A new tool for assessing human movement: the Kinematic Assessment Tool

Sensorimotor Challenges in Minimally Invasive Surgery: A Theoretically-Oriented Review

OBJECTIVE

This review surveys the literature on sensorimotor challenges impacting performance in laparoscopic minimally invasive surgery (MIS).

BACKGROUND

Despite its well-known benefits for patients, achieving proficiency in MIS can be challenging for surgeons due to many factors including altered visual perspectives and fulcrum effects in instrument handling. Research on these and other sensorimotor challenges has been hindered by imprecise terminology and the lack of a unified theoretical framework to guide research questions in the field.

METHOD

We conducted a systematic survey of the MIS literature, focusing on studies investigating sensorimotor challenges affecting laparoscopic performance. To provide a common foundation for cross-study comparisons, we propose a standardized taxonomy that distinguishes between different experimental paradigms used in the literature. We then show how the computational motor learning perspective provides a unifying theoretical framework for the field that can facilitate progress and motivate future research along clearer, hypothesis-driven lines.

RESULTS

The survey identified diverse sensorimotor perturbations in MIS, which can be effectively categorized according to our proposed taxonomy. Studies investigating monitor-, camera-, and tool-based perturbations were systematically analyzed, elucidating their impact on surgical performance. We also show how the computational motor learning perspective provides deeper insights and potential strategies to mitigate challenges.

CONCLUSION

Sensorimotor challenges significantly impact MIS, necessitating a systematic, empirically informed approach. Our proposed taxonomy and theoretical framework shed light on the complexities involved, paving the way for more structured research and targeted training approaches to enhance surgical proficiency.

APPLICATION

Understanding the sensorimotor challenges inherent to MIS can guide the design of improved training curricula and inform the configuration of setups in the operating room to enhance surgeon performance and ultimately patient outcomes. This review offers key insights for surgeons, educators, and researchers in surgical performance and technology development.

Characterization of Upper Extremity Kinematics Using Virtual Reality Movement Tasks and Wearable IMU Technology

Task-specific training has been shown to be an effective neuromotor rehabilitation intervention, however, this repetitive approach is not always very engaging. Virtual reality (VR) systems are becoming increasingly popular in therapy due to their ability to encourage movement through customizable and immersive environments. Additionally, VR can allow for a standardization of tasks that is often lacking in upper extremity research. Here, 16 healthy participants performed upper extremity movement tasks synced to music, using a commercially available VR game known as Beat Saber. VR tasks were customized to characterize participants' joint angles with respect to each task's specified cardinal direction (inward, outward, upward, or downward) and relative task location (medial, lateral, high, and/or low). Movement levels were designed using three common therapeutic approaches: (1) one arm moving only (unilateral), (2) two arms moving in mirrored directions about the participant's midline (mirrored), or (3) two arms moving in opposing directions about the participant's midline (opposing). Movement was quantified using an XSens System, a wearable inertial measurement unit (IMU) technology. Results reveal a highly engaging and effective approach to quantifying movement strategies. Inward and outward (horizontal) tasks resulted in decreased wrist extension. Upward and downward (vertical) tasks resulted in increased shoulder flexion, wrist radial deviation, wrist ulnar deviation, and elbow flexion. Lastly, compared to opposing, mirrored, and unilateral movement levels often exaggerated joint angles. Virtual reality games, like Beat Saber, offer a repeatable and customizable upper extremity intervention that has the potential to increase motivation in therapeutic applications.

A novel tablet-based motor coordination test performs on par with the Beery VMI subtest and offers superior temporal metrics: findings from children with pediatric acute-onset neuropsychiatric syndrome

Neuropsychiatric and neurodevelopmental disorders are often associated with coordination problems. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) constitutes a specific example of acute and complex symptomatology that includes difficulties with motor control. The present proof-of-concept study aimed at testing a new, bespoke tablet-based motor coordination test named SpaceSwipe, providing fine-grained measures that could be used to follow-up on symptoms evolution in PANS. This test enables computationally precise and objective metrics of motor coordination, taking into account both directional and spatial features continuously. We used SpaceSwipe to assess motor coordination in a group of children with PANS (n = 12, assessed on in total of 40 occasions) and compared it against the motor coordination subtest from the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) 6th edition, traditionally used to follow-up symptomatology. Using a bivariate linear regression, we found that 33 s of the directional offset from tracking a moving target in SpaceSwipe could predict the Beery VMI motor coordination (VMI MC) raw scores (mean absolute error: 1.75 points). Positive correlations between the predicted scores and the VMI MC scores were found for initial testing (r_adj = 0.87) and for repeated testing (r_adj = 0.79). With its short administration time and its close prediction to Beery VMI scores, this proof-of-concept study demonstrates the potential for SpaceSwipe as a patient-friendly tool for precise, objective assessment of motor coordination in children with neurodevelopmental or neuropsychiatric disorders.

Vision and Visuomotor Performance Following Acute Ischemic Stroke

Background

As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.

Methods

Sixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.

Results

Of the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.

Conclusions

EHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.

Making Best Use of Home-Based Rehabilitation Robots

Large-scale clinical trials have shown that rehabilitation robots are as affective as conventional therapy, but the cost-effectiveness is preventing their uptake. This study investigated whether a low-cost rehabilitation robot could be deployed in a home setting for rehabilitation of people recovering from stroke (n = 16) and whether clinical outcome measures correlated well with kinematic measures gathered by the robot. The results support the feasibility of patients independently using the robot with improvement in both clinical measures and kinematic data. We recommend using kinematic data early in an intervention to detect improvement while using a robotic device. The kinematic measures in the assessment task (hits/minute and normalised jerk) adequately pick up changes within a four-week period, thus allowing the rehabilitation regime to be adapted to suit the user’s needs. Estimating the long-term clinical benefit must be explored in future research.

