro E, Pinheiro ARV, Correia MV, Silva C. Comparison of upper limb kinematics in two activities of daily living with different handling requirements. Hum Mov Sci 2020; 72:102632. [PMID: 32452388 DOI: 10.1016/j.humov.2020.102632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recently, kinematic analysis of the drinking task (DRINK) has been recommended to assess the quality of upper limb (UL) movement after stroke, but the accomplishment of this task may become difficult for poststroke patients with hand impairment. Therefore, it is necessary to study ADLs that involve a simpler interaction with a daily life target, such as the turning on a light task (LIGHT). As the knowledge of movement performed by healthy adults becomes essential to assess the quality of movement of poststroke patients, the main goal of this article was to compare the kinematic strategies used by healthy adults in LIGHT with those that are used in DRINK. METHODS 63 adults, aged 30 to 69 years old, drank water and turned on a light, using both ULs separately, while seated. The movements of both tasks were captured by a 3D motion capture system. End-point and joint kinematics of reaching and returning phases were analysed. A multifactorial analysis of variance with repeated measures was applied to the kinematic metrics, using age, sex, body mass index and dominance as main factors. RESULTS Mean and peak velocities, index of curvature, shoulder flexion and elbow extension were lower in LIGHT, which suggests that the real hand trajectory was smaller in this task. In LIGHT, reaching was less smooth and returning was smoother than DRINK. The instant of peak velocity was similar in both tasks. There was a minimal anterior trunk displacement in LIGHT, and a greater anterior trunk displacement in DRINK. Age and sex were the main factors which exerted effect on some of the kinematics, especially in LIGHT. CONCLUSION The different target formats and hand contact in DRINK and LIGHT seem to be responsible for differences in velocity profile, efficiency, smoothness, joint angles and trunk displacement. Results suggest that the real hand trajectory was smaller in LIGHT and that interaction with the switch seems to be less demanding than with the glass. Accordingly, LIGHT could be a good option for the assessment of poststroke patients without grasping ability. Age and sex seem to be the main factors to be considered in future studies for a better match between healthy and poststroke adults.
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Affiliation(s)
- Inês Albuquerque Mesquita
- Center for Rehabilitation Research (CIR) (CIR), School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal; Department of Functional Sciences, School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal.
| | | | - Márcio Borgonovo-Santos
- LABIOMEP: Porto Biomechanics Laboratory, University of Porto. R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Edgar Ribeiro
- Center for Rehabilitation Research (CIR) (CIR), School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal
| | - Ana Rita Vieira Pinheiro
- Center for Rehabilitation Research (CIR) (CIR), School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal; School of Health Sciences, University of Aveiro, Edifício 30, Agras do Crasto - Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Miguel Velhote Correia
- Department of Electrical and Computer Engineering, Faculty of Engineering of the University of Porto (FEUP), R. Dr. Roberto Frias, 4200-465 Porto, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), R. Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Cláudia Silva
- Center for Rehabilitation Research (CIR) (CIR), School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal; Department of Physiotherapy, School of Health of Polytechnic of Porto (ESS-P.Porto), Rua Dr. António Bernardino de Almeida, 400, 4200 - 072 Porto, Portugal
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17
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Fan W, Zhang Y, Wang QM, Bai Y, Wu Y. An interactive motion-tracking system for home-based assessing and training reach-to-target tasks in stroke survivors-a preliminary study. Med Biol Eng Comput 2020; 58:1529-1547. [PMID: 32405968 DOI: 10.1007/s11517-020-02173-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/26/2020] [Indexed: 01/08/2023]
Abstract
Quantitative evaluation and training of the reach-to-target ability in stroke patients are needed for postdischarge rehabilitation, which can be achieved using a motion-tracking system. However, most of these systems are either costly, involve sophisticated parameter interpretation, or are not designed for rehabilitation. We developed an interactive reach-to-target assessment and training system (IRTATS) based on a camera and three marker straps to detect tracking signals. IRTATS supports audiovisual feedback, personal goal setting, and use in a small clinic or home without the internet. This study aims to evaluate the reliability, validity of IRTATS, and its measurement accuracy of the range of motion (ROM). Ninety-nine stroke patients and 20 healthy adults were recruited for the study. Kinematic variables and active joint ROM (AROM) were assessed using IRTATS. The AROM was measured by a universal goniometer, and scores from multiple clinical scales concerning motor and activity capability were calculated. Although the AROMs measured by IRTATS and the goniometer did not agree, IRTATS has clinically acceptable reliability and validity. Three variables in IRTATS could discriminate the motor performance of patients and healthy subjects. IRTATS may provide a new supplement to conventional physiotherapy in the assessment of the reach-to-target ability in stroke patients. Graphical abstract System configuration • The system is based on an infrared camera and the adjustable marker straps as a sensor module. • It is portable and compact, and has clinically acceptable reliability and validity. • It supports audiovisual feedback, personal goal setting, and use in regions without the internet. • It can be used as an adjunct to conventional physiotherapy in the assessment of the reach-to-target ability.
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Affiliation(s)
- Wenke Fan
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yuling Zhang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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18
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Williams HE, Chapman CS, Pilarski PM, Vette AH, Hebert JS. Gaze and Movement Assessment (GaMA): Inter-site validation of a visuomotor upper limb functional protocol. PLoS One 2019; 14:e0219333. [PMID: 31887218 PMCID: PMC6936776 DOI: 10.1371/journal.pone.0219333] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Successful hand-object interactions require precise hand-eye coordination with continual movement adjustments. Quantitative measurement of this visuomotor behaviour could provide valuable insight into upper limb impairments. The Gaze and Movement Assessment (GaMA) was developed to provide protocols for simultaneous motion capture and eye tracking during the administration of two functional tasks, along with data analysis methods to generate standard measures of visuomotor behaviour. The objective of this study was to investigate the reproducibility of the GaMA protocol across two independent groups of non-disabled participants, with different raters using different motion capture and eye tracking technology. Methods Twenty non-disabled adults performed the Pasta Box Task and the Cup Transfer Task. Upper body and eye movements were recorded using motion capture and eye tracking, respectively. Measures of hand movement, angular joint kinematics, and eye gaze were compared to those from a different sample of twenty non-disabled adults who had previously performed the same protocol with different technology, rater and site. Results Participants took longer to perform the tasks versus those from the earlier study, although the relative time of each movement phase was similar. Measures that were dissimilar between the groups included hand distances travelled, hand trajectories, number of movement units, eye latencies, and peak angular velocities. Similarities included all hand velocity and grip aperture measures, eye fixations, and most peak joint angle and range of motion measures. Discussion The reproducibility of GaMA was confirmed by this study, despite a few differences introduced by learning effects, task demonstration variation, and limitations of the kinematic model. GaMA accurately quantifies the typical behaviours of a non-disabled population, producing precise quantitative measures of hand function, trunk and angular joint kinematics, and associated visuomotor behaviour. This work advances the consideration for use of GaMA in populations with upper limb sensorimotor impairment.
