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Delmas S, Tiwari A, Tseng HY, Poisson SN, Diehl M, Lodha N. Amplified Intraindividual Variability in Motor Performance in Stroke Survivors: Links to Cognitive and Clinical Outcomes. Brain Behav 2025; 15:e70365. [PMID: 39972991 DOI: 10.1002/brb3.70365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 02/04/2025] [Accepted: 02/05/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Intraindividual variability (IIV) in motor performance reflects unintentional fluctuations in the motor output across repeated attempts. Behavioral variability in older adults has been linked to impaired neuronal integrity and cognitive decline. Despite this, the traditional motor assessments in stroke have neglected to characterize IIV in motor performance also known as "motor inconsistency." Therefore, the aim of this study was to investigate the impact of stroke on motor inconsistency and its relationship with cognitive and clinical outcomes. METHODS Sixty-six stroke survivors and 32 healthy older adults performed 30 trials of a goal-directed task to match a force-time target of 10 N in 180 ms. To measure motor inconsistency, we applied a well-established approach to measuring IIV from the cognitive aging literature that accounts for the inherent, systematic effects of practice and mean-level performance on IIV. In addition, participants completed domain-specific cognitive evaluations and global clinical assessments. Domain-specific cognitive evaluations assessed episodic memory, visuospatial processing, processing speed, and executive function. Global clinical assessments included years of education as a proxy of cognitive reserve, the Dementia Rating Scale-2 (DRS-2), ankle strength, and the Modified Rankin Score (mRS). RESULTS Stroke survivors exhibited greater motor inconsistency compared with healthy older adults. Declines in domain-specific cognitive function, particularly executive dysfunction, predicted motor inconsistency in stroke survivors. Cognitive reserve and mRS emerged as significant predictors of motor inconsistency. CONCLUSIONS Stroke significantly impairs the ability to perform a motor task with consistency. Compromised executive function following stroke is associated with increased motor inconsistency. Interestingly, reduced cognitive reserve and greater functional disability are linked to increased motor inconsistency in stroke survivors. These findings highlight that inconsistency is an important indicator of motor dysfunction following stroke that is linked to cognitive and clinical outcomes and may serve as an important target for stroke rehabilitation.
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Affiliation(s)
- Stefan Delmas
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Anjali Tiwari
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Han-Yun Tseng
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Manfred Diehl
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
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Collins KC, Clark AB, Pomeroy VM, Kennedy NC. The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke. Disabil Rehabil 2024; 46:6439-6446. [PMID: 38634228 DOI: 10.1080/09638288.2024.2337107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. METHODS In two identical data collection sessions, 1-3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. RESULTS 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. CONCLUSIONS The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. CLINICAL TRIAL REGISTRATION Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com.
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Affiliation(s)
- Kathryn C Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
- National Institute of Health Research Brain Injury MedTech Cooperative, Cambridge, UK
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Varas-Diaz G, Bhatt T, Oken B, Roth E, Hayes J, Cordo P. Concurrent ankle-assisted movement, biofeedback, and proprioceptive stimulation reduces lower limb motor impairment and improves gait in persons with stroke. Physiother Theory Pract 2024; 40:477-486. [PMID: 36102364 DOI: 10.1080/09593985.2022.2122763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Persons with stroke live with residual sensorimotor impairments in their lower limbs (LL), which affects their gait. PURPOSE We investigated whether these residual impairments and resulting gait deficits can be reduced through concurrently applied assisted movement, biofeedback, and proprioceptive stimulation. METHODS A robotic device provided impairment-oriented training to the affected LL of 24 persons with stroke (PwS) with moderate-to-severe LL impairment. Participants were given 22-30 training sessions over 2-3 months. During training, the interventional device cyclically dorsiflexed and plantarflexed the ankle at 5 deg/s through ±15 deg for 30 min while the participant assisted with the imposed movement. Concurrently, participants received visual biofeedback of assistive joint torque or agonist EMG while mechanical vibration was applied to the currently lengthening (i.e. antagonist) tendon. RESULTS Sensorimotor impairment significantly decreased over the training period, which was sustained over 3 months, based on the Fugl-Meyer Assessment (FMA-LL) (p < .001), modified Ashworth scale in dorsiflexors (p < .05), and an ankle strength test (dorsiflexors and plantarflexors) (p < .05). Balance and gait also improved, based on the Tinetti Performance Oriented Mobility Assessment (POMA) (p < .05). CONCLUSION Impairment-oriented training using a robotic device capable of applying assisted movement, biofeedback, and proprioceptive stimulation significantly reduces LL impairment and improves gait in moderately-to-severely impaired PwS.
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Affiliation(s)
- Gonzalo Varas-Diaz
- School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Barry Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
| | - John Hayes
- College of Optometry, Pacific University, Forest Grove, OR, USA
| | - Paul Cordo
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- AMES Technology Inc, Portland, OR, USA
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Ritter C, Senne M, Berberich N, Yilmazer K, Paredes-Acuna N, Cheng G. Grip Force Dynamics During Exoskeleton-Assisted and Virtual Grasping. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941167 DOI: 10.1109/icorr58425.2023.10304698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The grip force dynamics during grasping and lifting of diversely weighted objects are highly informative about an individual's level of sensorimotor control and potential neurological condition. Therefore, grip force profiles might be used for assessment and bio-feedback training during neurorehabilitation therapy. Modern neurorehabilitation methods, such as exoskeleton-assisted grasping and virtual-reality-based hand function training, strongly differ from classical grasp-and-lift experiments which might influence the sensorimotor control of grasping and thus the characteristics of grip force profiles. In this feasibility study with six healthy participants, we investigated the changes in grip force profiles during exoskeleton-assisted grasping and grasping of virtual objects. Our results show that a light-weight and highly compliant hand exoskeleton is able to assist users during grasping while not removing the core characteristics of their grip force dynamics. Furthermore, we show that when participants grasp objects with virtual weights, they adapt quickly to unknown virtual weights and choose efficient grip forces. Moreover, predictive overshoot forces are produced that match inertial forces which would originate from a physical object of the same weight. In summary, these results suggest that users of advanced neurorehabilitation methods employ and adapt their prior internal forward models for sensorimotor control of grasping. Incorporating such insights about the grip force dynamics of human grasping in the design of neurorehabilitation methods, such as hand exoskeletons, might improve their usability and rehabilitative function.
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Bisson JA, Dupre JR, DeJong SL. Training of isometric force tracking to improve motor control of the wrist after incomplete spinal cord injury: a case study. Physiother Theory Pract 2023; 39:1777-1788. [PMID: 35287525 PMCID: PMC9470767 DOI: 10.1080/09593985.2022.2049405] [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: 07/29/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Upper limb function is a high priority for people with cervical spinal cord injury (SCI). This case report describes an application of technology to activate spared neural pathways and improve wrist motor control. CASE DESCRIPTION A 73-year-old man with chronic incomplete C5 SCI completed 24 training sessions over 92 days. Each session included 2 maximal contractions, 6 test trials, and 10 training trials of a visuomotor force tracking task. The participant attempted to match a sinusoidal target force curve, using isometric wrist flexor and extensor contractions. Electromyography (EMG) and force signals were recorded. OUTCOMES Errors were elevated initially and improved with training, similarly during extension and flexion phases of the force tracking task. Improvement in both phases was associated with greater flexor activation in flexion phases and greater extensor relaxation in flexion phases. Errors were not related to EMG modulation during the extensor phases. Small improvements in active range of motion, grip force, spasticity, touch sensation, and corticospinal excitability were also observed. CONCLUSIONS Motor skill training improved motor control after incomplete SCI, within the range of residual force production capacity. Performance gains were associated with specific adjustments in muscle activation and relaxation, and increased corticospinal excitability.
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Affiliation(s)
- Jayden A Bisson
- Department of Physical Therapy and Rehabilitation Science, Roy J. And Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jacob R Dupre
- Department of Physical Therapy and Rehabilitation Science, Roy J. And Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stacey L DeJong
- Department of Physical Therapy and Rehabilitation Science, Roy J. And Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Térémetz M, Hamdoun S, Colle F, Gerardin E, Desvilles C, Carment L, Charron S, Cuenca M, Calvet D, Baron JC, Turc G, Maier MA, Rosso C, Mas JL, Lindberg PG. Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial. J Neuroeng Rehabil 2023; 20:93. [PMID: 37464404 PMCID: PMC10355015 DOI: 10.1186/s12984-023-01213-9] [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: 01/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).
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Affiliation(s)
- Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sonia Hamdoun
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Médecine Physique et de Réadaptation, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - Florence Colle
- SSR Neurologique, Hôpitaux de Saint-Maurice, 12/14 Rue du Val d'Osne, 94410, Saint-Maurice, France
| | - Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain/CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Claire Desvilles
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Marc A Maier
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, 75006, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jean-Louis Mas
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France.
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Fercho KA, Scholl JL, Kc B, Bosch TJ, Baugh LA. Sensorimotor control of object manipulation following middle cerebral artery (MCA) stroke. Neuropsychologia 2023; 182:108525. [PMID: 36858282 DOI: 10.1016/j.neuropsychologia.2023.108525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
Methods for assessing the loss of hand function post-stroke examine limited aspects of motor performance and are not sensitive to subtle changes that can cause deficits in everyday object manipulation tasks. Efficiently lifting an object entails a prediction of required forces based on intrinsic features of the object (sensorimotor integration), short-term updates in the forces required to lift objects that are poorly predicted (sensorimotor memory), as well as the ability to modulate distal fingertip forces, which are not measured by existing assessment tools used in clinics for both diagnostic and rehabilitative purposes. The presented research examined these three components of skilled object manipulation in 60 chronic, unilateral middle cerebral artery stroke participants. Performance was compared to age-matched control participants, and linear regressions were used to predict performance based on clinical scores. Most post-stroke participants performed below control levels in at least one of the tasks. Post-stroke participants presented with combinations of deficits in each of the tasks performed, regardless of the hemisphere damaged by the stroke. Surprisingly, the ability to modulate distal forces was impaired in those patients with damage ipsilateral (right hemisphere) to the hand being used. Sensorimotor integration was also impaired in patients with right hemisphere damage, though they performed at control levels in later lifts, whereas left-hemisphere-damaged patients did not. Lastly, during a task requiring sensorimotor memory, neither patient group performed outside of control ranges on initial lifts, with patients with right hemisphere damage showing impaired performance in later lifts suggesting they were unable to learn the mapping novel mapping of color and mass of the objects. The presented research demonstrates unilateral MCA stroke patients can have deficits in one or more components required for the successful manipulation of hand-held objects and that skillful object lifting requires intact bilateral systems. Further, this information may be used in future studies to aid efforts that target rehabilitation regimens to a stroke survivor's specific pattern of deficits.
