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Lindberg PG, AmirShemiraniha N, Krewer C, Maier MA, Hermsdörfer J. Increased dual-task interference during upper limb movements in stroke exceeding that found in aging - a systematic review and meta-analysis. Front Neurol 2024; 15:1375152. [PMID: 39036633 PMCID: PMC11258041 DOI: 10.3389/fneur.2024.1375152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 07/23/2024] Open
Abstract
Objective To determine whether dual-task interference during upper limb tasks is increased in patients after stroke compared to healthy older subjects and to compare magnitude of stroke-induced change in interference to that explained by aging. Methods We conducted a systematic literature search in MEDLINE, CINAHL, Google Scholar and PEDro databases up to October 2023 for studies on upper limb dual-tasks in stroke and elderly healthy subjects. Eleven upper limb dual-task studies in stroke patients and 11 studies in healthy older subjects were identified and systematically reviewed. A meta-analysis was performed on seven stroke studies and on five studies in healthy older subjects that included control groups. Results Most stroke studies investigated proximal arm movements with kinematic measures, but few studies evaluated manual dexterity. In contrast, studies in healthy older subjects used more distal (finger tapping) tasks. The meta-analysis showed that stroke patients had on average a 19% (CI 95% = 1.0-37.3) increase in dual-task interference compared to age-matched healthy controls (Z = 2.06, p = 0.04). Older healthy subjects showed greater dual-task interference compared to younger subjects (19% greater, CI 95% = 6.5-31.2, Z = 2.98, p = 0.003). Conclusion Meta-analysis revealed an increase in dual-task interference during upper limb movements in stroke patients, exceeding age-related changes, supporting the presence of subclinical impairments in divided attention post-stroke that may impede motor recovery.
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Affiliation(s)
- Påvel G. Lindberg
- Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, Paris, France
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Nadia AmirShemiraniha
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Carmen Krewer
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Marc A. Maier
- INCC UMR 8002, CNRS, Université Paris Cité, Paris, France
| | - Joachim Hermsdörfer
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
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2
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Mullick AA, Baniña MC, Tomita Y, Fung J, Levin MF. Obstacle Avoidance and Dual-Tasking During Reaching While Standing in Patients With Mild Chronic Stroke. Neurorehabil Neural Repair 2021; 35:915-928. [PMID: 34455852 DOI: 10.1177/15459683211023190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Poststroke individuals use their paretic arms less often than expected in daily life situations, even when motor recovery is scored highly in clinical tests. Real-world environments are often unpredictable and require the ability to multitask and make decisions about rapid and accurate arm movement adjustments. Objective. To identify whether and to what extent cognitive-motor deficits in well-recovered individuals with stroke affect the ability to rapidly adapt reaching movements in changing cognitive and environmental conditions. Methods. Thirteen individuals with mild stroke and 11 healthy controls performed an obstacle avoidance task in a virtual environment while standing. Subjects reached for a virtual juice bottle with their hemiparetic arm as quickly as possible under single- and dual-task conditions. In the single-task condition, a sliding glass door partially obstructed the reaching path of the paretic arm. A successful trial was counted when the subject touched the bottle without the hand colliding with the door. In the dual-task condition, subjects repeated the same task while performing an auditory-verbal working memory task. Results. Individuals with stroke had significantly lower success rates than controls in avoiding the moving door in single-task (stroke: 51.8 ± 21.2%, control: 70.6 ± 12.7%; P = .018) and dual-task conditions (stroke: 40.0 ± 27.6%, control: 65.3 ± 20.0%; P = .015). Endpoint speed was lower in stroke subjects for successful trials in both conditions. Obstacle avoidance deficits were exacerbated by increased cognitive demands in both groups. Individuals reporting greater confidence using their hemiparetic arm had higher success rates. Conclusion. Clinically well-recovered individuals with stroke may have persistent deficits performing a complex reaching task.