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Affiliation(s)
- Heather E. Williams
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Craig S. Chapman
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick M. Pilarski
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Albert H. Vette
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jacqueline S. Hebert
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- * E-mail:
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19
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Roche N, Bonnyaud C, Reynaud V, Bensmail D, Pradon D, Esquenazi A. Motion analysis for the evaluation of muscle overactivity: A point of view. Ann Phys Rehabil Med 2019; 62:442-452. [PMID: 31276837 DOI: 10.1016/j.rehab.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
Muscle overactivity is a general term for pathological increases in muscle activity such as spasticity. It is caused by damage to the central nervous system at the cortical, subcortical or spinal levels, leading to an upper motor neuron syndrome. In routine clinical practice, muscle overactivity, which induces abnormal muscle tone, is usually evaluated by using the Modified Ashworth Scale or the Tardieu Scale. However, both of these scales involve testing in passive conditions that do not always reflect muscle activity during dynamic tasks such as gait or reaching. To determine appropriate treatment strategies, muscle overactivity should be evaluated by using objective measures in dynamic conditions. Instrumental motion analysis systems that include 3-D motion analysis and electromyography are very useful for this purpose. The method can be used to identify patterns of abnormal muscle activity that can be related to abnormal kinematic patterns. It allows for objective and accurate assessment of the effects of treatments to reduce muscle overactivity on the movement to be improved. The aim of this point-of-view article is to describe the utility of instrumental motion analysis and to outline both its numerous advantages in evaluating muscle overactivity and to present the current limitations for its use (e.g., cost, the need for an engineer, errors relating to marker placement and cross talk between electromyography sensors).
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Affiliation(s)
- N Roche
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France.
| | - C Bonnyaud
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - V Reynaud
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - D Bensmail
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - D Pradon
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - A Esquenazi
- Gait and Motion Analysis Laboratory, Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, PA, USA
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20
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Broome K, Hudson I, Potter K, Kulk J, Dunn A, Arm J, Zeffiro T, Cooper G, Tian H, van Vliet P. A Modified Reach-to-Grasp Task in a Supine Position Shows Coordination Between Elbow and Hand Movements After Stroke. Front Neurol 2019; 10:408. [PMID: 31139132 PMCID: PMC6518444 DOI: 10.3389/fneur.2019.00408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: A modified reach-to-grasp task has been developed for the purpose of investigating arm-hand coordination in a supine position in the functional magnetic resonance imaging environment. The objective of this study was to investigate the kinematics of the reach-to-grasp task, in stroke and healthy participants. Design: Observational cohort study. Setting: Movement laboratory. Participants: Ten stroke participants and 10 age-matched healthy participants performed 10 repetitions of the modified reach-to-grasp task in two conditions—a natural condition and a standardized condition in a splint. Intervention: Not applicable. Main Outcome Measures: Kinematic variables of start time of transport, start time of aperture, movement duration, time of peak velocity (PV), percentage time of PV, peak deceleration (PD), percentage time of PD, peak aperture (PA), time of PA, and percentage time of PA were recorded. The correlation between key events in the grasp and transport trajectories were investigated. Performance between conditions and groups were compared. Results: Both groups demonstrated a significant correlation between the start time of aperture and the start time of transport and between the time of PA and PV in both conditions. A significant correlation was found between the time of PA and the PD in both conditions for the healthy group, but in neither condition for the stroke group. Movements by participants with stroke had a significantly longer movement duration, a smaller PV, and an earlier absolute time of PV and PD, and an earlier percentage time of PV and PD. They also had a smaller aperture than healthy participants. Wearing the splint resulted in a significantly higher PV, later absolute and percentage time of PV, PD, and PA, and a smaller PA compared to moving without the splint. The timing of transport variables time to peak velocity and time to peak deceleration, were strongest determinants of movement duration. Conclusion: The modified reach-to-grasp movement performed without the constraint of the splint, demonstrates similar motor control and coordination between the grasp and transport components of reach-to-grasp as in seated reach-to-grasp. This provides a new task that may be used to explore reach-to-grasp in the fMRI environment.
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Affiliation(s)
- Kate Broome
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Irene Hudson
- Department of Mathematical Sciences, College of Science, Engineering and Health, Royal Melbourne Institute of Technology, Melbourne, VIC, Australia.,School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Kaitlyn Potter
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Jason Kulk
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Ashlee Dunn
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Jameen Arm
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Tom Zeffiro
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Gavin Cooper
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Huiqiao Tian
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Paulette van Vliet
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.,Research and Innovation Division, University of Newcastle, Callaghan, NSW, Australia
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21
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Levin MF, Hiengkaew V, Nilanont Y, Cheung D, Dai D, Shaw J, Bayley M, Saposnik G. Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke. Neurorehabil Neural Repair 2019; 33:432-441. [PMID: 31072222 DOI: 10.1177/1545968319847969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Understanding the relationship between movement quality (impairment) and performance (activity) in poststroke patients is important for rehabilitation intervention studies. This has led to an interest in kinematic characterization of upper limb motor impairment. Since instrumented motion analysis is not readily clinically available, observational kinematics may be a viable alternative. Objective. To determine if upper limb movement quality during a reach-to-grasp task identified by observation could be used to describe the relationship between motor impairments and the time to perform functional tasks. Methods. Cross-sectional, secondary analysis of baseline data from 141 participants with stroke, age 18 to 85 years, who participated in a multicenter randomized controlled trial. Clinical assessment of movement quality using the Reaching Performance Scale for Stroke (RPSS-Close and Far targets) and of performance (activity) from the Wolf Motor Function Test (WMFT-7 items) was assessed. The degree to which RPSS component scores explained scores on WMFT items was determined by multivariable regression. Results. Clinically significant decreases (>2 seconds) in performance time for some of the more complex WMFT tasks involving prehension were predicted from RPSS-Close and Far target components. Trunk compensatory movements did not predict either increases or decreases in performance time for the WMFT tasks evaluated. Overall, the strength of the regression models was low. Conclusions. In lieu of kinematic analysis, observational clinical movement analysis may be a valid and accessible method to determine relationships between motor impairment, compensations and upper limb function in poststroke patients. Specific relationships are unlikely to generalize to all tasks due to kinematic redundancy and task specificity.
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Affiliation(s)
- Mindy F Levin
- 1 McGill University and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | | | | | - Donna Cheung
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Dai
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Shaw
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- 5 Toronto Rehabilitation Institute and University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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22
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Gracies JM, Pradines M, Ghédira M, Loche CM, Mardale V, Hennegrave C, Gault-Colas C, Audureau E, Hutin E, Baude M, Bayle N. Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial. BMC Neurol 2019; 19:39. [PMID: 30871480 PMCID: PMC6419473 DOI: 10.1186/s12883-019-1257-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/14/2019] [Indexed: 12/30/2022] Open
Abstract
Background After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. Methods One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. Discussion This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. Trial registration ClinicalTrials.gov: NCT02202954, July 29, 2014.
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Affiliation(s)
- Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Maud Pradines
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France. .,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.