Large-scale assessment of 7-11-year-olds' cognitive and sensorimotor function within the Born in Bradford longitudinal birth cohort study

Background: Cognitive ability and sensorimotor function are crucial aspects of children's development, and are associated with physical and mental health outcomes and educational attainment. This paper describes cross-sectional sensorimotor and cognitive function data collected on over 15,000 children aged 7-10 years, collected as part of the Born in Bradford (BiB) longitudinal birth-cohort study. Methodological details of the large-scale data collection process are described, along with initial analyses of the data involving the relationship between cognition/sensorimotor ability and age and task difficulty, and associations between tasks. Method: Data collection was completed in 86 schools between May 2016 and July 2019. Children were tested at school, individually, using a tablet computer with a digital stylus or finger touch for input. Assessments comprised a battery of three sensorimotor tasks (Tracking, Aiming, & Steering) and five cognitive tasks (three Working Memory tasks, Inhibition, and Processing Speed), which took approximately 40 minutes. Results: Performance improved with increasing age and decreasing task difficulty, for each task. Performance on all three sensorimotor tasks was correlated, as was performance on the three working memory tasks. In addition, performance on a composite working memory score correlated with performance on both inhibition and processing speed. Interestingly, within age-group variation was much larger than between age-group variation. Conclusions: The current project collected computerised measures of a range of cognitive and sensorimotor functions at 7-10 years of age in over 15,000 children. Performance varied as expected by age and task difficulty, and showed the predicted correlations between related tasks. Large within-age group variation highlights the need to consider the profile of individual children in studying cognitive and sensorimotor development. These data can be linked to the wider BiB dataset including measures of physical and mental health, biomarkers and genome-wide data, socio-demographic information, and routine data from local health and education services.

Green CURIOCITY: a study protocol for a European birth cohort study analysing childhood heat-related health impacts and protective effects of urban natural environments

INTRODUCTION

The European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as exposure to urban natural environments, is unknown. Green CURe In Outdoor CITY spaces (Green CURIOCITY) will analyse how heat exposure during pregnancy affects birth outcomes and how long-term heat exposure may influence children's neurodevelopment. We will also investigate if adverse effects can be mitigated by urban natural environments. A final goal is to visualise intraurban patterns of heat vulnerability and assist planning towards healthier cities.

METHODS AND ANALYSIS

We will use existing data from the Human Early-Life Exposure cohort, which includes information on birth outcomes and neurodevelopment from six European birth cohorts. The cohort is linked to data on prenatal heat exposure and impact on birth outcomes will be analysed with logistic regression models, adjusting for air pollution and noise and sociobehavioural covariates. Similarly, impact of cumulative and immediate heat exposure on neurodevelopmental outcomes at age 5 will be assessed. For both analyses, the potentially moderating impact of natural environments will be quantified. For visualisation, Geographical information systems data will be combined to develop vulnerability maps, demonstrating urban 'hot spots' where the risk of negative impacts of heat is aggravated due to sociodemographic and land use patterns. Finally, geospatial and meteorological data will be used for informing GreenUr, an existing software prototype developed by the WHO Regional Office for Europe to quantify health impacts and augment policy tools for urban green space planning.

ETHICS AND DISSEMINATION

The protocol was approved by the Comité Ético de Investigación Clínica Parc de Salut MAR, Spain. Findings will be published in peer-reviewed journals and presented at policy events. Through stakeholder engagement, the results will also reach user groups and practitioners.

Exploring the effects of degraded vision on sensorimotor performance

PURPOSE

Many people experience unilateral degraded vision, usually owing to a developmental or age-related disorder. There are unresolved questions regarding the extent to which such unilateral visual deficits impact on sensorimotor performance; an important issue as sensorimotor limitations can constrain quality of life by restricting 'activities of daily living'. Examination of the relationship between visual deficit and sensorimotor performance is essential for determining the functional implications of ophthalmic conditions. This study attempts to explore the effect of unilaterally degraded vision on sensorimotor performance.

METHODS

In Experiment 1 we simulated visual deficits in 30 participants using unilateral and bilateral Bangerter filters to explore whether motor performance was affected in water pouring, peg placing, and aiming tasks. Experiment 2 (n = 74) tested the hypothesis that kinematic measures are associated with visuomotor deficits by measuring the impact of small visual sensitivity decrements created by monocular viewing on sensorimotor interactions with targets presented on a planar surface in aiming, tracking and steering tasks.

RESULTS

In Experiment 1, the filters caused decreased task performance-confirming that unilateral (and bilateral) visual loss has functional implications. In Experiment 2, kinematic measures were affected by monocular viewing in two of three tasks requiring rapid online visual feedback (aiming and steering).

CONCLUSIONS

Unilateral visual loss has a measurable impact on sensorimotor performance. The benefits of binocular vision may be particularly important for some groups (e.g. older adults) where an inability to complete sensorimotor tasks may necessitate assisted living. There is an urgent need to develop rigorous kinematic approaches to the quantification of the functional impact of unilaterally degraded vision and of the benefits associated with treatments for unilateral ophthalmic conditions to enable informed decisions around treatment.

Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke

Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.