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Affiliation(s)
- Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Yosuke Tomita
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada.,Department of Physical Therapy, Faculty of Health Care, 47735Takasaki University of Health and Welfare, Takasaki, Japan
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
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3
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Kim H, Kim HK, Kim N, Nam CS. Dual Task Effects on Speed and Accuracy During Cognitive and Upper Limb Motor Tasks in Adults With Stroke Hemiparesis. Front Hum Neurosci 2021; 15:671541. [PMID: 34220473 PMCID: PMC8250862 DOI: 10.3389/fnhum.2021.671541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Adults with stroke need to perform cognitive-motor dual tasks during their day-to-day activities. However, they face several challenges owing to their impaired motor and cognitive functions. Objective This case-controlled pilot study investigates the speed and accuracy tradeoffs in adults with stroke while performing cognitive-upper limb motor dual tasks. Methods Ten adults with stroke and seven similar-aged controls participated in this study. The participants used a robotic arm for the single motor task and participated in either the serial sevens (S7) or the controlled oral word association test (COWAT) for single-cognitive task. For the dual task, the participants performed the motor and cognitive components simultaneously. Their speed and accuracy were measured for the motor and cognitive tasks, respectively. Results Two-sample t-statistics indicated that the participants with stroke exhibited a lower motor accuracy in the cross task than in the circle task. The cognitive speed and motor accuracy registered by the subjects with stroke in the dual task significantly decreased. There was a negative linear correlation between motor speed and accuracy in the subjects with stroke when the COWAT task was performed in conjunction with the cross task (ρ = -0.6922, p = 0.0388). Conclusions This study proves the existence of cognitive-upper limb motor interference in adults with stroke while performing dual tasks, based on the observation that their performance during one or both dual tasks deteriorated compared to that during the single task. Both speed and accuracy were complementary parameters that may indicate clinical effectiveness in motor and cognitive outcomes in individuals with stroke.
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Affiliation(s)
- Hogene Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
| | - Hyun-Ki Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
| | - Nayoung Kim
- Department of Industrial Engineering, North Carolina State University, Raleigh, NC, United States
| | - Chang S Nam
- Department of Industrial Engineering, North Carolina State University, Raleigh, NC, United States
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Yang SH, Chung EJ, Lee J, Lee SH, Lee BH. The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial. Healthcare (Basel) 2021; 9:healthcare9050532. [PMID: 34063280 PMCID: PMC8147414 DOI: 10.3390/healthcare9050532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.
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Affiliation(s)
- Seok-Hui Yang
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Eun-Jung Chung
- Department of Physical Therapy, Andong Science College, Andong 36616, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
| | - Su-Hyun Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
- Correspondence: ; Tel.: +82-2-3399-1634
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Schwarz A, Veerbeek JM, Held JPO, Buurke JH, Luft AR. Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks. Front Bioeng Biotechnol 2021; 8:620805. [PMID: 33585418 PMCID: PMC7876346 DOI: 10.3389/fbioe.2020.620805] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/18/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl–Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section. Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder–elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis. Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59). Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures. Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands
| | - Janne M Veerbeek
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands.,Roessingh Research and Development B.V., Enschede, Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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6
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The patients' perspective on the perceived difficulties of dual-tasking: development and validation of the Dual-task Impact on Daily-living Activities Questionnaire (DIDA-Q). Mult Scler Relat Disord 2020; 46:102601. [PMID: 33296993 DOI: 10.1016/j.msard.2020.102601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Everyday-life activities often require performing dual tasks (DT), with consequent possible occurrence of motor-cognitive or motor-motor interference. This could reduce quality of life, in particular in people with neurological diseases. However, there is lack of validated tools to assess the patients' perspective on DT difficulties in this population. Therefore, we developed the Dual-task Impact on Daily-living Activities-Questionnaire (DIDA-Q) and tested its psychometric properties in people with multiple sclerosis (PwMS). METHODS Items were generated based on existing scales, DT paradigms used in previous studies and the opinion of a multi-stakeholder group, including both experts and PwMS. Twenty DT constituted the preliminary version of the DIDA-Q which was administered to 230 PwMS. The psychometric properties of the scale were evaluated including internal consistency, validity and reliability. RESULTS Nineteen items survived after exploratory factor analysis, showing a three-factor solution which identifies the components mostly contributing to DT perceived difficulty (i.e., balance and mobility, cognition and upper-limb ability). The DIDA-Q appropriately fits the graded response model, with first evaluations supporting internal consistency (Cronbach's alpha=0.95), validity (70% of the hypotheses for convergent and discriminant constructs confirmed) and reliability (intraclass correlation coefficients=0.95) of this tool. CONCLUSION The DIDA-Q could be used in research and clinical settings to discriminate individuals with low vs. high cognitive-motor or motor-motor interference, and to develop and evaluate the efficacy of personalized DT rehabilitative treatments in PwMS.
