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Metaireau M, Osiurak F, Seye A, Lesourd M. The neural correlates of limb apraxia: An anatomical likelihood estimation meta-analysis of lesion-symptom mapping studies in brain-damaged patients. Neurosci Biobehav Rev 2024; 162:105720. [PMID: 38754714 DOI: 10.1016/j.neubiorev.2024.105720] [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: 01/19/2024] [Revised: 04/10/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
Limb apraxia is a motor disorder frequently observed following a stroke. Apraxic deficits are classically assessed with four tasks: tool use, pantomime of tool use, imitation, and gesture understanding. These tasks are supported by several cognitive processes represented in a left-lateralized brain network including inferior frontal gyrus, inferior parietal lobe (IPL), and lateral occipito-temporal cortex (LOTC). For the past twenty years, voxel-wise lesion symptom mapping (VLSM) studies have been used to unravel the neural correlates associated with apraxia, but none of them has proposed a comprehensive view of the topic. In the present work, we proposed to fill this gap by performing a systematic Anatomic Likelihood Estimation meta-analysis of VLSM studies which included tasks traditionally used to assess apraxia. We found that the IPL was crucial for all the tasks. Moreover, lesions within the LOTC were more associated with imitation deficits than tool use or pantomime, confirming its important role in higher visual processing. Our results questioned traditional neurocognitive models on apraxia and may have important clinical implications.
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Affiliation(s)
- Maximilien Metaireau
- Université de Franche-Comté, UMR INSERM 1322, LINC, Besançon F-25000, France; Maison des Sciences de l'Homme et de l'Environnement (UAR 3124), Besançon, France.
| | - François Osiurak
- Laboratoire d'Étude des Mécanismes Cognitifs (EA 3082), Université Lyon 2, Bron, France; Institut Universitaire de France, Paris, France
| | - Arthur Seye
- Laboratoire d'Étude des Mécanismes Cognitifs (EA 3082), Université Lyon 2, Bron, France
| | - Mathieu Lesourd
- Université de Franche-Comté, UMR INSERM 1322, LINC, Besançon F-25000, France; Maison des Sciences de l'Homme et de l'Environnement (UAR 3124), Besançon, France; Unité de Neurologie Vasculaire, CHU Besançon, France.
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Sánchez-Bermejo L, Milla-Ortega PJ, Pérez-Mármol JM. The Impact of Upper Limb Apraxia on General and Domain-Specific Self-Efficacy in Post-Stroke Patients. Healthcare (Basel) 2023; 11:2252. [PMID: 37628450 PMCID: PMC10454387 DOI: 10.3390/healthcare11162252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Upper limb apraxia (ULA) is a neurological syndrome characterized by the inability to perform purposeful movements. ULA could impact individuals' perceptions, including perceived self-efficacy. The aim of this study is to investigate whether ULA is related to general self-efficacy and self-efficacy for managing symptoms in post-stroke patients. METHODS A cross-sectional study was conducted involving 82 post-stroke patients. Regression analyses were implemented using a stepwise model including seven dimensions of ULA: imitation (non-symbolic, intransitive, and transitive), pantomime (non-symbolic, intransitive, and transitive), and dimension of apraxic performance in activities of daily living. These dimensions were independent variables, while general self-efficacy and symptom management self-efficacy dimensions were dependent variables. RESULTS The findings revealed that intransitive imitation accounted for 14% of the variance in general self-efficacy and 10% of self-efficacy for managing emotional symptoms. Transitive imitation explained 10% of the variance in self-efficacy for managing global symptoms and 5% for social-home integration symptoms. The combination of intransitive imitation, non-symbolic pantomime, and alterations in activities of daily living performance associated with ULA explained 24% of the variance in cognitive self-efficacy. CONCLUSIONS Hence, ULA dimensions seem to be related to the levels of general perceived self-efficacy and self-efficacy for managing symptoms among post-stroke patients.
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Affiliation(s)
- Laura Sánchez-Bermejo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Pedro Jesús Milla-Ortega
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Emergencies Primary Care Service, Granada Health District, 18012 Granada, Spain
| | - José Manuel Pérez-Mármol
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
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Seidel G, Rijntjes M, Güllmar D, Weiller C, Hamzei F. Understanding the concept of a novel tool requires interaction of the dorsal and ventral streams. Cereb Cortex 2023; 33:9652-9663. [PMID: 37365863 DOI: 10.1093/cercor/bhad234] [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: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
The left hemisphere tool-use network consists of the dorso-dorsal, ventro-dorsal, and ventral streams, each with distinct computational abilities. In the dual-loop model, the ventral pathway through the extreme capsule is associated with conceptual understanding. We performed a learning experiment with fMRI to investigate how these streams interact when confronted with novel tools. In session one, subjects observed pictures and video sequences in real world action of known and unknown tools and were asked whether they knew the tools and whether they understood their function. In session two, video sequences of unknown tools were presented again, followed again by the question of understanding their function. Different conditions were compared to each other and effective connectivity (EC) in the tool-use network was examined. During concept acquisition of an unknown tool, EC between dorsal and ventral streams was found posterior in fusiform gyrus and anterior in inferior frontal gyrus, with a functional interaction between BA44d and BA45. When previously unknown tools were presented for a second time, EC was prominent only between dorsal stream areas. Understanding the concept of a novel tool requires an interaction of the ventral stream with the dorsal streams. Once the concept is acquired, dorsal stream areas are sufficient.