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Affiliation(s)
| | - Jamie L Scholl
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Bikash Kc
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Taylor J Bosch
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Lee A Baugh
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA.
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Lafe CW, Liu F, Simpson TW, Moon CH, Collinger JL, Wittenberg GF, Urbin MA. Force oscillations underlying precision grip in humans with lesioned corticospinal tracts. Neuroimage Clin 2023; 38:103398. [PMID: 37086647 PMCID: PMC10173012 DOI: 10.1016/j.nicl.2023.103398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 04/24/2023]
Abstract
Stability of precision grip depends on the ability to regulate forces applied by the digits. Increased frequency composition and temporal irregularity of oscillations in the force signal are associated with enhanced force stability, which is thought to result from increased voluntary drive along the corticospinal tract (CST). There is limited knowledge of how these oscillations in force output are regulated in the context of dexterous hand movements like precision grip, which are often impaired by CST damage due to stroke. The extent of residual CST volume descending from primary motor cortex may help explain the ability to modulate force oscillations at higher frequencies. Here, stroke survivors with longstanding hand impairment (n = 17) and neurologically-intact controls (n = 14) performed a precision grip task requiring dynamic and isometric muscle contractions to scale and stabilize forces exerted on a sensor by the index finger and thumb. Diffusion spectrum imaging was used to quantify total white matter volume within the residual and intact CSTs of stroke survivors (n = 12) and CSTs of controls (n = 14). White matter volumes within the infarct region and an analogous portion of overlap with the CST, mirrored onto the intact side, were also quantified in stroke survivors. We found reduced ability to stabilize force and more restricted frequency ranges in force oscillations of stroke survivors relative to controls; though, more broadband, irregular output was strongly related to force-stabilizing ability in both groups. The frequency composition and temporal irregularity of force oscillations observed in stroke survivors did not correlate with maximal precision grip force, suggesting that it is not directly related to impaired force-generating capacity. The ratio of residual to intact CST volumes contained within infarct and mirrored compartments was associated with more broadband, irregular force oscillations in stroke survivors. Our findings provide insight into granular aspects of dexterity altered by corticospinal damage and supply preliminary evidence to support that the ability to modulate force oscillations at higher frequencies is explained, at least in part, by residual CST volume in stroke survivors.
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Affiliation(s)
- Charley W Lafe
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA
| | - Fang Liu
- Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Tyler W Simpson
- Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Chan Hong Moon
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jennifer L Collinger
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - George F Wittenberg
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Michael A Urbin
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Kanzler CM, Lessard I, Gassert R, Brais B, Gagnon C, Lambercy O. Digital health metrics reveal upper limb impairment profiles in ARSACS. J Neurol Sci 2023; 448:120621. [PMID: 37004405 DOI: 10.1016/j.jns.2023.120621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) often present with reduced upper limb coordination affecting their independence in daily life. Previous studies in ARSACS identified reduced performance in clinical assessments requiring fine and gross dexterity as well as prehension. However, the kinematic and kinetic aspects underlying reduced upper limb coordination in ARSACS have not been systematically investigated yet. In this work, we aimed to provide a detailed characterization of alterations in upper limb movement patterns and hand grip forces in 57 participants with ARSACS. METHODS We relied on a goal-directed technology-aided assessment task, which provides eight previously validated digital health metrics describing movement efficiency, smoothness, speed, and grip force control. RESULTS First, we observed that 98.3% of the participants were impaired in at least one of the metrics, that all metrics are significantly impaired on a population level, and that grip force control during precise manipulations is most commonly and strongly impaired. Second, we identified high inter-participant variability in the kinematic and kinetic impairment profiles, thereby capturing different clinical profiles subjectively observed in this population. Lastly, abnormal goal-directed task performance in ARSACS could be best explained by reduced movement speed, efficiency, and especially force control during precise manipulations, while abnormal movement smoothness did not have a significant effect. INTERPRETATION This work helped to refine the clinical profile of ARSACS and highlights the need for characterizing individual kinematic and kinetic impairment profiles in clinical trials in ARSACS.
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Lapresa M, Lauretti C, Scotto di Luzio F, Bressi F, Santacaterina F, Bravi M, Guglielmelli E, Zollo L, Cordella F. Development and Validation of a System for the Assessment and Recovery of Grip Force Control. Bioengineering (Basel) 2023; 10:63. [PMID: 36671635 PMCID: PMC9854469 DOI: 10.3390/bioengineering10010063] [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: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The ability to finely control hand grip forces can be compromised by neuromuscular or musculoskeletal disorders. Therefore, it is recommended to include the training and assessment of grip force control in rehabilitation therapy. The benefits of robot-mediated therapy have been widely reported in the literature, and its combination with virtual reality and biofeedback can improve rehabilitation outcomes. However, the existing systems for hand rehabilitation do not allow both monitoring/training forces exerted by single fingers and providing biofeedback. This paper describes the development of a system for the assessment and recovery of grip force control. An exoskeleton for hand rehabilitation was instrumented to sense grip forces at the fingertips, and two operation modalities are proposed: (i) an active-assisted training to assist the user in reaching target force values and (ii) virtual reality games, in the form of tracking tasks, to train and assess the user's grip force control. For the active-assisted modality, the control of the exoskeleton motors allowed generating additional grip force at the fingertips, confirming the feasibility of this modality. The developed virtual reality games were positively accepted by the volunteers and allowed evaluating the performance of healthy and pathological users.
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Affiliation(s)
- Martina Lapresa
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Clemente Lauretti
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesco Scotto di Luzio
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Federica Bressi
- Unit of Physical Medicine and Rehabilitation, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabio Santacaterina
- Unit of Physical Medicine and Rehabilitation, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Marco Bravi
- Unit of Physical Medicine and Rehabilitation, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Eugenio Guglielmelli
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Loredana Zollo
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesca Cordella
- Research Unit of Advanced Robotics and Human-Centred Technologies, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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11
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Force acquisition frequency is less impaired compared to grip strength or hand dexterity in individuals with chronic stroke. Exp Brain Res 2022; 240:2513-2521. [DOI: 10.1007/s00221-022-06432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
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12
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A low-dimensional representation of arm movements and hand grip forces in post-stroke individuals. Sci Rep 2022; 12:7601. [PMID: 35534629 PMCID: PMC9085765 DOI: 10.1038/s41598-022-11806-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Characterizing post-stroke impairments in the sensorimotor control of arm and hand is essential to better understand altered mechanisms of movement generation. Herein, we used a decomposition algorithm to characterize impairments in end-effector velocity and hand grip force data collected from an instrumented functional task in 83 healthy control and 27 chronic post-stroke individuals with mild-to-moderate impairments. According to kinematic and kinetic raw data, post-stroke individuals showed reduced functional performance during all task phases. After applying the decomposition algorithm, we observed that the behavioural data from healthy controls relies on a low-dimensional representation and demonstrated that this representation is mostly preserved post-stroke. Further, it emerged that reduced functional performance post-stroke correlates to an abnormal variance distribution of the behavioural representation, except when reducing hand grip forces. This suggests that the behavioural repertoire in these post-stroke individuals is mostly preserved, thereby pointing towards therapeutic strategies that optimize movement quality and the reduction of grip forces to improve performance of daily life activities post-stroke.
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13
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Robotic-Assisted Hand Therapy with Gloreha Sinfonia for the Improvement of Hand Function after Pediatric Stroke: A Case Report. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Stroke in childhood presents a serious rehabilitation challenge since it leads to physical, cognitive and psychosocial disability. The objective of our study was to describe the effectiveness of robot-mediated therapy (RMT) with Gloreha Sinfonia in addition to a conventional treatment in the recovery of the sensory-motor capabilities of the paretic hand and the quality of life in a ten-year-old child after a stroke. Methods: The girl was enrolled to undergo 10 sessions of RMT with Gloreha Sinfonia. She was evaluated with functional scales and with upper limb kinematic analysis at pre-treatment (T0) and at the end of treatment (T1). Outcome measures were Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Visual Analogic Scale (VAS) and Activities and Participation of Daily Life (ADL). In addition, a Force Assessment System based on Virtual Reality games was used to assess the force control and modulation capability at T0 and T1. Results: At the end of treatment, the patient improved in functional scales and in quality of life for greater involvement in some activity of daily living. Force control and modulation capability significantly increased after the treatment. Conclusions: This clinical case highlights possible positive effects of a combined (conventional plus robotic) rehabilitation treatment for the upper limb in pediatric stroke outcomes from both a sensorimotor and functional point of view, also improving the motivational and affective aspects of the patient and of family members. Further studies are needed to validate these results and to identify the most appropriate modalities and doses.