| | - Mouna Ghédira
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine-Marie Loche
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Valentina Mardale
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine Hennegrave
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Caroline Gault-Colas
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Etienne Audureau
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.,DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, F-94010, Créteil, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Marjolaine Baude
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
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Ranganathan R, Gebara R, Andary M, Sylvain J. Chronic stroke survivors show task-dependent modulation of motor variability during bimanual coordination. J Neurophysiol 2019; 121:756-763. [PMID: 30601671 DOI: 10.1152/jn.00218.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stroke often results in hemiparesis, leaving one side of the body "affected" relative to the other side. Prior research has shown that the affected arm has higher variability; however, the extent to which this variability can be modulated is unclear. Here we used a shared bimanual task to examine the degree to which participants could modulate the variability in the affected arm after stroke. Participants with chronic stroke ( n = 11) and age-matched controls ( n = 11) performed unimanual and bimanual reaching movements to move a cursor on a screen to different targets. In the unimanual condition, the cursor was controlled only by the movement of a single arm, whereas, in the bimanual condition, the cursor position was "shared" between the two arms by using a weighted average of the two hand positions. Unknown to the participants, we altered the weightings of the affected and unaffected arms to cursor motion and examined how the movement variability on each arm changed depending on its contribution to the task. Results showed that stroke survivors had higher movement variability on the affected arm; however, like age-matched controls, they were able to modulate the variability in both the affected and unaffected arms according to the weighting condition. Specifically, as the weighting on a particular arm increased (i.e., it became more important to the task), the movement variability decreased. These results show that stroke survivors are capable of modulating variability depending on the task context, and this feature may potentially be exploited for rehabilitation paradigms. NEW & NOTEWORTHY We show that chronic stroke survivors, similar to age-matched controls, are able to modulate variability in their affected and unaffected limbs in redundant bimanual tasks as a function of how these limbs contribute to the task. Specifically, in both affected and unaffected limbs, the variability of the limb increases as its contribution to the task decreases. This feature may potentially be exploited in rehabilitation paradigms using bimanual tasks.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, Michigan.,Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Rani Gebara
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Michael Andary
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Jim Sylvain
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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24
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Valevicius AM, Boser QA, Lavoie EB, Chapman CS, Pilarski PM, Hebert JS, Vette AH. Characterization of normative angular joint kinematics during two functional upper limb tasks. Gait Posture 2019; 69:176-186. [PMID: 30769260 DOI: 10.1016/j.gaitpost.2019.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/18/2019] [Accepted: 01/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Optical motion capture is a powerful tool for assessing upper body kinematics, including compensatory movements, in different populations. However, the lack of a standardized protocol with clear functional relevance hinders its clinical acceptance. RESEARCH QUESTION The objective of this study was to use motion capture to: (1) characterize angular joint kinematics in a normative population performing two complex, yet standardized upper limb tasks with clear functional relevance; and (2) assess the protocol's intra-rater reliability. METHODS Twenty non-disabled adults performed the previously developed Pasta Box Task and Cup Transfer Task. The kinematics of the upper body were captured using an optoelectronic motion capture system and rigid plates with reflective markers. Angular joint trajectories, peak angle, range of motion (RoM), and peak angular velocity were extracted for the trunk, shoulder, elbow, forearm, and wrist. Intra-class correlation was used to assess the intra-rater reliability of the kinematic measures. RESULTS Both tasks required minimal trunk motion. Cross-body movements required greater RoM at the trunk, shoulder, and elbow joints compared to movements in front of the body. Reaches to objects further away from the body required greater trunk and elbow joint RoM compared to reaches to objects closer to the body. Transporting the box of pasta required the wrist to maintain an extended position. The two different grasp patterns in the Cup Transfer Task forced the wrist into a flexed and ulnar-deviated position for the near cup, and an extended and radial-deviated position for the far cup. For both tasks, the majority of measures displayed intra-class correlation values above 0.75, indicating good reliability. SIGNIFICANCE Our protocol and functional tasks elicit a degree of movement sensitivity that is not available in current clinical assessments. Our study also provides a comprehensive dataset that can serve as a normative benchmark for quantifying movement compensations following impairment.
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Affiliation(s)
- Aïda M Valevicius
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada
| | - Quinn A Boser
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada
| | - Ewen B Lavoie
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, Alberta T6G 2H9, Canada
| | - Craig S Chapman
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, Alberta T6G 2H9, Canada
| | - Patrick M Pilarski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Walter C Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada
| | - Jacqueline S Hebert
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Walter C Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada
| | - Albert H Vette
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada; Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211 116 Street NW, Edmonton, Alberta T6G 1H9, Canada.
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25
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Mesquita IA, Pinheiro ARV, Velhote Correia MFP, Silva CICD. Methodological considerations for kinematic analysis of upper limbs in healthy and poststroke adults. Part I: A systematic review of sampling and motor tasks. Top Stroke Rehabil 2018; 26:142-152. [PMID: 30489216 DOI: 10.1080/10749357.2018.1551953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to review the methods used to analyze the kinematics of upper limbs (ULs) of healthy and poststroke adults, namely specificities of sampling and motor tasks. SUMMARY OF REVIEW A database of articles published in the last decade was compiled using the following search terms combinations: ("upper extremity" OR "upper limb" OR arm) AND (kinematics OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review (1) had the purpose to analyze objectively a three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living (ADL) involving uppers limbs, and (3) studied healthy and/or poststroke adults. Fourteen articles were included (four studied a healthy sample, three analyzed poststroke patients, and seven examined both poststroke and healthy participants). CONCLUSION Most of the recommended demographic and stroke information, such as some preexisting conditions to stroke, initial stroke severity, and stroke location, were not collected by all or most of the articles. Time poststroke onset was presented in all articles but showed great variability. Few articles identified anthropometric characteristics and adjusted task environment to them. Most of the samples were composed mainly by males and had a low mean age, which does not represent poststroke population. Most articles analyzed "functional movements", namely simulations of ADL. Implication of key findings: Future research should identify the recommended information to allow an adequate stratification. Acute phase after stroke, real ADL with different complexities, and ipsilesional UL should be studied.
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Affiliation(s)
- Inês Albuquerque Mesquita
- a Department of Functional Sciences and Center for Research in Rehabilitation (CIR) , School of Health Sciences of Polytechnic Institute of Porto (ESS-P.Porto) , Porto , Portugal
| | - Ana Rita Vieira Pinheiro
- b School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Center for Research in Rehabilitation (CIR) , School of Health Sciences of Polytechnic Institute of Porto (ESS-P.Porto) , Porto , Portugal
| | - Miguel Fernando Paiva Velhote Correia
- d Department of Electrical and Computer Engineering, Faculty of Engineering , University of Porto (FEUP) , Porto , Portugal.,e Institute for Systems and Computer Engineering , Technology and Science (INESC TEC) , Porto , Portugal
| | - Cláudia Isabel Costa da Silva
- f Department of Physiotherapy , and Center for Research in Rehabilitation (CIR), School of Health Sciences of Polytechnic Institute of Porto (ESS-P.Porto) , Porto , Portugal
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26
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Israely S, Leisman G, Carmeli E. Neuromuscular synergies in motor control in normal and poststroke individuals. Rev Neurosci 2018; 29:593-612. [PMID: 29397390 DOI: 10.1515/revneuro-2017-0058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/26/2017] [Indexed: 01/03/2023]
Abstract
Muscle synergies are proposed to function as motor primitives that are modulated by frontal brain areas to construct a large repertoire of movement. This paper reviews the history of the development of our current theoretical understanding of nervous system-based motor control mechanisms and more specifically the concept of muscle synergies. Computational models of muscle synergies, especially the nonnegative matrix factorization algorithm, are discussed with specific reference to the changes in synergy control post-central nervous system (CNS) lesions. An alternative approach for motor control is suggested, exploiting a combination of synergies control or flexible muscle control used for gross motor skills and for individualized finger movements. Rehabilitation approaches, either supporting or inhibiting the use of basic movement patterns, are discussed in the context of muscle synergies. Applications are discussed for the use of advanced technologies that can promote the recovery and functioning of the human CNS after stroke.
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Affiliation(s)
- Sharon Israely
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel
| | - Gerry Leisman
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel.,National Institute for Brain and Rehabilitation Sciences-Israel, Nazareth 16470, Israel
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel
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27
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Gopaul U, van Vliet P, Callister R, Nilsson M, Carey L. COMbined Physical and somatoSEnsory training after stroke: Development and description of a novel intervention to improve upper limb function. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1748. [PMID: 30230136 DOI: 10.1002/pri.1748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE After stroke, reach-to-grasp goal-directed movements are disrupted as a result of both residual motor and somatosensory impairments. This report describes the rationale and development of a new upper limb stroke rehabilitation intervention known as COMPoSE: "COMbined Physical and somatoSEnsory training," designed to improve somatosensory and motor deficits in the upper limb after stroke. A standardized training matrix has been developed to facilitate intervention delivery. METHODS The COMPoSE intervention was developed through the following stages: (a) Definition and operationalization of somatosensory and motor variables used in training sensation and movement after stroke; (b) development of methods to give feedback to enhance skill acquisition; and (c) Combination of somatosensory and motor variables, and feedback, into a standardized training matrix. The reporting of the COMPoSE intervention adheres to the recommendations of the Template for Intervention Description and Replication checklist to facilitate replication of the intervention in the future. RESULTS The essential features of COMPoSE include combined somatosensory-motor training variables (grasp pressure, distance, object size, crushability, surface texture, and friction), feedback, and calibration using a haptic device providing measures of grasp pressure, use of anticipation trials, and high-dose repetitive task practice. Ten treatment sessions are delivered over 3 weeks, using a standardized matrix for treatment delivery. CONCLUSION COMPoSE is a new intervention that combines somatosensory and movement training, delivered synchronously, within the same intervention, and within the same task.