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Affiliation(s)
- Gundula Seidel
- Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Hermann-Sachse-Strasse 46, 07639 Bad Klosterlausnitz, Germany
- Department of Neurology, Moritz Klinik Bad Klosterlausnitz, CW Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany
| | - Michel Rijntjes
- Department of Neurology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, CW Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany
| | - Daniel Güllmar
- Medical Physics Group, Department of Radiology, Jena University Hospital, Philosophenweg 3, Gebäude 5, 07743 Jena, Germany
| | - Cornelius Weiller
- Department of Neurology, Moritz Klinik Bad Klosterlausnitz, CW Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany
| | - Farsin Hamzei
- Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Hermann-Sachse-Strasse 46, 07639 Bad Klosterlausnitz, Germany
- Department of Neurology, Moritz Klinik Bad Klosterlausnitz, CW Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany
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Osiurak F, Reynaud E, Baumard J, Rossetti Y, Bartolo A, Lesourd M. Pantomime of tool use: looking beyond apraxia. Brain Commun 2021; 3:fcab263. [PMID: 35350708 PMCID: PMC8936430 DOI: 10.1093/braincomms/fcab263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
Pantomime has a long tradition in clinical neuropsychology of apraxia. It has been much more used by researchers and clinicians to assess tool-use disorders than real tool use. Nevertheless, it remains incompletely understood and has given rise to controversies, such as the involvement of the left inferior parietal lobe or the nature of the underlying cognitive processes. The present article offers a comprehensive framework, with the aim of specifying the neural and cognitive bases of pantomime. To do so, we conducted a series of meta-analyses of brain-lesion, neuroimaging and behavioural studies about pantomime and other related tasks (i.e. real tool use, imitation of meaningless postures and semantic knowledge). The first key finding is that the area PF (Area PF complex) within the left inferior parietal lobe is crucially involved in both pantomime and real tool use as well as in the kinematics component of pantomime. The second key finding is the absence of a well-defined neural substrate for the posture component of pantomime (both grip errors and body-part-as-tool responses). The third key finding is the role played by the intraparietal sulcus in both pantomime and imitation of meaningless postures. The fourth key finding is that the left angular gyrus seems to be critical in the production of motor actions directed towards the body. The fifth key finding is that performance on pantomime is strongly correlated with the severity of semantic deficits. Taken together, these findings invite us to offer a neurocognitive model of pantomime, which provides an integrated alternative to the two hypotheses that dominate the field: The gesture-engram hypothesis and the communicative hypothesis. More specifically, this model assumes that technical reasoning (notably the left area PF), the motor-control system (notably the intraparietal sulcus), body structural description (notably the left angular gyrus), semantic knowledge (notably the polar temporal lobes) and potentially theory of mind (notably the middle prefrontal cortex) work in concert to produce pantomime. The original features of this model open new avenues for understanding the neurocognitive bases of pantomime, emphasizing that pantomime is a communicative task that nevertheless originates in specific tool-use (not motor-related) cognitive processes. .
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Affiliation(s)
- François Osiurak
- Laboratoire d’Etude des Mécanismes Cognitifs (EA3082), Université Lyon 2, 69676 Bron, France
- Institut Universitaire de France, 75231 Paris, France
| | - Emanuelle Reynaud
- Laboratoire d’Etude des Mécanismes Cognitifs (EA3082), Université Lyon 2, 69676 Bron, France
| | - Josselin Baumard
- Normandie University, UNIROUEN, CRFDP (EA7475), 76821 Mont Saint Aignan, France
| | - Yves Rossetti
- Centre de Recherche en Neurosciences de Lyon, Trajectoires Team, CNRS U5292, Inserm U1028, Université de Lyon, 69676 Bron, France
- Mouvement, Handicap, et Neuro-Immersion, Hospices Civils de Lyon et Centre de Recherche en Neurosciences de Lyon, Hôpital Henry Gabrielle, 69230 Saint-Genis-Laval, France
| | - Angela Bartolo
- Institut Universitaire de France, 75231 Paris, France
- Univ. Lille, CNRS, UMR9193, SCALab—Sciences Cognitives et Sciences Affectives, 59653 Villeneuve d'Ascq, France
| | - Mathieu Lesourd
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive (UR481), Université de Bourgogne Franche-Comté, 25030 Besançon, France
- MSHE Ledoux, CNRS, Université de Bourgogne Franche-Comté, 25000 Besançon, France
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Dressing A, Kaller CP, Martin M, Nitschke K, Kuemmerer D, Beume LA, Schmidt CSM, Musso M, Urbach H, Rijntjes M, Weiller C. Anatomical correlates of recovery in apraxia: A longitudinal lesion-mapping study in stroke patients. Cortex 2021; 142:104-121. [PMID: 34265734 DOI: 10.1016/j.cortex.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition. METHODS 90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner-Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images. RESULTS Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions. CONCLUSION The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.