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14
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Kanzler CM, Lessard I, Gassert R, Brais B, Gagnon C, Lambercy O. Reliability and validity of digital health metrics for assessing arm and hand impairments in an ataxic disorder. Ann Clin Transl Neurol 2022; 9:432-443. [PMID: 35224896 PMCID: PMC8994987 DOI: 10.1002/acn3.51493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is the second most frequent recessive ataxia and commonly features reduced upper limb coordination. Sensitive outcome measures of upper limb coordination are essential to track disease progression and the effect of interventions. However, available clinical assessments are insufficient to capture behavioral variability and detailed aspects of motor control. While digital health metrics extracted from technology-aided assessments promise more fine-grained outcome measures, these have not been validated in ARSACS. Thus, the aim was to document the metrological properties of metrics from a technology-aided assessment of arm and hand function in ARSACS. METHODS We relied on the Virtual Peg Insertion Test (VPIT) and used a previously established core set of 10 digital health metrics describing upper limb movement and grip force patterns during a pick-and-place task. We evaluated reliability, measurement error, and learning effects in 23 participants with ARSACS performing three repeated assessment sessions. In addition, we documented concurrent validity in 57 participants with ARSACS performing one session. RESULTS Eight metrics had excellent test-retest reliability (intraclass correlation coefficient 0.89 ± 0.08), five low measurement error (smallest real difference % 25.4 ± 5.7), and none strong learning effects (systematic change η -0.11 ± 2.5). Significant correlations (ρ 0.39 ± 0.13) with clinical scales describing gross and fine dexterity and lower limb coordination were observed. INTERPRETATION This establishes eight digital health metrics as valid and robust endpoints for cross-sectional studies and five metrics as potentially sensitive endpoints for longitudinal studies in ARSACS, thereby promising novel insights into upper limb sensorimotor control.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and TechnologyInstitute of Robotics and Intelligent Systems, ETH ZurichZurichSwitzerland
- Future Health TechnologiesSingapore‐ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE)Singapore
| | - Isabelle Lessard
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN)Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay–Lac‐St‐JeanSaguenayQuebecCanada
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and TechnologyInstitute of Robotics and Intelligent Systems, ETH ZurichZurichSwitzerland
- Future Health TechnologiesSingapore‐ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE)Singapore
| | - Bernard Brais
- The Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
| | - Cynthia Gagnon
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN)Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay–Lac‐St‐JeanSaguenayQuebecCanada
- Faculty of Medicine and Health SciencesUniversité de SherbrookeSherbrookeQuebecCanada
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and TechnologyInstitute of Robotics and Intelligent Systems, ETH ZurichZurichSwitzerland
- Future Health TechnologiesSingapore‐ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE)Singapore
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15
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Rosso C, Moulton EJ, Kemlin C, Leder S, Corvol JC, Mehdi S, Obadia MA, Obadia M, Yger M, Meseguer E, Perlbarg V, Valabregue R, Magno S, Lindberg P, Meunier S, Lamy JC. Cerebello-Motor Paired Associative Stimulation and Motor Recovery in Stroke: a Randomized, Sham-Controlled, Double-Blind Pilot Trial. Neurotherapeutics 2022; 19:491-500. [PMID: 35226342 PMCID: PMC9226244 DOI: 10.1007/s13311-022-01205-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/27/2022] Open
Abstract
Cerebellum is a key structure for functional motor recovery after stroke. Enhancing the cerebello-motor pathway by paired associative stimulation (PAS) might improve upper limb function. Here, we conducted a randomized, double-blind, sham-controlled pilot trial investigating the efficacy of a 5-day treatment of cerebello-motor PAS coupled with physiotherapy for promoting upper limb motor function compared to sham stimulation. The secondary objectives were to determine in the active treated group (i) whether improvement of upper limb motor function was associated with changes in corticospinal excitability or changes in functional activity in the primary motor cortex and (ii) whether improvements were correlated to the structural integrity of the input and output pathways. To that purpose, hand dexterity and maximal grip strength were assessed along with TMS recordings and multimodal magnetic resonance imaging, before the first treatment, immediately after the last one and a month later. Twenty-seven patients were analyzed. Cerebello-motor PAS was effective compared to sham in improving hand dexterity (p: 0.04) but not grip strength. This improvement was associated with increased activation in the ipsilesional primary motor cortex (p: 0.04). Moreover, the inter-individual variability in clinical improvement was partly explained by the structural integrity of the afferent (p: 0.06) and efferent pathways (p: 0.02) engaged in this paired associative stimulation (i.e., cortico-spinal and dentato-thalamo-cortical tracts). In conclusion, cerebello-motor-paired associative stimulation combined with physiotherapy might be a promising approach to enhance upper limb motor function after stroke.Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT02284087.
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Affiliation(s)
- Charlotte Rosso
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
- ICM Infrastructure Stroke Network, STAR Team, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, DMU Neuroscience 6, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Eric Jr Moulton
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- ICM Infrastructure Stroke Network, STAR Team, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Claire Kemlin
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- ICM Infrastructure Stroke Network, STAR Team, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Sara Leder
- AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, DMU Neuroscience 6, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jean-Christophe Corvol
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- ICM Infrastructure Stroke Network, STAR Team, Hôpital Pitié-Salpêtrière, 75013, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Département de neurologieDMU Neuroscience 6, 75013, Paris, France
| | - Sophien Mehdi
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Centre de Neuro-Imagerie de Recherche, Institut du Cerveau, CENIR, Paris Brain Institute - ICM, 75013, Paris, France
| | - Mickael A Obadia
- Service de Neurologie, Fondation Rothschild, 75019, Paris, France
| | - Mickael Obadia
- Service de Neurologie, Fondation Rothschild, 75019, Paris, France
| | - Marion Yger
- AP-HP, Hôpital Saint Antoine, Unité neurovasculaire, 75012, Paris, France
| | - Elena Meseguer
- AP-HP, Service de Neurologie, Hôpital Bichat, 75018, Paris, France
- Laboratory for Vascular Translational Science, INSERM UMRS1148, 75018, Paris, France
| | - Vincent Perlbarg
- Centre de Neuro-Imagerie de Recherche, Institut du Cerveau, CENIR, Paris Brain Institute - ICM, 75013, Paris, France
| | - Romain Valabregue
- Centre de Neuro-Imagerie de Recherche, Institut du Cerveau, CENIR, Paris Brain Institute - ICM, 75013, Paris, France
| | - Serena Magno
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- ICM Infrastructure Stroke Network, STAR Team, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Pavel Lindberg
- Inserm U894, Université Paris Descartes, 75013, Paris, France
| | - Sabine Meunier
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Charles Lamy
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Centre de Neuro-Imagerie de Recherche, Institut du Cerveau, CENIR, Paris Brain Institute - ICM, 75013, Paris, France
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16
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Design of a 3D-Printed Hand Exoskeleton Based on Force-Myography Control for Assistance and Rehabilitation. MACHINES 2022. [DOI: 10.3390/machines10010057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Voluntary hand movements are usually impaired after a cerebral stroke, affecting millions of people per year worldwide. Recently, the use of hand exoskeletons for assistance and motor rehabilitation has become increasingly widespread. This study presents a novel hand exoskeleton, designed to be low cost, wearable, easily adaptable and suitable for home use. Most of the components of the exoskeleton are 3D printed, allowing for easy replication, customization and maintenance at a low cost. A strongly underactuated mechanical system allows one to synergically move the four fingers by means of a single actuator through a rigid transmission, while the thumb is kept in an adduction or abduction position. The exoskeleton’s ability to extend a typical hypertonic paretic hand of stroke patients was firstly tested using the SimScape Multibody simulation environment; this helped in the choice of a proper electric actuator. Force-myography was used instead of the standard electromyography to voluntarily control the exoskeleton with more simplicity. The user can activate the flexion/extension of the exoskeleton by a weak contraction of two antagonist muscles. A symmetrical master–slave motion strategy (i.e., the paretic hand motion is activated by the healthy hand) is also available for patients with severe muscle atrophy. An inexpensive microcontroller board was used to implement the electronic control of the exoskeleton and provide feedback to the user. The entire exoskeleton including batteries can be worn on the patient’s arm. The ability to provide a fluid and safe grip, like that of a healthy hand, was verified through kinematic analyses obtained by processing high-framerate videos. The trajectories described by the phalanges of the natural and the exoskeleton finger were compared by means of cross-correlation coefficients; a similarity of about 80% was found. The time required for both closing and opening of the hand exoskeleton was about 0.9 s. A rigid cylindric handlebar containing a load cell measured an average power grasp force of 94.61 N, enough to assist the user in performing most of the activities of daily living. The exoskeleton can be used as an aid and to promote motor function recovery during patient’s neurorehabilitation therapy.
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17
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Ebisu S, Kasahara S, Saito H, Ishida T. Decrease in force control among older adults under unpredictable conditions. Exp Gerontol 2021; 158:111649. [PMID: 34875350 DOI: 10.1016/j.exger.2021.111649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Falls in older adults generally occur during unpredictable situations. Controlling posture through fine-tuned muscle force before and after falls is necessary to avoid serious injuries. However, details regarding force control among older adults during unpredictable situations are unclear. This study determined the features of force control in a random force-tracking task among older adults. METHODS Ten healthy older adults (67-76 years) and eight healthy young adults (20-23 years) participated in three force-tracking tasks with ankle plantar flexion: low-range (LR), high-range (HR), and pseudo-random (PR) force tasks. Force control ability was assessed using the root mean square error (RMSE) between the target and muscle forces produced by the participants. Muscle activities from the lateral head of the gastrocnemius and the tibialis anterior during each task were measured using surface electromyography to calculate the co-contraction index (CCI). RESULTS In all tasks, older adults (RMSEs: 1.09-3.70, CCIs: 29.4-56.4) had a significantly greater RMSEs and CCIs than young adults (RMSEs: 0.49-1.83, CCIs: 11.7-20.6; all, p < 0.05). The RMSEs during force generation were significantly greater than those during force release (LR: p < 0.01, HR: p < 0.05), except for the random force-tracking task in older adults. CCIs during the force release phase in both groups (older adults: 27.8-56.4, young adults: 15.0-20.6) were consistently greater than those during force generation (older adults: 24.5-50.4, young adults: 11.7-17.2). CCIs in force-tracing tasks differed in older adults, whereas those in the random force-tracing task increased. RMSEs and CCIs in the random and LR force-tracing tasks were significantly negatively correlated with the functional reach test (all: r > 0.5, p < 0.05). CONCLUSION Force control in older adults declines in low-band and random muscle force output. Moreover, increased CCIs in older adults are particularly pronounced during unpredictable situations.