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Affiliation(s)
- Urvashy Gopaul
- School of Physiotherapy, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Paulette van Vliet
- School of Humanities and Social Sciences, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.,Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Michael Nilsson
- Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Leeanne Carey
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Ding Q, Patten C. External biomechanical constraints impair maximal voluntary grip force stability post-stroke. Clin Biomech (Bristol, Avon) 2018; 57:26-34. [PMID: 29894857 DOI: 10.1016/j.clinbiomech.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Grip strength is frequently measured as a global indicator of motor function. In clinical populations, such as hemiparesis post-stroke, grip strength is associated with upper-extremity motor impairment, function, and ability to execute activities of daily living. However, biomechanical configuration of the distal arm and hand may influence the magnitude and stability of maximal voluntary grip force and varies across studies. The influence of distal arm/hand biomechanical configuration on grip force remains unclear. Here we investigated how biomechanical configuration of the distal arm/hand influence the magnitude and trial-to-trial variability of maximal grip force performed in similar positions with variations in external constraint. METHODS We studied three groups of 20 individuals: healthy young, healthy older, and individuals post-stroke. We tested maximal voluntary grip force in 4 conditions: 1: self-determined/"free"; 2: standard; 3: fixed arm-rest; 4: gripper fixed to arm-rest, using an instrumented grip dynamometer in both dominant/non-dominant and non-paretic/paretic hands. FINDINGS Regardless of hand or group, maximal voluntary grip force was highest when the distal limb was most constrained (i.e., Condition 4), followed by the least constrained (i.e., Condition 1) (Cohen's f = 0.52, P's < 0.001). Coefficient of variation among three trials was greater in the paretic hand compared with healthy individuals, particularly in more (Conditions 3 and 4) compared to less (Conditions 1 and 2) constrained conditions (Cohen's f = 0.29, P's < 0.05). INTERPRETATION These findings have important implications for design of rehabilitation interventions and devices. Particularly in individuals post-stroke, external biomechanical constraints increase maximal voluntary grip force variability while fewer biomechanical constraints yield more stable performance.
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Affiliation(s)
- Qian Ding
- Neural Control of Movement Lab, Malcolm Randall VA Medical Center (151A), Gainesville, FL 32608, USA; Rehabilitation Sciences Doctoral Program, Department of Physical Therapy, University of Florida, Gainesville, FL 32608, USA
| | - Carolynn Patten
- Biomechanics and Neural Control of Movement Lab, University of California, Davis School of Medicine, Northern California VA Health Care System, Sacramento, CA 95817, USA.
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29
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Valevicius AM, Boser QA, Lavoie EB, Murgatroyd GS, Pilarski PM, Chapman CS, Vette AH, Hebert JS. Characterization of normative hand movements during two functional upper limb tasks. PLoS One 2018; 13:e0199549. [PMID: 29928022 PMCID: PMC6013217 DOI: 10.1371/journal.pone.0199549] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background Dexterous hand function is crucial for completing activities of daily living (ADLs), which typically require precise hand-object interactions. Kinematic analyses of hand trajectory, hand velocity, and grip aperture provide valuable mechanistic insights into task performance, but there is a need for standardized tasks representative of ADLs that are amenable to motion capture and show consistent performance in non-disabled individuals. Our objective was to develop two standardized functional upper limb tasks and to quantitatively characterize the kinematics of normative hand movement. Methods Twenty non-disabled participants were recruited to perform two tasks: the Pasta Box Task and Cup Transfer Task. A 12-camera motion capture system was used to collect kinematic data from which hand movement and grip aperture measures were calculated. Measures reported for reach-grasp and transport-release segments were hand distance travelled, hand trajectory variability, movement time, peak and percent-to-peak hand velocity, number of movement units, peak and percent-to-peak grip aperture, and percent-to-peak hand deceleration. A between-session repeatability analysis was conducted on 10 participants. Results Movement times were longer for transport-release compared to reach-grasp for every movement. Hand and grip aperture measures had low variability, with 55 out of 63 measures showing good repeatability (ICC > 0.75). Cross-body movements in the Pasta Box Task had longer movement times and reduced percent-to-peak hand velocity values. The Cup Transfer Task showed decoupling of peak grip aperture and peak hand deceleration for all movements. Movements requiring the clearing of an obstacle while transporting an object displayed a double velocity peak and typically a longer deceleration phase. Discussion Normative hand kinematics for two standardized functional tasks challenging various aspects of hand-object interactions important for ADLs showed excellent repeatability. The consistency in normative task performance across a variety of task demands shows promise as a potential outcome assessment for populations with upper limb impairment.
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Affiliation(s)
- Aïda M. Valevicius
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Quinn A. Boser
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ewen B. Lavoie
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Glyn S. Murgatroyd
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Patrick M. Pilarski
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Craig S. Chapman
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Albert H. Vette
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Jacqueline S. Hebert
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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30
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Use of optical motion capture for the analysis of normative upper body kinematics during functional upper limb tasks: A systematic review. J Electromyogr Kinesiol 2018. [PMID: 29533202 DOI: 10.1016/j.jelekin.2018.02.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Quantifying three-dimensional upper body kinematics can be a valuable method for assessing upper limb function. Considering that kinematic model characteristics, performed tasks, and reported outcomes are not consistently standardized and exhibit significant variability across studies, the purpose of this review was to evaluate the literature investigating upper body kinematics in non-disabled individuals via optical motion capture. Specific objectives were to report on the kinematic model characteristics, performed functional tasks, and kinematic outcomes, and to assess whether kinematic protocols were assessed for validity and reliability. Five databases were searched. Studies using anatomical and/or cluster marker sets, along with optical motion capture, and presenting normative data on upper body kinematics were eligible for review. Information extracted included model characteristics, performed functional tasks, kinematic outcomes, and validity or reliability testing. 804 publication records were screened and 20 reviewed based on the selection criteria. Thirteen studies described their kinematic protocols adequately for reproducibility, and 8 studies followed International Society of Biomechanics standards for quantifying upper body kinematics. Six studies assessed their protocols for validity or reliability. While a substantial number of studies have adequately reported their protocols, more systematic work is needed to evaluate the validity and reliability of existing protocols.
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31
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Collins KC, Kennedy NC, Clark A, Pomeroy VM. Getting a kinematic handle on reach-to-grasp: a meta-analysis. Physiotherapy 2017; 104:153-166. [PMID: 29402446 DOI: 10.1016/j.physio.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 10/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Reach-to-grasp is an essential everyday activity that is often impaired after stroke. The objectives of this review are: (1) identify differences in the kinematic characteristics of reach-to-grasp between individuals with and without stroke, and (2) determine the influence of object location on kinematics. DATA SOURCES MEDLINE, AMED, and Embase databases. ELIGIBILITY CRITERIA Studies investigating individuals with stroke and neurologically intact control participants completing reach-to-grasp (paretic upper limb) of an object assessed via kinematic assessment (motion analysis). REVIEW METHODS Following Cochrane Collaboration guidelines a meta-analysis comparing kinematic characteristics of reach-to-grasp between individuals with and without stroke. Potential risk of bias was assessed using the Down's and Black Tool. Data were synthesised by calculating the standardised mean difference (SMD) in kinematic characteristics between adults with and without stroke. RESULTS Twenty-nine studies met the review criteria, mainly of observational design; 460 individuals with stroke and 324 control participants. Kinematic differences in reach-to-grasp were identified in the central and ipsilateral workspace for example, individuals with stroke exhibited significantly lower peak velocity SMD -1.48 (95% CI -1.94, -1.02), and greater trunk displacement SMD 1.55 (95% CI 0.85, 2.25) than control participants. Included studies were assessed as demonstrating unclear or high potential risk-of-bias. CONCLUSIONS Differences in kinematic characteristics between individuals with and without stroke were identified which may be different reaching in the ipsilateral and central workspace. Suggesting, that object location may influence some kinematic characteristics and not others which may be pertinent when re-training reach-to-grasp. PROSPERO CRD42014009479.