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Affiliation(s)
- Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
| | - Christoph P Kaller
- Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany; Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Martin
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Kai Nitschke
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kuemmerer
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena-A Beume
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte S M Schmidt
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mariacristina Musso
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
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Rounis E, Halai A, Pizzamiglio G, Lambon Ralph MA. Characterising factors underlying praxis deficits in chronic left hemisphere stroke patients. Cortex 2021; 142:154-168. [PMID: 34271260 DOI: 10.1016/j.cortex.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/02/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
Limb apraxia, a disorder of skilled action not consequent on primary motor or sensory deficits, has traditionally been defined according to errors patients make on neuropsychological tasks. Previous models of the disorder have failed to provide a unified account of patients' deficits, due to heterogeneity in the patients and tasks used. In this study we hypothesised that we may be able to map apraxic deficits onto principal components, some of which may be specific, whilst others may align with other cognitive disorders. We implemented principal component analysis (PCA) to elucidate core factors of the disorder in a preliminary cohort of 41 unselected left hemisphere chronic stroke patients who were tested on a comprehensive and validated apraxia screen. Three principal components were identified: posture selection, semantic control and multi-demand sequencing. These were submitted to a lesion symptom mapping (VBCM) analysis in a subset of 24 patients, controlled for lesion volume, age and time post-stroke. The first component revealed no significant structural correlates. The second component was related to regions in inferior frontal gyrus, primary motor area, and adjacent parietal opercular (including inferior parietal and supramarginal gyrus) areas. The third component was associated with lesions within the white matter underlying the left sensorimotor cortex, likely involving the 2nd branch of the left superior longitudinal fasciculus as well as the posterior orbitofrontal cortex (pOFC). These results highlight a significant role of common cognitive functions in apraxia, which include action selection, and sequencing, whilst more specific deficits may relate to semantic control. Moreover, they suggest that previously described 'ideomotor' and 'ideational' deficits may have a common neural basis within semantic control. Further research using this technique would help elucidate the cognitive processes underlying limb apraxia, its neural correlates and their relationship with other cognitive disorders.
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Affiliation(s)
- Elisabeth Rounis
- Chelsea and Westminster NHS Foundation Trust, West Middlesex University Hospital, Isleworth, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Ajay Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Pastore-Wapp M, Nyffeler T, Nef T, Bohlhalter S, Vanbellingen T. Non-invasive brain stimulation in limb praxis and apraxia: A scoping review in healthy subjects and patients with stroke. Cortex 2021; 138:152-164. [PMID: 33691224 DOI: 10.1016/j.cortex.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/09/2020] [Accepted: 02/09/2021] [Indexed: 01/25/2023]
Abstract
Non-invasive brain stimulation (NIBS) techniques are widely used in research settings to investigate brain mechanisms and increasingly being used for treatment purposes. The aim of this study was to systematically identify and review the current literature on NIBS studies of limb praxis and apraxia in healthy subjects and stroke patients with a scoping review using PRISMA-ScR guidelines. MEDLINE-PubMed, EMBASE and PsycINFO were searched. Inclusion criteria were English peer-reviewed studies focusing on the investigation of limb praxis/apraxia using repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS). Fourteen out of 139 records met the inclusion criteria, including thirteen studies with healthy subjects and one with stroke patients. The results of our systematic review suggest that in healthy subjects NIBS over left inferior parietal lobe (IPL) mainly interfered with gesture processing, by either affecting reaction times in judgment tasks or real gesturing. First promising results suggest that inhibitory continuous theta burst stimulation (cTBS) over right IPL may enhance gesturing in healthy subjects, explained by transcallosal facilitation of left IPL. In stroke patients, excitatory anodal tDCS over left IPL may improve limb apraxia. However, larger well powered and sham-controlled clinical trials are needed to expand on these proof-of-concept results, before NIBS could be a treatment option to improve limb apraxia in stroke patients.
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Affiliation(s)
- Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Switzerland
| | - Thomas Nyffeler
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Biomedical Research (DBMR) and Department of Neurology, University of Bern, and Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland; University of Zurich, Zurich, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Switzerland.
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