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Affiliation(s)
- Shunsuke Ebisu
- Department of Physical Therapy, Rehabilitation part, Hokuto Social Medical Corporation Tokachi Rehabilitation Center, Japan
| | - Satoshi Kasahara
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Hiroshi Saito
- Department of Physical Therapy, School of Rehabilitation, Tokyo Kasei University, Sayama, Japan
| | - Tomoya Ishida
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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18
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Taud B, Lindenberg R, Darkow R, Wevers J, Höfflin D, Grittner U, Meinzer M, Flöel A. Limited Add-On Effects of Unilateral and Bilateral Transcranial Direct Current Stimulation on Visuo-Motor Grip Force Tracking Task Training Outcome in Chronic Stroke. A Randomized Controlled Trial. Front Neurol 2021; 12:736075. [PMID: 34858310 PMCID: PMC8631774 DOI: 10.3389/fneur.2021.736075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This randomized controlled trial investigated if uni- and bihemispheric transcranial direct current stimulation (tDCS) of the motor cortex can enhance the effects of visuo-motor grip force tracking task training and transfer to clinical assessments of upper extremity motor function. Methods: In a randomized, double-blind, sham-controlled trial, 40 chronic stroke patients underwent 5 days of visuo-motor grip force tracking task training of the paretic hand with either unilateral or bilateral (N = 15/group) or placebo tDCS (N = 10). Immediate and long-term (3 months) effects on training outcome and motor recovery (Upper Extremity Fugl-Meyer, UE-FM, Wolf Motor Function Test, and WMFT) were investigated. Results: Trained task performance significantly improved independently of tDCS in a curvilinear fashion. In the anodal stimulation group UE-FM scores were higher than in the sham group at day 5 (adjusted mean difference: 2.6, 95%CI: 0.6–4.5, p = 0.010) and at 3 months follow up (adjusted mean difference: 2.8, 95%CI: 0.8–4.7, p = 0.006). Neither training alone, nor the combination of training and tDCS improved WMFT performance. Conclusions: Visuo-motor grip force tracking task training can facilitate recovery of upper extremity function. Only minimal add-on effects of anodal but not dual tDCS were observed. Clinical Trial Registration:https://clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT01969097&cntry=&state=&city=&dist=, identifier: NCT01969097, retrospectively registered on 25/10/2013.
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Affiliation(s)
- Benedikt Taud
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Robert Lindenberg
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of History, Philosophy and Ethics of Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Robert Darkow
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Jasmin Wevers
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Dorothee Höfflin
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Ulrike Grittner
- Berlin Institute of Health at Charité, Charité University Medicine, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité University Medicine, Berlin, Germany
| | - Marcus Meinzer
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases, Site Greifswald/Rostock, Greifswald, Germany.,Center for Stroke Research, Charité University Medicine, Berlin, Germany
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19
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Feingold-Polak R, Yelkin A, Edelman S, Shapiro A, Levy-Tzedek S. The effects of an object's height and weight on force calibration and kinematics when post-stroke and healthy individuals reach and grasp. Sci Rep 2021; 11:20559. [PMID: 34663848 PMCID: PMC8523696 DOI: 10.1038/s41598-021-00036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
Impairment in force regulation and motor control impedes the independence of individuals with stroke by limiting their ability to perform daily activities. There is, at present, incomplete information about how individuals with stroke regulate the application of force and control their movement when reaching, grasping, and lifting objects of different weights, located at different heights. In this study, we assess force regulation and kinematics when reaching, grasping, and lifting a cup of two different weights (empty and full), located at three different heights, in a total of 46 participants: 30 sub-acute stroke participants, and 16 healthy individuals. We found that the height of the reached target affects both force calibration and kinematics, while its weight affects only the force calibration when post-stroke and healthy individuals perform a reach-to-grasp task. There was no difference between the two groups in the mean and peak force values. The individuals with stroke had slower, jerkier, less efficient, and more variable movements compared to the control group. This difference was more pronounced with increasing stroke severity. With increasing stroke severity, post-stroke individuals demonstrated altered anticipation and preparation for lifting, which was evident for either cortical lesion side.
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Affiliation(s)
- Ronit Feingold-Polak
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel
| | - Anna Yelkin
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel
- Beit Hadar Rehabilitation Center, Ashdod, Israel
| | - Shmil Edelman
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Shapiro
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shelly Levy-Tzedek
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel.
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany.
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20
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Zbytniewska M, Kanzler CM, Jordan L, Salzmann C, Liepert J, Lambercy O, Gassert R. Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke. J Neuroeng Rehabil 2021; 18:115. [PMID: 34271954 PMCID: PMC8283922 DOI: 10.1186/s12984-021-00904-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal}
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\begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00904-5.
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Affiliation(s)
- Monika Zbytniewska
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Lisa Jordan
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Salzmann
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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21
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Prados-Román E, Cabrera-Martos I, López-López L, Rodríguez-Torres J, Torres-Sánchez I, Ortiz-Rubio A, Valenza MC. Deficits underlying handgrip performance in mildly affected chronic stroke persons. Top Stroke Rehabil 2020; 28:190-197. [PMID: 32758034 DOI: 10.1080/10749357.2020.1803574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Knowledge of the deficits underlying handgrip performance is fundamental for the development of targeted interventions. OBJECTIVES The purpose of this study was to evaluate maximal handgrip strength, fatigue resistance, grip work, and muscle fatigue in mildly affected stroke persons. METHODS We conducted a prospective observational study. A total of 20 individuals after a first unilateral ischemic/hemorrhagic chronic stroke (months poststroke: mean 33.64 ± 19.60), mildly affected according to functional score (FIM: 112.71 ± 16.14) and with arm motor impairment (upper-extremity Fugl-Meyer score: mean 57.07 ± 7.82 on the contralesional side); and 20 sex and age-matched controls were included. The outcomes assessed were maximal handgrip strength evaluated through maximal voluntary contraction, fatigue resistance defined as the seconds during which grip strength dropped to 50% of its maximum and gripwork, which was calculated using the equation grip work = maximal grip strength * 0.75 * fatigue resistance. Muscle fatigue was assessed using surface electromyography during a sustained contraction over 50% of maximal voluntary contraction. RESULTS Persons with stroke demonstrated significantly reduced handgrip performance regarding maximal handgrip strength, resistance to fatigue, grip work, and muscle fatigue for the contralesional hand. In addition, a reduced grip resistance and muscle fatigue was shown for the ipsilesional hand compared with controls. We found no effect of the hemispheric side of the lesion on the grip performance measures assessed. CONCLUSIONS Our findings provide evidence that handgrip performance remain impaired after 6 months after stroke, and may serve as a target for interventions to improve these abilities after stroke.
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Affiliation(s)
- Esther Prados-Román
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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22
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Sun J, Yan F, Liu A, Liu T, Wang H. Electrical Stimulation of the Motor Cortex or Paretic Muscles Improves Strength Production in Stroke Patients: A Systematic Review and Meta-Analysis. PM R 2020; 13:171-179. [PMID: 32385898 DOI: 10.1002/pmrj.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are two widely applied methods of electrical stimulation for motor recovery among stroke patients. This systematic review and meta-analysis investigated the efficacy of tDCS and FES for strength production in stroke patients. TYPE: Systematic review. LITERATURE SURVEY Studies that explored the effects of tDCS or FES on the strength production of paralyzed muscles in stroke patients were retrieved on a comprehensive set of three databases: (1) Google Scholar, (2) PubMed, and (3) the Cochrane Database of Systematic Reviews until July 2019. METHODOLOGY Systematic study retrieval led to the inclusion of 15 studies that reported on strength production effects after tDCS and FES interventions among stoke patients. A sham control group and randomization were used in each study. The 15 studies included 20 comparisons with sham controls, 7 of which involved tDCS and 13 of which involved FES. SYNTHESIS Random-effects models showed that strength production was improved after tDCS (effect size [ES] = 0.52, 95% confidence interval [CI] = 0.35-0.69, P < .001, Z = 6.05) and FES (ES = 0.47, 95% CI = 0.16-0.78, P < .003, Z = 2.99). Additionally, tDCS was shown to improve strength production in the acute (ES = 0.52, 95% CI = 0.24-0.80, P < .001, Z = 3.65), subacute (ES = 0.85, 95% CI = 0.37-1.32, P < .001, Z = 3.51), but not chronic (ES = 0.06, 95% CI = -0.47-0.60, P = .82, Z = 0.23) phases of stroke recovery. Out of the 13 studies involving FES, 12 investigated strength production in the chronic phase and one investigated in the acute phase, showing a positive effect in these two stages. CONCLUSIONS The results of the meta-analysis showed that tDCS and FES successfully improved strength production in stroke patients.
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Affiliation(s)
- Jinping Sun
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Fei Yan
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Aili Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Tiaotiao Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - He Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
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23
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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24
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Transient changes in paretic and non-paretic isometric force control during bimanual submaximal and maximal contractions. J Neuroeng Rehabil 2020; 17:64. [PMID: 32410626 PMCID: PMC7227276 DOI: 10.1186/s12984-020-00693-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to investigate transient bimanual effects on the force control capabilities of the paretic and non-paretic arms in individuals post stroke across submaximal and maximal force control tasks. Methods Fourteen chronic stroke patients (mean age = 63.8 ± 15.9; stroke duration = 38.7 ± 45.2 months) completed two isometric force control tasks: (a) submaximal control and (b) maximal sustained force production. Participants executed both tasks with their wrist and fingers extending across unimanual (paretic and non-paretic arms) and bimanual conditions. Mean force, force variability using coefficient of variation, force regularity using sample entropy were calculated for each condition. Results During the submaximal force control tasks (i.e., 5, 25, and 50% of maximum voluntary contraction), the asymmetrical mean force between the paretic and non-paretic arms decreased from unimanual to bimanual conditions. The asymmetry of force variability and regularity between the two arms while executing unimanual force control tended to decrease in the bimanual condition because of greater increases in the force variability and regularity for the non-paretic arm than those for the paretic arm. During the maximal sustained force production tasks (i.e., 100% of maximum voluntary contraction), the paretic arm increased maximal forces and decreased force variability in the bimanual condition, whereas the non-paretic arm reduced maximal forces and elevated force variability from unimanual to bimanual conditions. Conclusions The current findings support a proposition that repetitive bimanual isometric training with higher execution intensity may facilitate progress toward stroke motor recovery.