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Affiliation(s)
- Kathryn C Collins
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Niamh C Kennedy
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK; School of Psychology, Ulster University, BT52 1SA, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK.
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García Álvarez A, Roby-Brami A, Robertson J, Roche N. Functional classification of grasp strategies used by hemiplegic patients. PLoS One 2017; 12:e0187608. [PMID: 29125855 PMCID: PMC5695285 DOI: 10.1371/journal.pone.0187608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022] Open
Abstract
This study aimed to identify and qualify grasp-types used by patients with stroke and determine the clinical parameters that could explain the use of each grasp. Thirty-eight patients with chronic stroke-related hemiparesis and a range of motor and functional capacities (17 females and 21 males, aged 25–78), and 10 healthy subjects were included. Four objects were used (tissue packet, teaspoon, bottle and tennis ball). Participants were instructed to “grasp the object as if you are going to use it”. Three trials were video-recorded for each object. A total of 456 grasps were analysed and rated using a custom-designed Functional Grasp Scale. Eight grasp-types were identified from the analysis: healthy subjects used Multi-pulpar, Pluri-digital, Lateral-pinch and Palmar grasps (Standard Grasps). Patients used the same grasps with in addition Digito-palmar, Raking, Ulnar and Interdigital grasps (Alternative Grasps). Only patients with a moderate or relatively good functional ability used Standard grasps. The correlation and regression analyses showed this was conditioned by sufficient finger and elbow extensor strength (Pluri-digital grasp); thumb extensor and wrist flexor strength (Lateral pinch) or in forearm supinator strength (Palmar grasp). By contrast, the patients who had severe impairment used Alternative grasps that did not involve the thumb. These strategies likely compensate specific impairments. Regression and correlation analyses suggested that weakness had a greater influence over grasp strategy than spasticity. This would imply that treatment should focus on improving hand strength and control although reducing spasticity may be useful in some cases.
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Affiliation(s)
- Alicia García Álvarez
- Department of Physical Medicine and Rehabilitation, CHU Raymond Poincare - APHP, Garches, France
- * E-mail:
| | - Agnès Roby-Brami
- Institut des Systèmes Intelligents et de Robotique, CNRS, University Pierre et Marie Curie - Sorbonne Universities, Paris, France
| | - Johanna Robertson
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes, France
| | - Nicolas Roche
- Department of Physiology, University of Versailles Saint-Quentin-en-Yvelines U1179, Garches, France
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Ballester BR, Nirme J, Camacho I, Duarte E, Rodríguez S, Cuxart A, Duff A, Verschure PFMJ. Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke. JMIR Serious Games 2017; 5:e15. [PMID: 28784593 PMCID: PMC5565792 DOI: 10.2196/games.6773] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. Objective The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. Methods We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. Conclusions These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. Trial Registration International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1)
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Affiliation(s)
- Belén Rubio Ballester
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Jens Nirme
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Irene Camacho
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Esther Duarte
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Susana Rodríguez
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ampar Cuxart
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Armin Duff
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Paul F M J Verschure
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain.,ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.,Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028, Barcelona, Spain
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Bochniewicz EM, Emmer G, McLeod A, Barth J, Dromerick AW, Lum P. Measuring Functional Arm Movement after Stroke Using a Single Wrist-Worn Sensor and Machine Learning. J Stroke Cerebrovasc Dis 2017; 26:2880-2887. [PMID: 28781056 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/19/2017] [Accepted: 07/10/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Trials of restorative therapies after stroke and clinical rehabilitation require relevant and objective efficacy end points; real-world upper extremity (UE) functional use is an attractive candidate. We present a novel, inexpensive, and feasible method for separating UE functional use from nonfunctional movement after stroke using a single wrist-worn accelerometer. METHODS Ten controls and 10 individuals with stroke performed a series of minimally structured activities while simultaneously being videotaped and wearing a sensor on each wrist that captured the linear acceleration and angular velocity of their UEs. Video data provided ground truth to annotate sensor data as functional or nonfunctional limb use. Using the annotated sensor data, we trained a machine learning tool, a Random Forest model. We then assessed the accuracy of that classification. RESULTS In intrasubject test trials, our method correctly classified sensor data with an average of 94.80% in controls and 88.38% in stroke subjects. In leave-one-out intersubject testing and training, correct classification averaged 91.53% for controls and 70.18% in stroke subjects. CONCLUSIONS Our method shows promise for inexpensive and objective quantification of functional UE use in hemiparesis, and for assessing the impact of UE treatments. Training a classifier on raw sensor data is feasible, and determination of whether patients functionally use their UE can thus be done remotely. For the restorative treatment trial setting, an intrasubject test/train approach would be especially accurate. This method presents a potentially precise, cost-effective, and objective measurement of UE use outside the clinical or laboratory environment.
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Affiliation(s)
- Elaine M Bochniewicz
- The MITRE Corporation, McLean, Virginia; Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia.
| | | | | | - Jessica Barth
- Medstar National Rehabilitation Network, Washington, District of Columbia
| | - Alexander W Dromerick
- Medstar National Rehabilitation Network, Washington, District of Columbia; Washington DC Veterans Affairs Medical Center, Washington, District of Columbia; Center for Brain Plasticity and Recovery, Georgetown University, Washington, District of Columbia; Department of Rehabilitation Medicine, Georgetown University, Washington, District of Columbia; Department of Neurology, Georgetown University, Washington, District of Columbia
| | - Peter Lum
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia; Medstar National Rehabilitation Network, Washington, District of Columbia; Washington DC Veterans Affairs Medical Center, Washington, District of Columbia; Center for Brain Plasticity and Recovery, Georgetown University, Washington, District of Columbia
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Demers M, Levin MF. Do Activity Level Outcome Measures Commonly Used in Neurological Practice Assess Upper-Limb Movement Quality? Neurorehabil Neural Repair 2017; 31:623-637. [DOI: 10.1177/1545968317714576] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marika Demers
- McGill University, Montréal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Canada
| | - Mindy F. Levin
- McGill University, Montréal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Canada
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Abstract
[Purpose] While electromyography (EMG) biofeedback has been recently used in diverse therapeutic interventions for stroke patients, research on its effects has been lacking. Most existing studies are confined to functions of the lower extremities, and research on upper extremity functional recovery using EMG biofeedback training is limited. Therefore, this study examined the effects of training using EMG biofeedback on stroke patients' upper extremity functions. [Subjects and Methods] The subjects of this study included 30 hemiplegia patients whose disease duration was longer than six months. They were randomly divided into a control group (n=15) receiving traditional rehabilitation therapy and an experimental group (n=15) receiving both traditional rehabilitation therapy and training using EMG biofeedback. The program lasted for a total of four weeks. In order to examine the subjects' functional recovery, the author measured their upper limb function using the Fugl-Meyer Assessment and Manual Function Test, and activities of daily living using the Functional Independence Measure before and after training. [Results] A comparison of the study groups revealed that those in the experimental group experienced greater improvement in upper extremity function after training in all tests compared to the control group; however, there was no significant difference in terms of the activities of daily living between the two groups. The results of this study were as follows. [Conclusion] Thus, stroke patients receiving intensive EMG biofeedback showed more significant upper extremity functional recovery than those who only received traditional rehabilitation therapy.