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7
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Hejazi-Shirmard M, Lajevardi L, Rassafiani M, Taghizadeh G. The effects of anxiety and dual-task on upper limb motor control of chronic stroke survivors. Sci Rep 2020; 10:15085. [PMID: 32934249 PMCID: PMC7492359 DOI: 10.1038/s41598-020-71845-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.
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Affiliation(s)
- Mahnaz Hejazi-Shirmard
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Laleh Lajevardi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait.,Neurorehabilitaion Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
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8
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van Cappellen – van Maldegem SJ, van Abswoude F, Krajenbrink H, Steenbergen B. Motor learning in children with developmental coordination disorder: The role of focus of attention and working memory. Hum Mov Sci 2018; 62:211-220. [DOI: 10.1016/j.humov.2018.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
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9
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Bank PJM, Marinus J, van Tol RM, Groeneveld IF, Goossens PH, de Groot JH, van Hilten JJ, Meskers CGM. Cognitive-motor interference during goal-directed upper-limb movements. Eur J Neurosci 2018; 48:3146-3158. [PMID: 30251278 PMCID: PMC6282826 DOI: 10.1111/ejn.14168] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022]
Abstract
Research and clinical practice have focused on effects of a cognitive dual‐task on highly automated motor tasks such as walking or maintaining balance. Despite potential importance for daily life performance, there are only a few small studies on dual‐task effects on upper‐limb motor control. We therefore developed a protocol for assessing cognitive‐motor interference (CMI) during upper‐limb motor control and used it to evaluate dual‐task effects in 57 healthy individuals and two highly prevalent neurological disorders associated with deficits of cognitive and motor processing (57 patients with Parkinson's disease [PD], 57 stroke patients). Performance was evaluated in cognitive and motor domains under single‐ and dual‐task conditions. Patterns of CMI were explored to evaluate overall attentional capacity and attention allocation. As expected, patients with neurological deficits showed different patterns of CMI compared to healthy individuals, depending on diagnosis (PD or stroke) and severity of cognitive and/or motor symptoms. Healthy individuals experienced CMI especially under challenging conditions of the motor task. CMI was greater in PD patients, presumably due to insufficient attentional capacity in relation to increased cognitive involvement in motor control. Although no general increase of CMI was observed in stroke patients, correlation analyses suggested that especially patients with severe motor dysfunction experienced CMI. Clinical ratings of cognitive and motor function were weakly associated with CMI, suggesting that CMI reflects a different construct than these unidimensional clinical tests. It remains to be investigated whether CMI is an indicator of difficulties with day‐to‐day activities.