Large-scale assessment of 7-11-year-olds’ cognitive and sensorimotor function within the Born in Bradford longitudinal birth cohort study

Background: Cognitive ability and sensorimotor function are crucial aspects of children’s development, and are associated with physical and mental health outcomes and educational attainment. The current project forms part of the Born in Bradford (BiB) longitudinal birth-cohort study, and involved measuring sensorimotor and cognitive function in over 15,000 children aged 7-10 years. This paper describes the large-scale data collection process and presents initial analyses of the data, including the relationship between cognition/sensorimotor ability and age and task difficulty, and associations between tasks. Method: Data collection was completed in 86 schools between May 2016 and July 2019. Children were tested at school, individually, using a tablet computer with a digital stylus or finger touch for input. Assessments comprised a battery of three sensorimotor tasks (Tracking, Aiming, & Steering) and five cognitive tasks (three Working Memory tasks, Inhibition, and Processing Speed), which took approximately 40 minutes. Results: Performance improved with increasing age and decreasing task difficulty, for each task. Performance on all three sensorimotor tasks was correlated, as was performance on the three working memory tasks. In addition, performance on a composite working memory score correlated with performance on both inhibition and processing speed. Interestingly, within age-group variation was much larger than between age-group variation. Conclusions: The current project collected computerised measures of a range of cognitive and sensorimotor functions at 7-10 years of age in over 15,000 children. Performance varied as expected by age and task difficulty, and showed the predicted correlations between related tasks. Large within-age group variation highlights the need to consider the profile of individual children in studying cognitive and sensorimotor development. These data can be linked to the wider BiB dataset including measures of physical and mental health, biomarkers and genome-wide data, socio-demographic information, and routine data from local health and education services.

Cognitive and sensorimotor function in participants being treated for trigeminal neuralgia pain

BACKGROUND

Trigeminal neuralgia (TN) is an orofacial condition defined by reoccurring, spontaneous, short-lived but excruciating stabbing pain. Pharmacological interventions constitute the first-line treatment for TN, with antiepileptic drugs commonly prescribed. People treated for TN pain with antiepileptic drugs describe cognitive and motor difficulties affecting activities of daily living, and report poorer quality of life. We undertook the first comprehensive objective evaluation of sensorimotor and cognitive performance in participants being treated for TN pain with antiepileptic drugs relative to age-matched controls.

METHODS

Participants (43 TN, 41 control) completed a battery of sensorimotor (steering, aiming and tracking) and cognitive (working memory, processing speed, inhibition) tasks.

RESULTS

The TN group performed significantly worse than controls on the sensorimotor tracking and aiming tasks and across all cognitive measures.

CONCLUSIONS

The data explain why patients treated with antiepileptic drugs report impairment when conducting activities of daily living (given the need for cognitive and motor capability within most of these). The study is an important first step in: (i) ensuring there is adequate information on the impact of pharmacological treatment; (ii) identifying measures to determine optimal medication dosage and track change over time; (iii) creating an evidence base that could allow scientific justification of alternative pain treatment options for TN (e.g. the costs/benefits of surgery).

Starting School: a large-scale start of school assessment within the ‘Born in Bradford’ longitudinal cohort

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

The effect of using a cycling workstation on mouse dexterity

This study investigated the effect of using a cycling workstation on mouse dexterity, including if and how this changed with practice. Thirty-four healthy adults were allocated to a sitting group (n = 17) or cycling group (n = 17). All participants completed standardised computer tasks on 6 occasions: baseline and final—all participants were seated; practice 1 to 4—sitting group participants were seated, cycling group participants pedalled on an under desk cycle. Three computer tasks were employed: (1) Tracking (continuous task)—participants used the mouse pointer to track a dot in a figure of 8 pattern at 3 different speeds without a guide then with a guide (2) Aiming (discrete task)—participants moved the mouse pointer to a dot which repeatedly disappeared then reappeared again in different locations, creating the outline of a pentagram (3) Steering (continuous task)—participants steered the mouse pointer around two different pathways. Accuracy was measured during the Tracking and Steering tasks as the root mean square error and penalised path accuracy respectively. Speed was measured during the Aiming task as the movement time. Data was analysed using frequentist and Bayes Factor analyses. During the continuous tasks (Tracking and Steering), accuracy was impaired among participants using the cycling workstation, both compared to their accuracy when seated and to the accuracy of participants in the sitting group. In contrast, no deficits in speed were noted among participants using the cycling work station during the discrete task (Aiming). No learning effects were observed among either group for any tasks. These findings suggest using a cycling workstation may impair the accuracy but not speed of mouse use, regardless of task practice. Overall this supports the implementation of cycling workstations in typical office settings, but suggests cycling workstations may impair productivity among workers performing high precision mouse tasks.

Populations Norms for "SLURP"-An iPad App for Quantification of Visuomotor Coordination Testing

Currently the integrity of brain function that drives behavior is predominantly measured in terms of pure motor function, yet most human behavior is visually driven. A means of easily quantifying such visually-driven brain function for comparison against population norms is lacking. Analysis of eye-hand coordination (EHC) using a digital game-like situation with downloadable spatio-temporal details has potential for clinicians and researchers. A simplified protocol for the Lee-Ryan EHC (Slurp) Test app for iPad® has been developed to monitor EHC. The two subtests selected, each of six quickly completed items with appeal to all ages, were found equivalent in terms of total errors/time and sensitive to developmental and aging milestones known to affect EHC. The sensitivity of outcomes due to the type of stylus being used during testing was also explored. Populations norms on 221 participants aged 5 to 80⁺years are presented for each test item according to two commonly used stylus types. The Slurp app uses two-dimensional space and is suited to clinicians for pre/post-intervention testing and to researchers in psychological, medical, and educational domains who are interested in understanding brain function.