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25
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Patel P, Kaingade SR, Wilcox A, Lodha N. Force control predicts fine motor dexterity in high-functioning stroke survivors. Neurosci Lett 2020; 729:135015. [PMID: 32360934 DOI: 10.1016/j.neulet.2020.135015] [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] [Received: 12/12/2019] [Revised: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE High-functioning stroke survivors with mild to moderate motor impairments show greater functional autonomy in activities of daily living, and often return to work or prior activities. Increased functional independence necessitates dexterous use of hands to execute tasks such as typing, using a phone, and driving. Despite the absence of any pronounced motor impairments, high-functioning individuals with stroke report challenges in performing skilled manual tasks. Two prominent motor deficits that limit functional performance after stroke are decline in strength and force control. Here, we quantify the deficits in fine motor dexterity in high-functioning stroke survivors and determine the relative contribution of strength and force control to fine motor dexterity. METHODS Fifteen high-functioning participants with stroke (upper-limb Fugl-Meyer score ≥43/66) and 15 controls performed following tasks with the paretic and non-dominant hands respectively: i) Nine-hole peg pest, ii) maximum voluntary contraction and iii) dynamic force tracking with isometric finger flexion. RESULTS High-functioning stroke participants required greater time to complete the pegboard task, showed reduced finger strength, and increased force variability relative to the controls. Importantly, the time to complete pegboard task in high-functioning stroke participants was explained by finger force variability, not strength. DISCUSSION AND CONCLUSIONS High-functioning stroke survivors show persistent deficits in fine motor dexterity, finger strength, and force control. The ability to modulate forces (control) contributes to fine motor dexterity in high-functioning stroke survivors. Interventions to improve fine motor dexterity in these individuals should include the assessment and training of force control.
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Affiliation(s)
- Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Sarthak R Kaingade
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Anthony Wilcox
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.
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26
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Carment L, Khoury E, Dupin L, Guedj L, Bendjemaa N, Cuenca M, Maier MA, Krebs MO, Lindberg PG, Amado I. Common vs. Distinct Visuomotor Control Deficits in Autism Spectrum Disorder and Schizophrenia. Autism Res 2020; 13:885-896. [PMID: 32157824 DOI: 10.1002/aur.2287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SCZ) are neurodevelopmental disorders with partly overlapping clinical phenotypes including sensorimotor impairments. However, direct comparative studies on sensorimotor control across these two disorders are lacking. We set out to compare visuomotor upper limb impairment, quantitatively, in ASD and SCZ. Patients with ASD (N = 24) were compared to previously published data from healthy control participants (N = 24) and patients with SCZ (N = 24). All participants performed a visuomotor grip force-tracking task in single and dual-task conditions. The dual-task (high cognitive load) presented either visual distractors or required mental addition during grip force-tracking. Motor inhibition was measured by duration of force release and from principal component analysis (PCA) of the participant's force-trajectory. Common impairments in patients with ASD and SCZ included increased force-tracking error in single-task condition compared to controls, a further increase in error in dual-task conditions, and prolonged duration of force release. These three sensorimotor impairments were found in both patient groups. In contrast, distinct impairments in patients with ASD included greater error under high cognitive load and delayed onset of force release compared to SCZ. The PCA inhibition component was higher in ASD than SCZ and controls, correlated to duration of force release, and explained group differences in tracking error. In conclusion, sensorimotor impairments related to motor inhibition are common to ASD and SCZ, but more severe in ASD, consistent with enhanced neurodevelopmental load in ASD. Furthermore, impaired motor anticipation may represent a further specific impairment in ASD. Autism Res 2020, 13: 885-896. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorder (ASD) and schizophrenia (SCZ) are neurodevelopmental disorders with partly overlapping and partly distinct clinical symptoms. Sensorimotor impairments rank among these symptoms, but it is less clear whether they are shared or distinct. In this study, we showed using a grip force task that sensorimotor impairments related to motor inhibition are common to ASD and SCZ, but more severe in ASD. Impaired motor anticipation may represent a further specific impairment in ASD.
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Affiliation(s)
- Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France
| | | | - Lucile Dupin
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France
| | - Laura Guedj
- Resource Center for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), Université de Paris, Hôpital Sainte-Anne, Paris, France
| | - Narjes Bendjemaa
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France.,Resource Center for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), Université de Paris, Hôpital Sainte-Anne, Paris, France.,Centre de Recherche Clinique, Hôpital Sainte-Anne, Paris, France
| | - Macarena Cuenca
- Institut de Psychiatrie CNRS GDR3557, Paris, France.,Centre de Recherche Clinique, Hôpital Sainte-Anne, Paris, France
| | - Marc A Maier
- Institut de Psychiatrie CNRS GDR3557, Paris, France.,Université de Paris UMR 8002 CNRS, Paris, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France.,Resource Center for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), Université de Paris, Hôpital Sainte-Anne, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France
| | - Isabelle Amado
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France.,Institut de Psychiatrie CNRS GDR3557, Paris, France.,Resource Center for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), Université de Paris, Hôpital Sainte-Anne, Paris, France
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27
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Abstract
OBJECTIVES To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage. METHODS Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment. RESULTS A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups. CONCLUSIONS When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470-478).
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28
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Parry R, Macias Soria S, Pradat-Diehl P, Marchand-Pauvert V, Jarrassé N, Roby-Brami A. Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis. Front Neurol 2019; 10:240. [PMID: 30941091 PMCID: PMC6433942 DOI: 10.3389/fneur.2019.00240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/22/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object. Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task. Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm. Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release.
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Affiliation(s)
- Ross Parry
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France.,Centre de Recherche sur le Sport et le Mouvement, EA 2931, Université Paris Nanterre, Nanterre, France
| | - Sandra Macias Soria
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Pascale Pradat-Diehl
- Service de Médecine Physique et de Réadaptation, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,AP-HP, GRC n°18 Handicap cognitif et réadaptation (HanCRe), Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | | | - Nathanaël Jarrassé
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Agnès Roby-Brami
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
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29
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Yang Q, Zheng M, Ye Y, Li L, Yan T, Song R. The Step Response in Isometric Grip Force Tracking: A Model to Characterize Aging- and Stroke-Induced Changes. IEEE Trans Neural Syst Rehabil Eng 2019; 27:673-681. [PMID: 30872233 DOI: 10.1109/tnsre.2019.2904251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper aimed to construct a model to represent dynamic motor behavior to quantitatively investigate aging- and stroke-induced changes and, thus, to explore the underlying mechanisms of grip control. Grip force tracking tasks were conducted by stroke patients, age-matched healthy controls, and healthy young adults at 25%, 50%, and 75% maximum voluntary contractions (MVC), respectively. Sensorimotor control of the tracking task was modeled as the step response of a second-order system. The results revealed that aging had no significant effect on the parameters of the model, whereas significant differences were found between the age-matched control and stroke groups. Target force level significantly affected the damping ratio and natural frequency in the young group, and significantly affected the damping ratio in the stroke group. Significant correlations were found between the wolf motor function test score and damping ratio, natural frequency, and settling time at 25% MVC. The model could describe the stroke-induced oscillation and slow response in dynamic grip force control and has the potential to be a quantitative evaluation of motor disabilities in clinic.
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30
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Lodha N, Patel P, Casamento-Moran A, Hays E, Poisson SN, Christou EA. Strength or Motor Control: What Matters in High-Functioning Stroke? Front Neurol 2019; 9:1160. [PMID: 30687217 PMCID: PMC6333669 DOI: 10.3389/fneur.2018.01160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background: The two primary motor impairments that hinder function after stroke are declines in strength and motor control. The impact of motor impairments on functional capacity may vary with the severity of stroke motor impairments. In this study, we focus on high-functioning stroke individuals who experience mild to moderate motor impairments and often resume prior activities or return to work. These tasks require the ability to move independently, placing high demands on their functional mobility. Therefore, the purpose of this study was to quantify impairments in strength and motor control and their contribution to functional mobility in high-functioning stroke. Methods:Twenty-one high-functioning stroke individuals (Fugl Meyer Lower Extremity Score = 28.67 ± 4.85; Functional Activity Index = 28.47 ± 7.04) and 21 age-matched healthy controls participated in this study. To examine motor impairments in strength and motor control, participants performed the following tasks with the paretic ankle (1) maximum voluntary contractions (MVC) and (2) visuomotor tracking of a sinusoidal trajectory. Strength was quantified as the maximum force produced during ankle plantarflexion and dorsiflexion. Motor control was quantified as (a) the accuracy and (b) variability of ankle movement during the visuomotor tracking task. For functional mobility, participants performed (1) overground walking for 7 meters and (2) simulated driving task. Functional mobility was determined by walking speed, stride length variability, and braking reaction time. Results: Compared with the controls, the stroke group showed decreased plantarflexion strength, decreased accuracy, and increased variability of ankle movement. In addition, the stroke group demonstrated decreased walking speed, increased stride length variability, and increased braking reaction time. The multiple-linear regression model revealed that motor accuracy was a significant predictor of the walking speed and braking reaction time. Further, motor variability was a significant predictor of stride length variability. Finally, the dorsiflexion or plantarflexion strength did not predict walking speed, stride length variability or braking reaction time. Conclusions: The impairments in motor control but not strength predict functional deficits in walking and driving in high-functioning stroke individuals. Therefore, rehabilitation interventions assessing and improving motor control will potentially enhance functional outcomes in high-functioning stroke survivors.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Agostina Casamento-Moran
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Emily Hays
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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31
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Smith BW, Rowe JB, Reinkensmeyer DJ. Directly Measuring the Rate of Slacking as Stroke Survivors produced Isometric Forces during a Tracking Task. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2519-2522. [PMID: 30440920 DOI: 10.1109/embc.2018.8512740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Slacking limits the rehabilitative effectiveness of certain exercises following stroke. When patients receive assistance during an exercise, they exhibit a persistent tendency to reduce their own contribution to that exercise. This phenomenon was first coined 'slacking' in the context of robot-mediated therapy, where controller design continues to involve prediction and mitigation of slacking. In this pilot study, 14 individuals in the chronic stage of stroke participated in a visuomotor tracking task during which they produced isometric grip forces. Visual feedback displayed on a monitor helped participants track eight distinct forces ranging effort level from 4 to 30% maximum voluntary contraction (MVC). A specialized method of toggling between veridical and nonveridical visual feedback isolated each participant's realtime slacking rate at each of the eight effort levels, with both their contralesional and ipsilesional hand. Below 10-15% MVC, participants did not slack. At higher effort levels, participants slacked, and their slacking rate increased non-linearly with effort. Slacking took the form of smooth reductions in grip force. On average, across participants, slacking rates were remarkably similar between hands, just marginally faster with the contralesional hand. However, individualized slacking rates varied from almost zero to approximately double the acrossparticipant average. The paradigm for measuring slacking rate, used here, might be incorporated into robot-mediated therapy to maintain an accurate, individualized estimate of a patient's slacking rate at various force levels and ensure the robot provides assistance only as needed.