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Affiliation(s)
- Paulina J. M. Bank
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Johan Marinus
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rosanne M. van Tol
- Department of Human Movement SciencesFaculty of Behavioural and Movement SciencesAmsterdam Movement SciencesVU AmsterdamAmsterdamThe Netherlands
| | - Iris F. Groeneveld
- Rijnlands Rehabilitation CenterLeidenThe Netherlands
- Sophia RehabilitationDen HaagThe Netherlands
| | - Paula H. Goossens
- Rijnlands Rehabilitation CenterLeidenThe Netherlands
- Department of Rehabilitation MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Jurriaan H. de Groot
- Department of Rehabilitation MedicineLeiden University Medical CenterLeidenThe Netherlands
| | | | - Carel G. M. Meskers
- Department of Rehabilitation MedicineAmsterdam Movement SciencesVU University Medical CenterAmsterdamThe Netherlands
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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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Principles of Motor Recovery After Neurological Injury Based on a Motor Control Theory. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 957:121-140. [PMID: 28035563 DOI: 10.1007/978-3-319-47313-0_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Problems of neurological rehabilitation are considered based on two levels of the International Classification of Functioning (ICF)-Body Structures and Function level and Activity level-and modulating factors related to the individual and the environment. Specifically, at the Body Structures and Function level, problems addressed include spasticity, muscle weakness, disordered muscle activation patterns and disruptions in coordinated movement. At the Activity level, deficits in multi-joint and multi-segment upper limb reaching movements are reviewed. We address how physiologically well established principles in the control of actions, Threshold Control and Referent Control as outlined in the Equilibrium-Point theory can help advance the understanding of underlying deficits that may limit recovery at each level.
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12
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Gulde P, Hughes CML, Hermsdörfer J. Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living. Front Hum Neurosci 2017; 11:42. [PMID: 28223927 PMCID: PMC5293874 DOI: 10.3389/fnhum.2017.00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/19/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments. Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a). Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen's d = 1.77); the RA (Cohen's d = 1.72) and the parameters of peak velocities (Cohen's d = 1.49/1.97) were decreased in the patient group. Analysis of the task's sub-actions repeated measures analysis of variance (rmANOVA) revealed no impact of the different demands of the sub-actions on the relative performance of the patient group. Conclusion: The analyses revealed kinematic peculiarities in the performance with the ipsilesional hand. These deficits apparently arose from the cognitive demands like sequencing rather than motor constraints. End-effector kinematics proved as a sensitive method to detect and quantify aspects of disturbed multi-step ADL performance after stroke. If standardized, the examination and the analysis are quick and deliver objective data supporting clinical research.
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Affiliation(s)
- Philipp Gulde
- Institute of Movement Science, Department of Sport and Health Sciences, Technical University of Munich Munich, Germany
| | | | - Joachim Hermsdörfer
- Institute of Movement Science, Department of Sport and Health Sciences, Technical University of Munich Munich, Germany
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13
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Cognitive-Motor Interference on Upper Extremity Motor Performance in a Robot-Assisted Planar Reaching Task Among Patients With Stroke. Arch Phys Med Rehabil 2016; 98:730-737. [PMID: 28049003 DOI: 10.1016/j.apmr.2016.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/22/2016] [Accepted: 12/07/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore motor performance on 2 different cognitive tasks during robotic rehabilitation in which motor performance was longitudinally assessed. DESIGN Prospective study. SETTING Rehabilitation hospital. PARTICIPANTS Patients (N=22) with chronic stroke and upper extremity impairment. INTERVENTION A total of 640 repetitions of robot-assisted planar reaching, 5 times a week for 4 weeks. MAIN OUTCOME MEASURES Longitudinal robotic evaluations regarding motor performance included smoothness, mean velocity, path error, and reach error by the type of cognitive task. Dual-task effects (DTEs) of motor performance were computed to analyze the effect of the cognitive task on dual-task interference. RESULTS Cognitive task type influenced smoothness (P=.006), the DTEs of smoothness (P=.002), and the DTEs of reach error (P=.052). Robotic rehabilitation improved smoothness (P=.007) and reach error (P=.078), while stroke severity affected smoothness (P=.01), reach error (P<.001), and path error (P=.01). Robotic rehabilitation or severity did not affect the DTEs of motor performance. CONCLUSIONS The results provide evidence for the effect of cognitive-motor interference on upper extremity performance among participants with stroke using a robotic-guided rehabilitation system.