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Affiliation(s)
- Ju-Hong Kim
- Department of Occupational Therapy, Howon University, Republic of Korea
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37
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Abstract
Stroke instigates a dynamic process of repair and remodelling of remaining neural circuits, and this process is shaped by behavioural experiences. The onset of motor disability simultaneously creates a powerful incentive to develop new, compensatory ways of performing daily activities. Compensatory movement strategies that are developed in response to motor impairments can be a dominant force in shaping post-stroke neural remodelling responses and can have mixed effects on functional outcome. The possibility of selectively harnessing the effects of compensatory behaviour on neural reorganization is still an insufficiently explored route for optimizing functional outcome after stroke.
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Affiliation(s)
- Theresa A Jones
- Department of Psychology and Institute for Neuroscience, University of Texas at Austin, Texas 78712, USA
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38
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Chen J, Nichols D, Brokaw EB, Lum PS. Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME). IEEE Trans Neural Syst Rehabil Eng 2017; 25:2305-2312. [PMID: 28436882 DOI: 10.1109/tnsre.2017.2695379] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In previous work, we developed a lightweight wearable hand exoskeleton (Hand Spring Operated Movement Enhancer) that improves range of motion and function in laboratory testing. In this pilot study, we added the ability to log movement data for extended periods and recruited ten chronic stroke subjects to use the device during reach and grasp task practice at home for 1.5 h/day, five days per week, and for four weeks. Seven subjects completed the study, performing 448 ± 651 hand movements per training day. After training, impairment was reduced (Fugl-Meyer test; gain = 4.9 ± 4.1; p = .039) and function was improved (Action Research Arm Test; gain = 3.3 ± 2.6; p = .032). There was a significant correlation between gains in the Action Research Arm Test and the number of movements during training (r = 0.90; p = .005). Proximal arm control also improved, as evidenced by a significant reduction in the reach path ratio (p = 0.038). Five subjects responded well to the treatment, having gains of six points or more on the Fugl-Meyer or action research arm test, and achieving significant gains in digit extension (gain = 19.8 ± 10.2°; p = 0.024). However, all of the gains that were significant immediately after training were no longer significant at the three month follow-up. This treatment approach appears promising, but longer periods of home training may be needed to achieve sustainable gains.
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39
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Geed S, van Kan PLE. Grasp-Based Functional Coupling Between Reach- and Grasp-Related Components of Forelimb Muscle Activity. J Mot Behav 2016; 49:312-328. [PMID: 27589010 DOI: 10.1080/00222895.2016.1204265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
How are appropriate combinations of forelimb muscles selected during reach-to-grasp movements in the presence of neuromotor redundancy and important task-related constraints? The authors tested whether grasp type or target location preferentially influence the selection and synergistic coupling between forelimb muscles during reach-to-grasp movements. Factor analysis applied to 14-20 forelimb electromyograms recorded from monkeys performing reach-to-grasp tasks revealed 4-6 muscle components that showed transport/preshape- or grasp-related features. Weighting coefficients of transport/preshape-related components demonstrated strongest similarities for reaches that shared the same grasp type rather than the same target location. Scaling coefficients of transport/preshape- and grasp-related components showed invariant temporal coupling. Thus, grasp type influenced strongly both transport/preshape- and grasp-related muscle components, giving rise to grasp-based functional coupling between forelimb muscles.
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Affiliation(s)
- Shashwati Geed
- a Department of Kinesiology , University of Wisconsin-Madison , Wisconsin.,b MedStar National Rehabilitation Hospital , Washington , DC.,c Department of Rehabilitation Medicine , Georgetown University Medical Center , Washington , DC
| | - Peter L E van Kan
- a Department of Kinesiology , University of Wisconsin-Madison , Wisconsin
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40
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de los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying upper limb ability and dexterity after cervical spinal cord injury. Med Biol Eng Comput 2016; 55:833-844. [DOI: 10.1007/s11517-016-1555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/30/2016] [Indexed: 12/17/2022]
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Lang CE, Wagner JM, Edwards DF, Sahrmann SA, Dromerick AW. Recovery of Grasp versus Reach in People with Hemiparesis Poststroke. Neurorehabil Neural Repair 2016; 20:444-54. [PMID: 17082499 DOI: 10.1177/1545968306289299] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objective. The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp. Methods. Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations. Results. The authors’ results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accuracy were greater in the reach than the grasp acutely, and these deficits lessened such that by the 90-day time point, the relative accuracy of the 2 movements was the same. In contrast, deficits in efficiency were greater in the grasp than the reach acutely, and grasp efficiency did not recover. The majority of recovery in reaching and grasping occurred by the 90-day time point, with little change occurring between the 90-day and 1-year time points. Conclusions. The authors hypothesize that, in chronic hemiparesis, purposeful movements requiring distal control may be more impaired than purposeful movements requiring proximal control, not because of the initial lesion, but because, over the course of recovery, spared components of the descending motor systems may be able to compensate for the accuracy deficits in reaching (proximal control) but not the efficiency deficits in grasping (distal muscular control).
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Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Department of Neurology, Washington University, St. Louis, MO 63108, USA.
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Israely S, Carmeli E. Handwriting performance versus arm forward reach and grasp abilities among post-stroke patients, a case-control study. Top Stroke Rehabil 2016; 24:5-11. [PMID: 27223335 DOI: 10.1080/10749357.2016.1183383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence-based studies regarding deficits in handwriting performance relative to hand reaching and grasping after a stroke are lacking. OBJECTIVE To evaluate the extent of damage to handwriting skills compared to arm reach and grasp task among post-stroke patients. METHODS Eighteen patients and 19 healthy subjects were recruited to this case-control study. Patients were evaluated 15.2 days (±6.5) after the stroke using a Computerized Penmanship Evaluation Tool, surface Electromyography and Fugl-Meyer assessment. This study compared motor deficits in hand reaching and grasping and in handwriting between stroke patients and healthy subjects. Damage to handwriting performance relative to hand reaching and grasping skills was also evaluated. RESULTS Significant differences were found between groups in handwriting performance (p < 0.05). The performance of the trapezius, biceps, and triceps muscles can predict 63.5% of the variance in the ability to write a short sentence (p < 0.023). Pen pressure can predict 74.9% of the hand motor performance from Fugl-Meyer assessment (p < 0.05). Handwriting was more damaged than was the pattern of activation of the proximal muscles of the shoulder and arm (p < 0.05). FM scores were highly, negatively correlated with the in-air writing time across tasks (r = -0.819, p < 0.004). CONCLUSIONS This study confirms the clinical observation that dexterity skills are more damaged than are arm forward reach after a stroke. However, these differences in motor performance were not significant in mildly disabled patients, demonstrating the feasibility of handwriting rehabilitation in these patients. Therefore, we modestly recommend focusing on handwriting rehabilitation of the hemiparetic upper extremity in mildly impaired patients after a stroke.