Using kinematic analyses to explore sensorimotor control impairments in children with 22q11.2 deletion syndrome

BACKGROUND

The 22q11.2 deletion is associated with psychiatric and behavioural disorders, intellectual disability and multiple physical abnormalities. Recent research also indicates impaired coordination skills may be part of the clinical phenotype. This study aimed to characterise sensorimotor control abilities in children with 22q11.2 deletion syndrome (22q11.2DS) and investigate their relationships with co-occurring IQ impairments and psychopathology.

METHODS

Fifty-four children with 22q11.2DS and 24 unaffected sibling controls, comparable in age and gender, underwent kinematic analysis of their hand movements, whilst performing a battery of three visuo-manual coordination tasks that measured their tracking, aiming and steering abilities. Additionally, standardised assessments of full-scale IQ (FSIQ), attention deficit hyperactivity disorder, indicative autism spectrum disorder (ASD) and anxiety disorder symptomatology were conducted.

RESULTS

Children with 22q11.2DS showed deficits on seven of eight kinematic descriptors of movement quality across the three coordination tasks, compared to controls. Within 22q11.2DS cases, the extent of impairment on only three kinematic descriptors was significantly related to FSIQ after correction for multiple testing. Moreover, only error whilst visuo-manually tracking was nominally associated with ADHD symptom counts.

CONCLUSIONS

Impairments in sensorimotor control are seen on a range of visuo-manual tasks in children with 22q11.2DS but the extent of these impairments are largely unrelated to the severity of other psychopathological and intellectual impairments commonly found in children with 22q11.2DS.

Skill acquisition as a function of age, hand and task difficulty: Interactions between cognition and action

Some activities can be meaningfully dichotomised as 'cognitive' or 'sensorimotor' in nature-but many cannot. This has radical implications for understanding activity limitation in disability. For example, older adults take longer to learn the serial order of a complex sequence but also exhibit slower, more variable and inaccurate motor performance. So is their impaired skill acquisition a cognitive or motor deficit? We modelled sequence learning as a process involving a limited capacity buffer (working memory), where reduced performance restricts the number of elements that can be stored. To test this model, we examined the relationship between motor performance and sequence learning. Experiment 1 established that older adults were worse at learning the serial order of a complex sequence. Experiment 2 found that participants showed impaired sequence learning when the non-preferred hand was used. Experiment 3 confirmed that serial order learning is impaired when motor demands increase (as the model predicted). These results can be captured by reinforcement learning frameworks which suggest sequence learning will be constrained both by an individual's sensorimotor ability and cognitive capacity.

Adverse effects of anti-epileptics in trigeminal neuralgiform pain

BACKGROUND

Side effects of anti-epileptic drugs (AEDs) have not been adequately documented in trigeminal neuralgia and its variants. The aim of this observational cross-sectional study was to compare the A-B Neuropsychological Assessment Schedule (ABNAS), which measures cognitive side effects to the Adverse Events Profile (AEP), which looks at a broader range of side effects, and to investigate drug/dosage relationships with questionnaire scores to help determine a point at which a drug change would be indicated.

METHODS

One hundred five patients were recruited from a facial pain clinic, over a 10-month period. Self-complete questionnaire scores were compared between patients using different AEDs.

RESULTS

A-B Neuropsychological Assessment Schedule score correlated well with AEP indicating that cognitive side effects were a significant burden. Toxic range on the ABNAS was estimated to occur when scores were >43/72 (95% CI: 37.4-48.6). Polytherapy is weakly associated with the higher scores. Oxcarbazepine dosage was found to linearly correlate with AEP and ABNAS scores, better than carbamazepine dosage. Memory alteration was least common with lamotrigine and oxcarbazepine, and there was less association between fatigues with oxcarbazepine/pregabalin.

CONCLUSION

Anti-epileptic drugs have significant side effects. The ABNAS questionnaire is a useful tool along with the AEP to recognize and monitor AEDs' side effects and to help to adjust medications to optimal dosage.

Should prospective dental students be screened for colour vision deficits?

A perennial question in dental education is: what skills and aptitudes should be assessed in prospective dental students? Intellectual capacity and manual dexterity understandably rank highly, but are there minimum thresholds for visual perception that applicants need be able to demonstrate before they enter the profession? We have recently flagged this issue with regard to the thresholds of stereoscopic acuity required for a dentist when operating on teeth. In the present article, we highlight the issue of identifying a minimum acceptable level of colour vision.

Self-Control of Haptic Assistance for Motor Learning: Influences of Frequency and Opinion of Utility

Studies of self-controlled practice have shown benefits when learners controlled feedback schedule, use of assistive devices and task difficulty, with benefits attributed to information processing and motivational advantages of self-control. Although haptic assistance serves as feedback, aids task performance and modifies task difficulty, researchers have yet to explore whether self-control over haptic assistance could be beneficial for learning. We explored whether self-control of haptic assistance would be beneficial for learning a tracing task. Self-controlled participants selected practice blocks on which they would receive haptic assistance, while participants in a yoked group received haptic assistance on blocks determined by a matched self-controlled participant. We inferred learning from performance on retention tests without haptic assistance. From qualitative analysis of open-ended questions related to rationales for/experiences of the haptic assistance that was chosen/provided, themes emerged regarding participants' views of the utility of haptic assistance for performance and learning. Results showed that learning was directly impacted by the frequency of haptic assistance for self-controlled participants only and view of haptic assistance. Furthermore, self-controlled participants' views were significantly associated with their requested haptic assistance frequency. We discuss these findings as further support for the beneficial role of self-controlled practice for motor learning.