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Birchenall J, Térémetz M, Roca P, Lamy JC, Oppenheim C, Maier MA, Mas JL, Lamy C, Baron JC, Lindberg PG. Individual recovery profiles of manual dexterity, and relation to corticospinal lesion load and excitability after stroke -a longitudinal pilot study. Neurophysiol Clin 2018; 49:149-164. [PMID: 30391148 DOI: 10.1016/j.neucli.2018.10.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In this longitudinal pilot study, we investigated how manual dexterity recovery was related to corticospinal tract (CST) injury and excitability, in six patients undergoing conventional rehabilitation. METHODS Key components of manual dexterity, namely finger force control, finger tapping rate and independence of finger movements, were quantified. Structural MRI was obtained to calculate CST lesion load. CST excitability was assessed by measuring rest motor threshold (RMT) and the amplitude of motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS). Measurements were obtained at two weeks, three and six months post-stroke. RESULTS At six months post-stroke, complete recovery of hand gross motor impairment (i.e., maximal Fugl-Meyer score for hand) had occurred in three patients and four patients had recovered ability to accurately control finger force. However, tapping rate and independence of finger movements remained impaired in all six patients at six months. Recovery in hand gross motor impairment and finger force control occurred in patients with smaller CST lesion load and almost complete recovery of CST excitability, although RMT or MEP size remained slightly altered in the stroke-affected hemisphere compared to the unaffected hemisphere. The two patients with poorest recovery showed persistent absence of MEPs and greatest structural injury to CST. DISCUSSION The findings support good motor recovery being overall correlated with smaller CST lesion, and with almost complete recovery of CST excitability. However, impairment of manual dexterity persisted despite recovery in gross hand movements and grasping abilities, suggesting involvement of additional brain structures for fine manual tasks.
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Affiliation(s)
- Julia Birchenall
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Maxime Térémetz
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - Pauline Roca
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne universités, UPMC université Paris 06 UMR S 1127, institut du cerveau et de la Moelle épinière, ICM, centre de neuro-imagerie de recherche (CENIR), 75013 Paris, France
| | - Catherine Oppenheim
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Marc A Maier
- FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France
| | - Jean-Louis Mas
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Catherine Lamy
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Claude Baron
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Påvel G Lindberg
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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Carment L, Abdellatif A, Lafuente-Lafuente C, Pariel S, Maier MA, Belmin J, Lindberg PG. Manual Dexterity and Aging: A Pilot Study Disentangling Sensorimotor From Cognitive Decline. Front Neurol 2018; 9:910. [PMID: 30420830 PMCID: PMC6215834 DOI: 10.3389/fneur.2018.00910] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
Abstract
Manual dexterity measures can be useful for early detection of age-related functional decline and for prediction of cognitive decline. However, what aspects of sensorimotor function to assess remains unclear. Manual dexterity markers should be able to separate impairments related to cognitive decline from those related to healthy aging. In this pilot study, we aimed to compare manual dexterity components in patients diagnosed with cognitive decline (mean age: 84 years, N = 11) and in age comparable cognitively intact elderly subjects (mean age: 78 years, N = 11). In order to separate impairments due to healthy aging from deficits due to cognitive decline we also included two groups of healthy young adults (mean age: 26 years, N = 10) and middle-aged adults (mean age: 41 years, N = 8). A comprehensive quantitative evaluation of manual dexterity was performed using three tasks: (i) visuomotor force tracking, (ii) isochronous single finger tapping with auditory cues, and (iii) visuomotor multi-finger tapping. Results showed a highly significant increase in force tracking error with increasing age. Subjects with cognitive decline had increased finger tapping variability and reduced ability to select the correct tapping fingers in the multi-finger tapping task compared to cognitively intact elderly subjects. Cognitively intact elderly subjects and those with cognitive decline had prolonged force release and reduced independence of finger movements compared to young adults and middle-aged adults. The findings suggest two different patterns of impaired manual dexterity: one related to cognitive decline and another related to healthy aging. Manual dexterity tasks requiring updating of performance, in accordance with (temporal or spatial) task rules maintained in short-term memory, are particularly affected in cognitive decline. Conversely, tasks requiring online matching of motor output to sensory cues were affected by age, not by cognitive status. Remarkably, no motor impairments were detected in patients with cognitive decline using clinical scales of hand function. The findings may have consequences for the development of manual dexterity markers of cognitive decline.
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Affiliation(s)
- Loic Carment
- Inserm U894, Université Paris Descartes, Paris, France
| | - Abir Abdellatif
- Plateforme de Recherche Clinique en Gériatrie, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, APHP, Ivry-sur-Seine, France
| | - Carmelo Lafuente-Lafuente
- Service de Gériatrie à orientation Cardiologique et Neurologique, Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Ivry-sur-Seine, France
| | - Sylvie Pariel
- Département de soins ambulatoires, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, APHP, Ivry-sur-Seine, France
| | - Marc A Maier
- FR3636 CNRS, Université Paris Descartes, Paris, France.,Department of Life Sciences, Université Paris Diderot, Paris, France
| | - Joël Belmin
- Service de Gériatrie à orientation Cardiologique et Neurologique, Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Ivry-sur-Seine, France
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Allgöwer K, Fürholzer W, Hermsdörfer J. Impaired performance of patients with writer's cramp in complex fine motor tasks. Clin Neurophysiol 2018; 129:2392-2402. [PMID: 30278388 DOI: 10.1016/j.clinph.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 08/17/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Writer's cramp (WC) is a task-specific focal dystonia. WC is characterized by involuntary contractions of muscles of the hand and arm during handwriting, resulting in impaired writing with exaggerated finger forces. The generalization of symptoms to other fine motor tasks is widely discussed. The aim of the study was to determine affected fine motor aspects with an extensive testing battery. METHODS Twelve people with WC and twelve healthy controls were examined. Performance in the Jebsen-Taylor Hand Function Test, Nine-Hole-Peg Test and 2-point discrimination was evaluated. To analyze object manipulation skills, we examined grip forces, temporal measures and other aspects of force control during (1) lifting actions with variations of weight and surface (2) cyclic movements (3) visuomotor tracking (4) fast force changes and (5) grip strength. In addition, correlation between the dependent variables of the fine motor tasks and the handwriting deficits was assessed. RESULTS WC patients had impaired performance in the visuomotor tracking task (root mean square error (RMSE), p = 0.03 and time lag, p = 0.05) and the fast force changes (frequency, p = 0.01). There were no statistically significant group differences in the other tasks. We found a correlation between the RMSE of the tracking task and the time needed to write the test sentence (r = 0.643, p = 0.01). CONCLUSION WC patients revealed abnormalities in complex fine motor performance in tasks with high demands on coordination and visual components, specifically in tracking and fast force changes. SIGNIFICANCE This suggests a deficit in visuomotor integration, coordination and cognitive aspects related to movement processing particularly with respect to low forces. These insights may prove useful in the development of targeted training approaches.
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Affiliation(s)
- Kathrin Allgöwer
- Technical University of Munich, Department of Sport and Health Sciences, Chair of Human Movement Science, Munich, Germany.
| | | | - Joachim Hermsdörfer
- Technical University of Munich, Department of Sport and Health Sciences, Chair of Human Movement Science, Munich, Germany
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Right Hemisphere Contributions to Bilateral Force Control in Chronic Stroke: A Preliminary Report. J Stroke Cerebrovasc Dis 2018; 27:3218-3223. [PMID: 30093198 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bilateral motor control deficits poststroke may be lateralized by hemisphere damage. This preliminary study investigated bilateral force control between left and right hemisphere-damaged groups at baseline and after coupled bilateral movement training with neuromuscular stimulation. METHODS Stroke participants (8 left hemisphere and 6 right hemisphere cerebrovascular accidents) performed a bilateral isometric force control task at 3 submaximal force levels (5%, 25%, and 50% of maximum voluntary contraction [MVC]) before and after training. Force accuracy, force variability, and interlimb force coordination were analyzed in 3-way mixed design ANOVAs (2 × 2 × 3; Group × Test Session × Force Level) with repeated measures on test session and force level. RESULTS The findings indicated that force accuracy and variability at 50% of MVC in the right hemisphere-damaged group were more impaired than lower targeted force levels at baseline, and the impairment at the highest target level was improved after coupled bilateral movement training. However, these patterns were not observed in the left hemisphere-damaged group. CONCLUSIONS Current findings support a proposition that the right hemisphere presumably contributes to controlling bilateral force production.