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Zielinski IM, Jongsma MLA, Baas CM, Aarts PBM, Steenbergen B. Unravelling developmental disregard in children with unilateral cerebral palsy by measuring event-related potentials during a simple and complex task. BMC Neurol 2014; 14:6. [PMID: 24397355 PMCID: PMC3893558 DOI: 10.1186/1471-2377-14-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/30/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In a subset of children with unilateral Cerebral Palsy (CP) a discrepancy between capacity and performance of the affected upper limb can be observed. This discrepancy is known as Developmental Disregard (DD). Though the phenomenon of DD has been well documented, its underlying cause is still under debate. DD has originally been explained based on principles of operant conditioning. Alternatively, it has been proposed that DD results from a diminished automaticity of movements, resulting in an increased cognitive load when using the affected hand. To investigate the amount of involved cognitive load we studied Event-Related Potentials (ERPs) preceding task-related motor responses during a single-hand capacity and a dual-hand performance task. It was hypothesised that children with DD show alterations related to long-latency ERP components when selecting a response with the affected upper limb, reflecting increased cognitive load in order to generate an adequate response and especially so within the dual-hand task. METHODS Fifteen children with unilateral CP participated in the study. One of the participants was excluded due to major visual impairments. Seven of the remaining participants displayed DD. The other seven children served as a control group. All participants performed two versions of a cue-target paradigm, a single-hand capacity and a dual-hand performance task. The ERP components linked to target presentation were inspected: the mid-latency P2 component and the consecutive long-latency N2b component. RESULTS In the dual-hand performance task children with DD showed an enhancement in mean amplitude of the long-latency N2b component when selecting a response with their affected hand. No differences were found regarding the amplitude of the mid-latency P2 component. No differences were observed regarding the single-hand capacity task. The control group did not display any differences in ERPs linked to target evaluation processes between both hands. CONCLUSION These electrophysiological findings show that DD is associated with increased cognitive load when movements are prepared with the affected hand during a dual-hand performance task. These findings confirm behavioural observations, advance our insights on the neural substrate of DD and have implications for therapy.
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Affiliation(s)
- Ingar M Zielinski
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500, HE Nijmegen, The Netherlands
| | - Marijtje LA Jongsma
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500, HE Nijmegen, The Netherlands
| | - C Marjolein Baas
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500, HE Nijmegen, The Netherlands
| | - Pauline BM Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500, HE Nijmegen, The Netherlands
- School of Psychology, Australian Catholic University, 115 Victoria Pde, Melbourne, VIC 3450, Australia
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Steenbergen B, Jongbloed-Pereboom M, Spruijt S, Gordon AM. Impaired motor planning and motor imagery in children with unilateral spastic cerebral palsy: challenges for the future of pediatric rehabilitation. Dev Med Child Neurol 2013; 55 Suppl 4:43-6. [PMID: 24237279 DOI: 10.1111/dmcn.12306] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/28/2022]
Abstract
Compromised action performance is one of the most characteristic features of children with unilateral spastic cerebral palsy (USCP). Current rehabilitation efforts predominantly aim to improve the capacity and performance of the affected arm. Recent evidence, however, suggests that compromised motor planning may also negatively affect performance of activities of daily living. In this paper we will first discuss the recent evidence for this motor planning deficit, followed by studies on motor imagery in this population. Motor imagery is an experimental approach in which the contents of the motor plan become overt. Converging evidence indicates a compromised motor imagery ability in USCP. As the neural structures of both motor planning and motor imagery overlap, rehabilitation by motor imagery training may alleviate motor problems in USCP. Increasing evidence for this approach exists in older adults with stroke. We conclude this review with recommendations on such a training approach for children with USCP.
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Affiliation(s)
- Bert Steenbergen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
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