Feedback and motor skill acquisition using a haptic dental simulator

AIM

To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator.

METHODS

Sixty-three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device-only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post-test.

RESULTS

Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks.

CONCLUSION

These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education.

A new clinical test for sensorimotor function of the hand - development and preliminary validation

BACKGROUND

Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

METHODS

Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

RESULTS

The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC_2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.

CONCLUSIONS

The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

Counting on the mental number line to make a move: sensorimotor ('pen') control and numerical processing

Mathematics is often conducted with a writing implement. But is there a relationship between numerical processing and sensorimotor 'pen' control? We asked participants to move a stylus so it crossed an unmarked line at a location specified by a symbolic number (1-9), where number colour indicated whether the line ran left-right ('normal') or vice versa ('reversed'). The task could be simplified through the use of a 'mental number line' (MNL). Many modern societies use number lines in mathematical education and the brain's representation of number appears to follow a culturally determined spatial organisation (so better task performance is associated with this culturally normal orientation-the MNL effect). Participants (counter-balanced) completed two consistent blocks of trials, 'normal' and 'reversed', followed by a mixed block where line direction varied randomly. Experiment 1 established that the MNL effect was robust, and showed that the cognitive load associated with reversing the MNL not only affected response selection but also the actual movement execution (indexed by duration) within the mixed trials. Experiment 2 showed that an individual's motor abilities predicted performance in the difficult (mixed) condition but not the easier blocks. These results suggest that numerical processing is not isolated from motor capabilities-a finding with applied consequences.

Manual tracking impairs postural stability in older adults

Introduction

Older adults show increased postural sway and a greater risk of falls when completing activities with high cognitive demands. While dual-task approaches have clarified an association between cognitive processes and postural control, it is unclear how manual ability, which is also required for the successful completion of cognitively demanding tasks (such as putting a key into a lock), affects this relationship.

Method

Kinematic technology was used to explore the relationship between postural sway and manual control in healthy younger and older adults. Participants ( n = 82) remained standing to complete a visual-motor tracking task on a tablet computer. Root mean square tracking error measured manual performance, and a balance board measured deviations in centre of pressure as a marker of postural sway.

Results

Older adults displayed poorer manual accuracy and increased postural sway across all testing conditions.

Conclusions

Cognitive capacity can interact with multiple task demands, and in turn affect postural sway in older adults. Improving our understanding of factors that influence postural control will assist falls-prevention efforts and inform clinical practice.

Assessment of motor skill task performance with a task progress-weighted error measure

A quantitative measure has been developed for the assessment and skill ordering of target-cued motor control and coordination task performances. It is similar to the classical root mean square error (RMSE) measure but modified with task progress weighting that attenuates with target proximity to its destination and amplifies as data sampling occurrences accumulate prior to task completion. The measure has the same mathematical form whether the task design is of the tracing type or of the tracking type, and thus can be used in cross task type comparisons. The new measure is applied to a few simple hypothetical task performances in order to illustrate some of its properties, and then applied to actual experimental data from a tracing task and a tracking task to demonstrate its use.

Sensorimotor control dynamics and cultural biases: learning to move in the right (or left) direction

The nativist hypothesis suggests universal features of human behaviour can be explained by biologically determined cognitive substrates. This nativist account has been challenged recently by evolutionary models showing that the cultural transmission of knowledge can produce behavioural universals. Sensorimotor invariance is a canonical example of a behavioural universal, raising the issue of whether culture can influence not only which skills people acquire but also the development of the sensorimotor system. We tested this hypothesis by exploring whether culture influences the developing sensorimotor system in children. We took kinematic measures of motor control asymmetries in adults and children from differing cultures where writing follows opposite directions. British and Kuwaiti adults (n = 69) and first grade (5-6 year old) children (n = 140) completed novel rightward and leftward tracing tasks. The Kuwaitis were better when moving their arm leftward while the British showed the opposite bias. Bayesian analysis techniques showed that while children were worse than adults, they also showed asymmetries-with the asymmetry magnitude related to accuracy levels. Our findings support the idea that culture influences the sensorimotor system.

It Pays to Go Off-Track: Practicing with Error-Augmenting Haptic Feedback Facilitates Learning of a Curve-Tracing Task

Researchers in the domain of haptic training are now entering the long-standing debate regarding whether or not it is best to learn a skill by experiencing errors. Haptic training paradigms provide fertile ground for exploring how various theories about feedback, errors and physical guidance intersect during motor learning. Our objective was to determine how error minimizing, error augmenting and no haptic feedback while learning a self-paced curve-tracing task impact performance on delayed (1 day) retention and transfer tests, which indicate learning. We assessed performance using movement time and tracing error to calculate a measure of overall performance – the speed accuracy cost function. Our results showed that despite exhibiting the worst performance during skill acquisition, the error augmentation group had significantly better accuracy (but not overall performance) than the error minimization group on delayed retention and transfer tests. The control group’s performance fell between that of the two experimental groups but was not significantly different from either on the delayed retention test. We propose that the nature of the task (requiring online feedback to guide performance) coupled with the error augmentation group’s frequent off-target experience and rich experience of error-correction promoted information processing related to error-detection and error-correction that are essential for motor learning.