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Smith BW, Rowe JB, Reinkensmeyer DJ. Real-time slacking as a default mode of grip force control: implications for force minimization and personal grip force variation. J Neurophysiol 2018; 120:2107-2120. [PMID: 30089024 DOI: 10.1152/jn.00700.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During trial-to-trial movement adaptation, the motor system systematically reduces extraneous muscle forces when kinematic errors experienced on previous movements are small, a phenomenon termed "slacking." There is also growing evidence that the motor system slacks continuously (i.e., in real-time) during arm movement or grip force control, but the initiation of this slacking is not well-characterized, obfuscating its physiological cause. Here, we addressed this issue by asking participants ( n = 32) to track discrete force targets presented visually using isometric grip force, then applying a brief, subtle error-clamp to that visual feedback on random trials. Participants reduced their force in an exponential fashion, on these error-clamp trials, except when the target force was <10% maximum voluntary contraction (MVC). This force drift began <250 ms after the onset of the error-clamp, consistent with slacking being an ongoing process unmasked immediately after the motor system finished reacting to the last veridical feedback. Above 10% MVC, the slacking rate increased linearly with grip force magnitude. Grip force variation was approximately 50-100% higher with veridical feedback, largely due to heightened signal power at ~1 Hz, the band of visuomotor feedback control. Finally, the slacking rate measured for each participant during error-clamp trials correlated with their force variation during control trials. That is, participants who slacked more had greater force variation. These results suggest that real-time slacking continuously reduces grip force until visual error prompts correction. Whereas such slacking is suited for force minimization, it may also account for ~30% of the variability in personal grip force variation. NEW & NOTEWORTHY We provide evidence that a form of slacking continuously conditions real-time grip force production. This slacking is well-suited to promote efficiency but is expected to increase force variation by triggering additional feedback corrections. Moreover, we show that the rate at which a person slacks is substantially correlated with the variation of their grip force. In combination, at the neurophysiological level, our results suggest slacking is caused by one or more relatively smooth neural adaptations.
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Affiliation(s)
- Brendan W Smith
- Department of Mechanical Engineering, Loyola Marymount University , Los Angeles, California
| | - Justin B Rowe
- Department of Biomedical Engineering, University of California , Irvine, California
| | - David J Reinkensmeyer
- Department of Biomedical Engineering, University of California , Irvine, California.,Departments of Anatomy and Neurobiology, Mechanical and Aerospace Engineering, and Physical Medicine and Rehabilitation, University of California , Irvine, California
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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: 0.4] [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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Wolbrecht ET, Rowe JB, Chan V, Ingemanson ML, Cramer SC, Reinkensmeyer DJ. Finger strength, individuation, and their interaction: Relationship to hand function and corticospinal tract injury after stroke. Clin Neurophysiol 2018; 129:797-808. [PMID: 29453171 PMCID: PMC5856636 DOI: 10.1016/j.clinph.2018.01.057] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 01/11/2018] [Accepted: 01/25/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine the relative contributions of finger weakness and reduced finger individuation to reduced hand function after stroke, and their association with corticospinal tract (CST) injury. METHODS We measured individuated and synergistic maximum voluntary contractions (MVCs) of the index and middle fingers, in both flexion and extension, of 26 individuals with a chronic stroke using a robotic exoskeleton. We quantified finger strength and individuation, and defined a novel metric that combines them - "multifinger capacity". We used stepwise linear regression to identify which measure best predicted hand function (Box and Blocks Test, Nine Hole Peg Test) and arm impairment (the Upper Extremity Fugl-Meyer Test). RESULTS Compared to metrics of strength or individuation, capacity survived the stepwise regression as the strongest predictor of hand function and arm impairment. Capacity was also most strongly related to presence or absence of lesion overlap with the CST. CONCLUSIONS Reduced strength and individuation combine to shrink the space of achievable finger torques, and it is the resulting size of this space - the multifinger capacity - that is of elevated importance for predicting loss of hand function. SIGNIFICANCE Multi-finger capacity may be an important target for rehabilitative hand training.
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Affiliation(s)
- Eric T Wolbrecht
- Department of Mech. Engineering, University of Idaho, United States.
| | - Justin B Rowe
- Department of Biomedical Engineering, University of California at Irvine, United States
| | - Vicky Chan
- Department of Neurology, University of California at Irvine, United States
| | - Morgan L Ingemanson
- Department of Anatomy and Neurobiology, University of California at Irvine, United States
| | - Steven C Cramer
- Department of Neurology, University of California at Irvine, United States; Department of Anatomy and Neurobiology, University of California at Irvine, United States; Department of Physical Medicine and Rehabilitation, University of California at Irvine, United States
| | - David J Reinkensmeyer
- Department of Biomedical Engineering, University of California at Irvine, United States; Department of Anatomy and Neurobiology, University of California at Irvine, United States; Department of Mechanical and Aerospace Engineering, University of California at Irvine, United States; Department of Physical Medicine and Rehabilitation, University of California at Irvine, United States
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Abstract
Simple voluntary movements (e.g., reaching or gripping) deteriorate with distraction, suggesting that the attention-control system—which suppresses distraction—influences motor control. Here, we tested the causal dependency of simple movements on attention control, and its neuroanatomical basis, in healthy elderly and patients with focal brain lesions. Not only did we find that attention control correlates with motor performance, correcting for lesion size, fatigue, etc., but we found a revealing pattern of dissociations: Severe motor impairment could occur with normal attention control whereas impaired attention control never occurred with disproportionately milder motor impairment—suggesting that attention control is required for normal motor performance. One implication is that a component of stroke paralysis arises from poor attentional control, which could itself be a therapeutic target. Attention control (or executive control) is a higher cognitive function involved in response selection and inhibition, through close interactions with the motor system. Here, we tested whether influences of attention control are also seen on lower level motor functions of dexterity and strength—by examining relationships between attention control and motor performance in healthy-aged and hemiparetic-stroke subjects (n = 93 and 167, respectively). Subjects undertook simple-tracking, precision-hold, and maximum force-generation tasks, with each hand. Performance across all tasks correlated strongly with attention control (measured as distractor resistance), independently of factors such as baseline performance, hand use, lesion size, mood, fatigue, or whether distraction was tested during motor or nonmotor cognitive tasks. Critically, asymmetric dissociations occurred in all tasks, in that severe motor impairment coexisted with normal (or impaired) attention control whereas normal motor performance was never associated with impaired attention control (below a task-dependent threshold). This implies that dexterity and force generation require intact attention control. Subsequently, we examined how motor and attention-control performance mapped to lesion location and cerebral functional connectivity. One component of motor performance (common to both arms), as well as attention control, correlated with the anatomical and functional integrity of a cingulo-opercular “salience” network. Independently of this, motor performance difference between arms correlated negatively with the integrity of the primary sensorimotor network and corticospinal tract. These results suggest that the salience network, and its attention-control function, are necessary for virtually all volitional motor acts while its damage contributes significantly to the cardinal motor deficits of stroke.
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Archer DB, Kang N, Misra G, Marble S, Patten C, Coombes SA. Visual feedback alters force control and functional activity in the visuomotor network after stroke. NEUROIMAGE-CLINICAL 2017; 17:505-517. [PMID: 29201639 PMCID: PMC5700823 DOI: 10.1016/j.nicl.2017.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022]
Abstract
Modulating visual feedback may be a viable option to improve motor function after stroke, but the neurophysiological basis for this improvement is not clear. Visual gain can be manipulated by increasing or decreasing the spatial amplitude of an error signal. Here, we combined a unilateral visually guided grip force task with functional MRI to understand how changes in the gain of visual feedback alter brain activity in the chronic phase after stroke. Analyses focused on brain activation when force was produced by the most impaired hand of the stroke group as compared to the non-dominant hand of the control group. Our experiment produced three novel results. First, gain-related improvements in force control were associated with an increase in activity in many regions within the visuomotor network in both the stroke and control groups. These regions include the extrastriate visual cortex, inferior parietal lobule, ventral premotor cortex, cerebellum, and supplementary motor area. Second, the stroke group showed gain-related increases in activity in additional regions of lobules VI and VIIb of the ipsilateral cerebellum. Third, relative to the control group, the stroke group showed increased activity in the ipsilateral primary motor cortex, and activity in this region did not vary as a function of visual feedback gain. The visuomotor network, cerebellum, and ipsilateral primary motor cortex have each been targeted in rehabilitation interventions after stroke. Our observations provide new insight into the role these regions play in processing visual gain during a precisely controlled visuomotor task in the chronic phase after stroke.
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Affiliation(s)
- Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Nyeonju Kang
- Division of Sport Science, Incheon National University, Incheon, South Korea
| | - Gaurav Misra
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Shannon Marble
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Carolynn Patten
- Neural Control of Movement Lab, Department of Physical Therapy, University of Florida and Malcolm-Randall VA Medical Center, Gainesville, FL, United States
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States.
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Yap HK, Lim JH, Nasrallah F, Yeow CH. Design and Preliminary Feasibility Study of a Soft Robotic Glove for Hand Function Assistance in Stroke Survivors. Front Neurosci 2017; 11:547. [PMID: 29062267 PMCID: PMC5640819 DOI: 10.3389/fnins.2017.00547] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Various robotic exoskeletons have been proposed for hand function assistance during activities of daily living (ADL) of stroke survivors. However, traditional exoskeletons involve the use of complex rigid systems that impede the natural movement of joints, and thus reduce the wearability and cause discomfort to the user. The objective of this paper is to design and evaluate a soft robotic glove that is able to provide hand function assistance using fabric-reinforced soft pneumatic actuators. These actuators are made of silicone rubber which has an elastic modulus similar to human tissues. Thus, they are intrinsically soft and compliant. Upon air pressurization, they are able to support finger range of motion (ROM) and generate the desired actuation of the finger joints. In this work, the soft actuators were characterized in terms of their blocked tip force, normal and frictional grip force outputs. Combining the soft actuators and flexible textile materials, a soft robotic glove was developed for grasping assistance during ADL for stroke survivors. The glove was evaluated on five healthy participants for its assisted ROM and grip strength. Pilot test was performed in two stroke survivors to evaluate the efficacy of the glove in assisting functional grasping activities. Our results demonstrated that the actuators designed in this study could generate desired force output at a low air pressure. The glove had a high kinematic transparency and did not affect the active ROM of the finger joints when it was being worn by the participants. With the assistance of the glove, the participants were able to perform grasping actions with sufficient assisted ROM and grip strength, without any voluntary effort. Additionally, pilot test on stroke survivors demonstrated that the patient's grasping performance improved with the presence and assistance of the glove. Patient feedback questionnaires also showed high level of patient satisfaction and comfort. In conclusion, this paper has demonstrated the possibility of using soft wearable exoskeletons that are more wearable, lightweight, and suitable to be used on a daily basis for hand function assistance of stroke survivors during activities of daily living.