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Affiliation(s)
- Sharon Israely
- a Faculty of Welfare and Health, Department of Physical Therapy , University of Haifa , Haifa , Israel
| | - Eli Carmeli
- a Faculty of Welfare and Health, Department of Physical Therapy , University of Haifa , Haifa , Israel
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Baldassarre A, Ramsey L, Rengachary J, Zinn K, Siegel JS, Metcalf NV, Strube MJ, Snyder AZ, Corbetta M, Shulman GL. Dissociated functional connectivity profiles for motor and attention deficits in acute right-hemisphere stroke. Brain 2016; 139:2024-38. [PMID: 27225794 DOI: 10.1093/brain/aww107] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/24/2016] [Indexed: 12/31/2022] Open
Abstract
Strokes often cause multiple behavioural deficits that are correlated at the population level. Here, we show that motor and attention deficits are selectively associated with abnormal patterns of resting state functional connectivity in the dorsal attention and motor networks. We measured attention and motor deficits in 44 right hemisphere-damaged patients with a first-time stroke at 1-2 weeks post-onset. The motor battery included tests that evaluated deficits in both upper and lower extremities. The attention battery assessed both spatial and non-spatial attention deficits. Summary measures for motor and attention deficits were identified through principal component analyses on the raw behavioural scores. Functional connectivity in structurally normal cortex was estimated based on the temporal correlation of blood oxygenation level-dependent signals measured at rest with functional magnetic resonance imaging. Any correlation between motor and attention deficits and between functional connectivity in the dorsal attention network and motor networks that might spuriously affect the relationship between each deficit and functional connectivity was statistically removed. We report a double dissociation between abnormal functional connectivity patterns and attention and motor deficits, respectively. Attention deficits were significantly more correlated with abnormal interhemispheric functional connectivity within the dorsal attention network than motor networks, while motor deficits were significantly more correlated with abnormal interhemispheric functional connectivity patterns within the motor networks than dorsal attention network. These findings indicate that functional connectivity patterns in structurally normal cortex following a stroke link abnormal physiology in brain networks to the corresponding behavioural deficits.
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Affiliation(s)
- Antonello Baldassarre
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA 2 Department of Neuroscience, Imaging, and Clinical Sciences, University of Chieti, via dei Vestini 33, 66013, Chieti, Italy 3 Institute for Advanced Biomedical Technologies, University of Chieti G. d'Annunzio, via dei Vestini 33, 66013, Chieti, Italy
| | - Lenny Ramsey
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Jennifer Rengachary
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Kristi Zinn
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Joshua S Siegel
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Nicholas V Metcalf
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Michael J Strube
- 4 Department of Psychology, Washington University in St. Louis, 1 Brooking Dr., St Louis, MO, USA
| | - Abraham Z Snyder
- 5 Department of Radiology, Washington University in Saint Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Maurizio Corbetta
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA 5 Department of Radiology, Washington University in Saint Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA 6 Department of Neuroscience, University of Padua, Via Giustiniani, 5 35128, Padova, Italy 7 Department of Anatomy and Neurobiology, Washington University in St. Louis, School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA 8 Department of Bioengineering, Washington University in St. Louis, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Gordon L Shulman
- 1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
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Reinkensmeyer DJ, Burdet E, Casadio M, Krakauer JW, Kwakkel G, Lang CE, Swinnen SP, Ward NS, Schweighofer N. Computational neurorehabilitation: modeling plasticity and learning to predict recovery. J Neuroeng Rehabil 2016; 13:42. [PMID: 27130577 PMCID: PMC4851823 DOI: 10.1186/s12984-016-0148-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/13/2016] [Indexed: 01/19/2023] Open
Abstract
Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling - regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity.
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Affiliation(s)
- David J Reinkensmeyer
- Departments of Anatomy and Neurobiology, Mechanical and Aerospace Engineering, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, USA.
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - John W Krakauer
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Catherine E Lang
- Department of Neurology, Program in Physical Therapy, Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Stephan P Swinnen
- Department of Kinesiology, KU Leuven Movement Control & Neuroplasticity Research Group, Leuven, KU, Belgium
- Leuven Research Institute for Neuroscience & Disease (LIND), KU, Leuven, Belgium
| | - Nick S Ward
- Sobell Department of Motor Neuroscience and UCLPartners Centre for Neurorehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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De los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying movement agility and smoothness after cervical Spinal Cord Injury. NeuroRehabilitation 2016; 38:199-209. [PMID: 26923358 DOI: 10.3233/nre-161311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND After cervical Spinal Cord Injury (SCI), upper limb movements made by patients have a lack of smoothness and a hand velocity profile characterized by a high number of velocity peaks. OBJECTIVE The aim of the present paper is to propose three novel kinematic indices for quantifying movement agility and smoothness, and to analyze their discriminative capability between healthy and pathological people. METHODS 18 people, healthy and two groups of patients with cervical SCI, participated in the study. Kinematic indices in relation to movement agility and smoothness were computed from hand trajectories and velocity profiles during the performance of the ADL of drinking from a glass. RESULTS The proposed indices discriminated between healthy and SCI people. The results are greater in healthy than SCI people. Both smoothness indices detected significant differences between healthy and both SCI groups. Moreover, the Agility index showed capacity for discriminating between both patients groups. CONCLUSIONS The main contribution of this research consists on the proposal of kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.
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Affiliation(s)
- Ana De los Reyes-Guzmán
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Iris Dimbwadyo-Terrer
- Occupational Thinks Research Group, Centro Superior de Estudios La Salle (UAM), C/La Salle, Madrid, Spain
| | - Soraya Pérez-Nombela
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Félix Monasterio-Huelin
- Department of Special Technologies Applied to Telecommunication. Higher Technical School of Telecommunications Engineering, Technical University of Madrid, University City, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - José Luis Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - Angel Gil-Agudo
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
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Schaefer SY, Hengge CR. Testing the concurrent validity of a naturalistic upper extremity reaching task. Exp Brain Res 2015; 234:229-40. [PMID: 26438508 DOI: 10.1007/s00221-015-4454-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/22/2015] [Indexed: 01/02/2023]
Abstract
Point-to-point reaching has been widely used to study upper extremity motor control. We have been developing a naturalistic reaching task that adds tool manipulation and object transport to this established paradigm. The purpose of this study was to determine the concurrent validity of a naturalistic reaching task in a sample of healthy adults. This task was compared to the criterion measure of standard point-to-point reaching. Twenty-eight adults performed unconstrained out-and-back movements in three different directions relative to constant start location along midline using their nondominant arm. In the naturalistic task, participants manipulated a tool to transport objects sequentially between physical targets anchored to the planar workspace. In the standard task, participants moved a digital cursor sequentially between virtual targets, veridical to the planar workspace. In both tasks, the primary measure of performance was trial time, which indicated the time to complete 15 reaches (five cycles of three reaches/target). Two other comparator tasks were also designed to test concurrent validity when components of the naturalistic task were added to the standard task. Spearman's rank correlation coefficients indicated minimal relationship between the naturalistic and standard tasks due to differences in progressive task difficulty. Accounting for this yielded a moderate linear relationship, indicating concurrent validity. The comparator tasks were also related to both the standard and naturalistic task. Thus, the principles of motor control and learning that have been established by the wealth of point-to-point reaching studies can still be applied to the naturalistic task to a certain extent.
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Affiliation(s)
- S Y Schaefer
- Motor Rehabilitation and Learning Laboratory, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA.