Kinematic measures provide useful information after intracranial aneurysm treatment

INTRODUCTION

Current methods of assessing the outcomes of intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage are relatively insensitive, and thus unlikely to detect subtle deficits. Failures to identify cognitive and motor outcomes of intracranial aneurysm treatment might prevent delivery of optimal post-operative care. There are also concerns over risks associated with using intracranial aneurysm treatment as a preventative measure.

METHODS

We explored whether our kinematic tool would yield useful information regarding motor/cognitive function in patients who underwent intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage or unruptured aneurysm. Computerised kinematic motor and learning tasks were administered alongside standardised clinical outcome measures of cognition and functional ability, in 10 patients, as a pilot trial. Tests at post-intracranial aneurysm treatment discharge and six-week follow-up were compared to see which measures detected changes.

RESULTS

Kinematic tests captured significant improvements from discharge to six-week follow-up, indexed by reduced motor errors and improved learning. Increased Addenbrooke's Cognitive Examination-Revised scores reflected some recovery of memory function for most individuals, but other standardised cognitive measures, functional outcome scores and a psychological questionnaire showed no changes.

CONCLUSIONS

Kinematic measures can identify variation in performance in individuals with only slightly improved abilities post-intracranial aneurysm treatment. These measures may provide a sensitive way to explore post-operative outcomes following intracranial aneurysm treatment, or other similar surgical procedures.

Motor Sequence Learning in Healthy Older Adults Is Not Necessarily Facilitated by Transcranial Direct Current Stimulation (tDCS)

Background: Transcranial Direct Current Stimulation (tDCS) of the primary motor cortex (M1) can modulate neuronal activity, and improve performance of basic motor tasks. The possibility that tDCS could assist in rehabilitation (e.g., for paresis post-stroke) offers hope but the evidence base is incomplete, with some behavioural studies reporting no effect of tDCS on complex motor learning. Older adults who show age-related decline in movement and learning (skills which tDCS could potentially facilitate), are also under-represented within tDCS literature. To address these issues, we examined whether tDCS would improve motor sequence learning in healthy young and older adults. Methods: In Experiment One, young participants learned 32 aiming movements using their preferred (right) hand whilst receiving: (i) 30 min Anodal Stimulation of left M1; (ii) 30 min Cathodal Stimulation of right M1; or (iii) 30 min Sham. Experiment Two used a similar task, but with older adults receiving Anodal Stimulation or Sham. Results: Whilst motor learning occurred in all participants, tDCS did not improve the rate or accuracy of motor learning for either age group. Conclusion: Our results suggest that the effects of tDCS may be limited to motor performance with no clear beneficial effects for motor learning.

Laparoscopic Motor Learning and Workspace Exploration

BACKGROUND

Laparoscopic surgery requires operators to learn novel complex movement patterns. However, our understanding of how best to train surgeons' motor skills is inadequate, and research is needed to determine optimal laparoscopic training regimes. This difficulty is confounded by variables inherent in surgical practice, for example, the increasing prevalence of morbidly obese patients presents additional challenges related to restriction of movement because of abdominal wall resistance and reduced intra-abdominal space. The aim of this study was to assess learning of a surgery-related task in constrained and unconstrained conditions using a novel system linking a commercially available robotic arm with specialised software creating the novel kinematic assessment tool (Omni-KAT).

METHODS

We created an experimental tool that records motor performance by linking a commercially available robotic arm with specialized software that presents visual stimuli and objectively measures movement outcome (kinematics). Participants were given the task of generating aiming movements along a horizontal plane to move a visual cursor on a vertical screen. One group received training that constrained movements to the correct plane, whereas the other group was unconstrained and could explore the entire "action space."

RESULTS

The tool successfully generated the requisite force fields and precisely recorded the aiming movements. Consistent with predictions from structural learning theory, the unconstrained group produced better performance after training as indexed by movement duration (p < 0.05).

CONCLUSION

The data showed improved performance for participants who explored the entire action space, highlighting the importance of learning the full dynamics of laparoscopic instruments. These findings, alongside the development of the Omni-KAT, open up exciting prospects for better understanding of the learning processes behind surgical training and investigate ways in which learning can be optimized.

Training compliance control yields improved drawing in 5-11year old children with motor difficulties

There are a large number of children with motor difficulties including those that have difficulty producing movements qualitatively well enough to improve in perceptuo-motor learning without intervention. We have developed a training method that supports active movement generation to allow improvement in a 3D tracing task requiring good compliance control. Previously, we tested a limited age range of children and found that training improved performance on the 3D tracing task and that the training transferred to a 2D drawing test. In the present study, school children (5-11years old) with motor difficulties were trained in the 3D tracing task and transfer to a 2D drawing task was tested. We used a cross-over design where half of the children received training on the 3D tracing task during the first training period and the other half of the children received training during the second training period. Given previous results, we predicted that younger children would initially show reduced performance relative to the older children, and that performance at all ages would improve with training. We also predicted that training would transfer to the 2D drawing task. However, the pre-training performance of both younger and older children was equally poor. Nevertheless, post-training performance on the 3D task was dramatically improved for both age groups and the training transferred to the 2D drawing task. Overall, this work contributes to a growing body of literature that demonstrates relatively preserved motor learning in children with motor difficulties and further demonstrates the importance of games in therapeutic interventions.