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Affiliation(s)
- Hong Kai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Jeong Hoon Lim
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Fatima Nasrallah
- Queensland Brain Institute, University of Queensland, St. Lucia, QLD, Australia
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
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Allgöwer K, Hermsdörfer J. Fine motor skills predict performance in the Jebsen Taylor Hand Function Test after stroke. Clin Neurophysiol 2017; 128:1858-1871. [DOI: 10.1016/j.clinph.2017.07.408] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/02/2017] [Accepted: 07/23/2017] [Indexed: 12/01/2022]
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Short-Term Effects of Whole-Body Vibration Combined with Task-Related Training on Upper Extremity Function, Spasticity, and Grip Strength in Subjects with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial. Am J Phys Med Rehabil 2017; 95:608-17. [PMID: 26829094 DOI: 10.1097/phm.0000000000000454] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of whole-body vibration training combined with task-related training on arm function, spasticity, and grip strength in subjects with poststroke hemiplegia. DESIGN Forty-five subjects with poststroke were randomly allocated to 3 groups, each with 15 subjects as follows: control group, whole-body vibration group, and whole-body vibration plus task-related training group. Outcome was evaluated by clinical evaluation and measurements of the grip strength before and 4 weeks after intervention. RESULTS Our results show that there was a significantly greater increase in the Fugl-Meyer scale, maximal grip strength of the affected hand, and grip strength normalized to the less affected hand in subjects undergoing the whole-body vibration training compared with the control group after the test. Furthermore, there was a significantly greater increase in the Wolf motor function test and a decrease in the modified Ashworth spasticity total scores in subjects who underwent whole-body vibration plus task-related training compared with those in the other 2 groups after the test. CONCLUSIONS The findings indicate that the use of whole-body vibration training combined with task-related training has more benefits on the improvement of arm function, spasticity, and maximal grip strength than conventional upper limb training alone or with whole-body vibration in people with poststroke hemiplegia.
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Sarigul-Klijn Y, Smith BW, Reinkensmeyer DJ. Design and experimental evaluation of yoked hand-clutching for a lever drive chair. Assist Technol 2017; 30:281-288. [DOI: 10.1080/10400435.2017.1326413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yasemin Sarigul-Klijn
- Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Brendan W. Smith
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, California, USA
| | - David J. Reinkensmeyer
- Department of Biomedical Engineering, University of California, Irvine, California, USA
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, California, USA
- Department of Anatomy and Neurobiology, University of California, Irvine, California, USA
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Pavlova EL, Lindberg P, Khan A, Ruschkowski S, Nitsche MA, Borg J. Transcranial direct current stimulation combined with visuo-motor training as treatment for chronic stroke patients. Restor Neurol Neurosci 2017; 35:307-317. [PMID: 28506002 DOI: 10.3233/rnn-160706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies exploring the combined effect of motor learning and transcranial direct current stimulation (tDCS) for stroke rehabilitation have shown partially conflicting results. OBJECTIVE To test the efficacy of an optimized hand training approach combined with tDCS in stroke patients. METHODS In the present pilot study we investigated motor effects of four-week training with a visuomotor grip force tracking task combined with tDCS in 11 chronic stroke patients. Anodal (0.5 mA) or sham tDCS was applied over the primary motor cortex of the lesioned side for 20 minutes, twice a day, during training. RESULTS No difference between the Active and Sham groups in the total upper extremity (UE) Fugl-Meyer Assessment (FMA) score was found. The most prominent recovery occurred in the shoulder-elbow FMA sub-score; in this segment a significantly greater improvement in the Active compared to the Sham group was observed up to two months after the intervention. Mean hold force during the first treatment session predicted the change in the total UE FMA score after treatment. CONCLUSION Four-week visuo-motor training combined with tDCS showed no difference between the Active and Sham groups in the total UE FMA score, which may be explained by heterogeneity of the degree of recovery in the Active group. However, the shoulder-elbow FMA sub-score improved significantly more in the Active compared to the Sham group, which deserves further study.
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Affiliation(s)
- Elena L Pavlova
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Påvel Lindberg
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.,Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Amirah Khan
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Sigurd Ruschkowski
- Stockholm County Council Innovation, Danderyd University Hospital, Stockholm, Sweden
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Jörgen Borg
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
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Bilateral synergy as an index of force coordination in chronic stroke. Exp Brain Res 2017; 235:1501-1509. [DOI: 10.1007/s00221-017-4904-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
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47
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Rinne P, Mace M, Nakornchai T, Zimmerman K, Fayer S, Sharma P, Liardon JL, Burdet E, Bentley P. Democratizing Neurorehabilitation: How Accessible are Low-Cost Mobile-Gaming Technologies for Self-Rehabilitation of Arm Disability in Stroke? PLoS One 2016; 11:e0163413. [PMID: 27706248 PMCID: PMC5051962 DOI: 10.1371/journal.pone.0163413] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022] Open
Abstract
Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available solution to supplement arm physiotherapy after stroke. We assessed the proportions of hemiplegic stroke patients who, with their plegic hand, could meaningfully engage with mobile-gaming devices using a range of standard control-methods, as well as by using a novel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed hemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects were compared on their ability to control a tablet or smartphone cursor using: finger-swipe, tap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement (0); less than full-range movement (1); full-range movement (2); directed movement (3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed testing. The commonest reason for exclusion was cognitive impairment. Using conventional controls, the proportion of patients able to direct cursor movement was 38–48%; and to move it full-range was 55–67% (controller comparison: p>0.1). By comparison, handgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison: p<0.001). This difference between controllers was most apparent amongst severely-disabled subjects, with 0% achieving directed or full-range control with conventional controls, compared to 58% and 83% achieving these two levels of movement, respectively, with handgrip. In conclusion, hand, or arm, training Apps played on conventional mobile devices are likely to be accessible only to mildly-disabled stroke patients. Technological adaptations such as grip-control can enable more severely affected subjects to engage with self-training software.
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Affiliation(s)
- Paul Rinne
- Division of Brain Sciences, Imperial College, London, United Kingdom
- Dept. of Bioengineering, Human Robotics Group, Imperial College, London, United Kingdom
| | - Michael Mace
- Dept. of Bioengineering, Human Robotics Group, Imperial College, London, United Kingdom
| | - Tagore Nakornchai
- Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Karl Zimmerman
- Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Susannah Fayer
- Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University, London, United Kingdom
| | - Jean-Luc Liardon
- Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Etienne Burdet
- Dept. of Bioengineering, Human Robotics Group, Imperial College, London, United Kingdom
| | - Paul Bentley
- Division of Brain Sciences, Imperial College, London, United Kingdom
- * E-mail:
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Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:662-670. [DOI: 10.1016/j.brs.2016.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 11/22/2022] Open
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Santisteban L, Térémetz M, Bleton JP, Baron JC, Maier MA, Lindberg PG. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review. PLoS One 2016; 11:e0154792. [PMID: 27152853 PMCID: PMC4859525 DOI: 10.1371/journal.pone.0154792] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/19/2016] [Indexed: 02/04/2023] Open
Abstract
Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. Objective In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time. Methods Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included. Results In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus. Conclusions The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.
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Affiliation(s)
- Leire Santisteban
- Service de Médecine Physique et de Réadaptation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Maxime Térémetz
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Bleton
- Unité James Parkinson, service de Neurologie, Fondation OPH Rothschild, Paris, France
- Centre de Psychiatrie et Neurosciences, Inserm U894, Paris, France
| | | | - Marc A. Maier
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Påvel G. Lindberg
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Psychiatrie et Neurosciences, Inserm U894, Paris, France
- * E-mail:
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Deficits in motor abilities for multi-finger force control in hemiparetic stroke survivors. Exp Brain Res 2016; 234:2391-402. [PMID: 27071926 DOI: 10.1007/s00221-016-4644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
The ability to control redundant motor effectors is one of hallmarks in human motor control, and the topic has been studied extensively over several decades since the initial inquiries proposed by Nicholi Bernstein. However, our understanding of the influence of stroke on the control of redundant motor systems is very limited. This study aimed to investigate the effect of stroke-related constraints on multi-finger force control abilities in a visuomotor task. Impaired (IH) and less-impaired hands (LH) of 19 hemiparetic stroke survivors and 19 age-matched control subjects were examined. Each hand repeatedly produced isometric forces to match a target force of 5 N shown on a computer screen using all four fingers. The hierarchical variability decomposition (HVD) model was used to separate force-matching errors (motor performance) into task-relevant measures (accuracy, steadiness, and reproducibility). Task-irrelevant sources of variability in individual finger force profiles within and between trials (flexibility and multiformity) were also quantified. The IH in the stroke survivors showed deficits in motor performance attributed mainly to lower accuracy and reproducibility as compared to control hands (p < 0.05). The LH in stroke survivors showed lower reproducibility and both hands in stroke also had higher multiformity than the control hands (p < 0.05). The findings from our HVD model suggest that accuracy, reproducibility, and multiformity were mainly impaired during force-matching task in the stroke survivors. The specific motor deficits identified through the HVD model with the new conceptual framework may be considered as critical factors for scientific investigation on stroke and evidence-based rehabilitation of this population.
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