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
- The Center on Aging, University of Utah, 30 North 1900 East, AB193 SOM, Salt Lake City, UT, 84132, USA.
| | - C R Hengge
- Motor Rehabilitation and Learning Laboratory, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA
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McLeod A, Bochniewicz EM, Lum PS, Holley RJ, Emmer G, Dromerick AW. Using Wearable Sensors and Machine Learning Models to Separate Functional Upper Extremity Use From Walking-Associated Arm Movements. Arch Phys Med Rehabil 2015; 97:224-31. [PMID: 26435302 DOI: 10.1016/j.apmr.2015.08.435] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/30/2015] [Accepted: 08/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To improve measurement of upper extremity (UE) use in the community by evaluating the feasibility of using body-worn sensor data and machine learning models to distinguish productive prehensile and bimanual UE activity use from extraneous movements associated with walking. DESIGN Comparison of machine learning classification models with criterion standard of manually scored videos of performance in UE prosthesis users. SETTING Rehabilitation hospital training apartment. PARTICIPANTS Convenience sample of UE prosthesis users (n=5) and controls (n=13) similar in age and hand dominance (N=18). INTERVENTIONS Participants were filmed executing a series of functional activities; a trained observer annotated each frame to indicate either UE movement directed at functional activity or walking. Synchronized data from an inertial sensor attached to the dominant wrist were similarly classified as indicating either a functional use or walking. These data were used to train 3 classification models to predict the functional versus walking state given the associated sensor information. Models were trained over 4 trials: on UE amputees and controls and both within subject and across subject. Model performance was also examined with and without preprocessing (centering) in the across-subject trials. MAIN OUTCOME MEASURE Percent correct classification. RESULTS With the exception of the amputee/across-subject trial, at least 1 model classified >95% of test data correctly for all trial types. The top performer in the amputee/across-subject trial classified 85% of test examples correctly. CONCLUSIONS We have demonstrated that computationally lightweight classification models can use inertial data collected from wrist-worn sensors to reliably distinguish prosthetic UE movements during functional use from walking-associated movement. This approach has promise in objectively measuring real-world UE use of prosthetic limbs and may be helpful in clinical trials and in measuring response to treatment of other UE pathologies.
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Affiliation(s)
| | - Elaine M Bochniewicz
- MITRE Corporation, McLean, VA; Department of Biomedical Engineering, Catholic University of America, Washington, DC
| | - Peter S Lum
- Department of Biomedical Engineering, Catholic University of America, Washington, DC; MedStar National Rehabilitation Network, Washington, DC; Washington DC Veterans Affairs Medical Center, Washington, DC; Center for Brain Plasticity and Recovery, Georgetown University, Washington, DC
| | | | | | - Alexander W Dromerick
- MedStar National Rehabilitation Network, Washington, DC; Washington DC Veterans Affairs Medical Center, Washington, DC; Center for Brain Plasticity and Recovery, Georgetown University, Washington, DC; Department of Rehabilitation Medicine, Georgetown University, Washington, DC; Department of Neurology, Georgetown University, Washington, DC.
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Pelton TA, Wing AM, Fraser D, van Vliet P. Differential Effects of Parietal and Cerebellar Stroke in Response to Object Location Perturbation. Front Hum Neurosci 2015; 9:293. [PMID: 26217208 PMCID: PMC4499699 DOI: 10.3389/fnhum.2015.00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The differential contributions of the cerebellum and parietal lobe to coordination between hand transport and hand shaping to an object have not been clearly identified. OBJECTIVE To contrast impairments in reach-to-grasp coordination, in response to object location perturbation, in patients with right parietal and cerebellar lesions, in order to further elucidate the role of each area in reach-to-grasp coordination. METHOD A two-factor design with one between subject factor (right parietal stroke; cerebellar stroke; controls) and one within subject factor (presence or absence of object location perturbation) examined correction processes used to maintain coordination between transport-to-grasp in the presence of perturbation. Sixteen chronic stroke participants (eight with right parietal lesions and eight with cerebellar lesions) were matched in age (mean = 61 years; standard deviation = 12) and hand dominance with 16 healthy controls. Hand and arm movements were recorded during unperturbed baseline trials (10) and unpredictable trials (60) in which the target was displaced to the left (10) or right (10) or remained fixed (40). RESULTS Cerebellar patients had a slowed response to perturbation with anticipatory hand opening, an increased number of aperture peaks and disruption to temporal coordination, and greater variability. Parietal participants also exhibited slowed movements, with increased number of aperture peaks, but in addition, increased the number of velocity peaks and had a longer wrist path trajectory due to difficulties planning the new transport goal and thus relying more on feedback control. CONCLUSION Patients with parietal or cerebellar lesions showed some similar and some contrasting deficits. The cerebellum was more dominant in controlling temporal coupling between transport and grasp components, and the parietal area was more concerned with using sensation to relate arm and hand state to target position.
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Affiliation(s)
- Trudy A. Pelton
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Alan M. Wing
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Dagmar Fraser
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Paulette van Vliet
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
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Efficacy of robot-assisted fingers training in chronic stroke survivors: a pilot randomized-controlled trial. J Neuroeng Rehabil 2015; 12:42. [PMID: 25906983 PMCID: PMC4422529 DOI: 10.1186/s12984-015-0033-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While constraint-induced movement therapy (CIMT) is one of the most promising techniques for upper limb rehabilitation after stroke, it requires high residual function to start with. Robotic device, on the other hand, can provide intention-driven assistance and is proven capable to complement conventional therapy. However, with many robotic devices focus on more proximal joints like shoulder and elbow, recovery of hand and fingers functions have become a challenge. Here we propose the use of robotic device to assist hand and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training. METHODS Participants (6 to 24 months post-stroke) were randomly assigned into two groups: robot-assisted (robot) and non-assisted (control) fingers training groups. Each participant underwent 20-session training. Action Research Arm Test (ARAT) was used as the primary outcome measure, while, Wolf Motor Function Test (WMFT) score, its functional tasks (WMFT-FT) sub-score, Fugl-Meyer Assessment (FMA), its shoulder and elbow (FMA-SE) sub-score, and finger individuation index (FII) served as secondary outcome measures. RESULTS Nineteen patients completed the 20-session training ( TRIAL REGISTRATION HKClinicalTrials.com HKCTR-1554); eighteen of them came back for a 6-month follow-up. Significant improvements (p < 0.05) were found in the clinical scores for both robot and control group after training. However, only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training. The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group. CONCLUSIONS This study showed the potential efficacy of robot-assisted fingers training for hand and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors; and hence, can be used to complement CIMT.
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de los Reyes-Guzmán A, Dimbwadyo-Terrer I, Trincado-Alonso F, Monasterio-Huelin F, Torricelli D, Gil-Agudo A. Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review. Clin Biomech (Bristol, Avon) 2014; 29:719-27. [PMID: 25017296 DOI: 10.1016/j.clinbiomech.2014.06.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/14/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quantitative measures of human movement quality are important for discriminating healthy and pathological conditions and for expressing the outcomes and clinically important changes in subjects' functional state. However the most frequently used instruments for the upper extremity functional assessment are clinical scales, that previously have been standardized and validated, but have a high subjective component depending on the observer who scores the test. But they are not enough to assess motor strategies used during movements, and their use in combination with other more objective measures is necessary. The objective of the present review is to provide an overview on objective metrics found in literature with the aim of quantifying the upper extremity performance during functional tasks, regardless of the equipment or system used for registering kinematic data. METHODS A search in Medline, Google Scholar and IEEE Xplore databases was performed following a combination of a series of keywords. The full scientific papers that fulfilled the inclusion criteria were included in the review. FINDINGS A set of kinematic metrics was found in literature in relation to joint displacements, analysis of hand trajectories and velocity profiles. These metrics were classified into different categories according to the movement characteristic that was being measured. INTERPRETATION These kinematic metrics provide the starting point for a proposed objective metrics for the functional assessment of the upper extremity in people with movement disorders as a consequence of neurological injuries. Potential areas of future and further research are presented in the Discussion section.
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Affiliation(s)
- Ana de los Reyes-Guzmán
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain.
| | - Iris Dimbwadyo-Terrer
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
| | - Fernando Trincado-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
| | - Félix Monasterio-Huelin
- Special Technologies Applied to Telecommunication Department, Higher Technical School of Telecommunications Engineering, Technical University of Madrid (UPM), Avenida Complutense, 30, University City, 28040 Madrid, Spain
| | - Diego Torricelli
- Bioengineering Group, Centre of Automatics and Robotics, Spanish National Research Council (CSIC), Ctra. Campo Real, Km 0.2, Arganda del Rey, 28500 Madrid, Spain
| | - Angel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
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