Moving to Capture Children's Attention: Developing a Methodology for Measuring Visuomotor Attention

Attention underpins many activities integral to a child's development. However, methodological limitations currently make large-scale assessment of children's attentional skill impractical, costly and lacking in ecological validity. Consequently we developed a measure of 'Visual Motor Attention' (VMA)-a construct defined as the ability to sustain and adapt visuomotor behaviour in response to task-relevant visual information. In a series of experiments, we evaluated the capability of our method to measure attentional processes and their contributions in guiding visuomotor behaviour. Experiment 1 established the method's core features (ability to track stimuli moving on a tablet-computer screen with a hand-held stylus) and demonstrated its sensitivity to principled manipulations in adults' attentional load. Experiment 2 standardised a format suitable for use with children and showed construct validity by capturing developmental changes in executive attention processes. Experiment 3 tested the hypothesis that children with and without coordination difficulties would show qualitatively different response patterns, finding an interaction between the cognitive and motor factors underpinning responses. Experiment 4 identified associations between VMA performance and existing standardised attention assessments and thereby confirmed convergent validity. These results establish a novel approach to measuring childhood attention that can produce meaningful functional assessments that capture how attention operates in an ecologically valid context (i.e. attention's specific contribution to visuomanual action).

The effect of standing desks on manual control in children and young adults

The aim of the present study was to establish if and how the additional postural constraint of standing affects accuracy and precision of goal directed naturalistic actions. Forty participants, comprising 20 young adults aged 20-23 years and 20 children aged 9-10 years completed 3 manual dexterity tasks on a tablet laptop with a handheld stylus during two separate conditions (1) while standing and (2) while seated. The order of conditions was counterbalanced across both groups of participants. The tasks were (1) a tracking task, where the stylus tracked a dot in a figure of 8 at 3 speeds, (2) an aiming task where the stylus moved from dot to dot with individual movements creating the outline of a pentagram and (3) a tracing task, where participants had to move the stylus along a static pathway or maze. Root mean squared error (RMSE), movement time and path accuracy, respectively, were used to quantify the effect that postural condition had on manual control. Overall adults were quicker and more accurate than children when performing all 3 tasks, and where the task speed was manipulated accuracy was better at slower speeds for all participants. Surprisingly, children performed these tasks more quickly and more accurately when standing compared to when sitting. In conclusion, standing at a desk while performing goal directed tasks did not detrimentally affect children's manual control, and moreover offered a benefit.

Effect of reduced visual acuity on precision of two-dimensional tracing movements

PURPOSE

We intended to assess consequences of reduced visual acuity for performance in a natural simple motor task (tracing) using objective kinematic performance measures. Specifically, we intended to elucidate the kind of relationship between the task performance and best corrected binocular visual acuity and to determine the threshold of visual acuity when task performance starts to deteriorate.

METHODS

Ninety-five individuals with different best corrected visual acuity participated in the study (age 49±12 years, mean±SD, 27 men and 68 women). The participants manually traced maze-like visual patterns of different spatial complexity presented on the screen of a portable notebook computer using Clinical Kinematic Assessment Tool software. Tracing error was computed as performance measure in each trial with a spatial pattern matching technique - rigid point set registration method.

RESULTS

The segmented linear regression analysis showed that the relation between visual acuity and tracing errors was best described with a regression function having a break point between two data segments. Tracing performance was unaffected by values of visual acuity below 0.2 on logMAR scale, but when logMAR values increased above this critical limit (i.e. when visual acuity is further reduced), tracing errors linearly increased. The rate of the increase of the tracing error correlated with the complexity of visual stimulus shape.

CONCLUSION

Testing of fine motor functions with objective kinematic measures during visuomotor tasks may help differentiating between actual effects of reduced visual acuity on eye-hand coordination in individuals with similar levels of impairment of visual acuity.

Robot Guided 'Pen Skill' Training in Children with Motor Difficulties

Motor deficits are linked to a range of negative physical, social and academic consequences. Haptic robotic interventions, based on the principles of sensorimotor learning, have been shown previously to help children with motor problems learn new movements. We therefore examined whether the training benefits of a robotic system would generalise to a standardised test of ‘pen-skills’, assessed using objective kinematic measures [via the Clinical Kinematic Assessment Tool, CKAT]. A counterbalanced, cross-over design was used in a group of 51 children (37 male, aged 5–11 years) with manual control difficulties. Improved performance on a novel task using the robotic device could be attributed to the intervention but there was no evidence of generalisation to any of the CKAT tasks. The robotic system appears to have the potential to support motor learning, with the technology affording numerous advantages. However, the training regime may need to target particular manual skills (e.g. letter formation) in order to obtain clinically significant improvements in specific skills such as handwriting.

The relationship between manual coordination and mental health

Motor coordination impairments frequently co-occur with other developmental disorders and mental health problems in clinically referred populations. But does this reflect a broader dimensional relationship within the general population? A clearer understanding of this relationship might inform improvements in mental health service provision. However, ascertainment and referral bias means that there is limited value in conducting further research with clinically referred samples. We, therefore, conducted a cross-sectional population-based study investigating children's manual coordination using an objective computerised test. These measures were related to teacher-completed responses on a behavioural screening questionnaire [the Strength and Difficulties Questionnaire (SDQ)]. We sampled 298 children (4-11 years old; 136 males) recruited from the general population. Hierarchical (logistic and linear) regression modelling indicated significant categorical and continuous relationships between manual coordination and overall SDQ score (a dimensional measure of psychopathology). Even after controlling for gender and age, manual coordination explained 15 % of the variance in total SDQ score. This dropped to 9 % after exclusion of participants whose SDQ responses indicated potential mental health problems. These results: (1) indicate that there is a clear relationship between children's motor and mental health development in community-based samples; (2) demonstrate the relationship's dimensional nature; and (3) have implications for service provision.

The attraction of emotions: Irrelevant emotional information modulates motor actions

Emotional expressions are important cues that capture our attention automatically. Although a wide range of work has explored the role and influence of emotions on cognition and behavior, little is known about the way that emotions influence motor actions. Moreover, considering how critical detecting emotional facial expressions in the environment can be, it is important to understand their impact even when they are not directly relevant to the task being performed. Our novel approach was to explore this issue from the attention-and-action perspective, using a task-irrelevant distractor paradigm in which participants are asked to reach for a target while a nontarget stimulus is also presented. We tested whether the movement trajectory would be influenced by irrelevant stimuli-faces with or without emotional expressions. The results showed that reaching paths veered toward faces with emotional expressions, in particular happiness, but not toward neutral expressions. This reinforces the view of emotions as attention-capturing stimuli that are, however, also potential sources of distraction for motor actions.

Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP)

Background

Adverse effects of drugs are poorly reported in the literature . The aim of this study was to examine the frequency of the adverse events of antiepileptic drugs (AEDs), in particular carbamazepine (CBZ) and oxcarbazepine (OXC) in patients with neuralgiform pain using the psychometrically tested Liverpool Adverse Events Profile (AEP) and provide clinicians with guidance as to when to change management.

Methods

The study was conducted as a clinical prospective observational exploratory survey of 161 patients with idiopathic trigeminal neuralgia and its variants of whom 79 were on montherapy who attended a specialist clinic in a London teaching hospital over a period of 2 years. At each consultation they completed the AEP questionnaire which provides scores of 19–76 with toxic levels being considered as scores >45.

Results

The most common significant side effects were: tiredness 31.3 %, sleepiness 18.2 %, memory problems 22.7 %, disturbed sleep 14.1 %, difficulty concentrating and unsteadiness 11.6 %. Females reported significantly more side effects than males. Potential toxic dose for females is approximately 1200 mg of OXC and 800 mg of CBZ and1800mg of OXC and 1200 mg of CBZ for males.

Conclusions

CBZ and OXC are associated with cognitive impairment. Pharmacokinetic and pharmacodynamic differences are likely to be the reason for gender differences in reporting side effects. Potentially, females need to be prescribed lower dosages in view of their tendency to reach toxic levels at lower dosages.

Side effects associated with AED could be a major reason for changing drugs or to consider a referral for surgical management.

Training to improve manual control in 7-8 and 10-12 year old children: Training eliminates performance differences between ages

Many children have difficulty producing movements well enough to improve in perceptuo-motor learning. We have developed a training method that supports active movement generation to allow improvement in a 3D tracing task requiring good compliance control. We previously tested 7-8 year old children who exhibited poor performance and performance differences before training. After training, performance was significantly improved and performance differences were eliminated. According to the Dynamic Systems Theory of development, appropriate support can enable younger children to acquire the ability to perform like older children. In the present study, we compared 7-8 and 10-12 year old school children and predicted that younger children would show reduced performance that was nonetheless amenable to training. Indeed, the pre-training performance of the 7-8 year olds was worse than that of the 10-12 year olds, but post-training performance was equally good for both groups. This was similar to previous results found using this training method for children with DCD and age-matched typically developing children. We also found in a previous study of 7-8 year old school children that training in the 3D tracing task transferred to a 2D drawing task. We now found similar transfer for the 10-12 year olds.

The ontogeny of visual-motor memory and its importance in handwriting and reading: a developing construct

Humans have evolved a remarkable ability to remember visual shapes and use these representations to generate motor activity (from Palaeolithic cave drawings through Jiahu symbols to cursive handwriting). The term visual-motor memory (VMM) describes this psychological ability, which must have conveyed an evolutionary advantage and remains critically important to humans (e.g. when learning to write). Surprisingly, little empirical investigation of this unique human ability exists--almost certainly because of the technological difficulties involved in measuring VMM. We deployed a novel technique for measuring this construct in 87 children (6-11 years old, 44 females). Children drew novel shapes presented briefly on a tablet laptop screen, drawing their responses from memory on the screen using a digitizer stylus. Sophisticated algorithms (using point-registration techniques) objectively quantified the accuracy of the children's reproductions. VMM improved with age and performance decreased with shape complexity, indicating that the measure captured meaningful developmental changes. The relationship between VMM and scores on nationally standardized writing assessments were explored with the results showing a clear relationship between these measures, even after controlling for age. Moreover, a relationship between VMM and the nationally standardized reading test was mediated via writing ability, suggesting VMM's wider importance within language development.

A new tool for assessing head movements and postural sway in children

Current methods of measuring gross motor abilities in children involve either high-cost specialist apparatus that is unsuitable for use in schools, or low-cost but nonoptimal observational measures. We describe the development of a low-cost system that is capable of providing high-quality objective data for the measurement of head movements and postural sway. This system is based on off-the-shelf components available for the Nintendo Wii: (1) The infrared cameras in a pair of WiiMotes are used to track head movements by resolving the position of infrared-emitting diodes in three dimensions, and (2) center-of-pressure data are captured using the WiiFit Balance board. This allows the assessment of children in school settings, and thus provides a mechanism for identifying children with neurological problems affecting posture. In order to test the utility of the system, we installed the apparatus in two schools to determine whether we could collect meaningful data on hundreds of children in a short time period. The system was successfully deployed in each school over a week, and data were collected on all of the children within the school buildings at the time of testing (N = 269). The data showed reliable effects of age and viewing condition, as predicted from previous small-scale studies that had used specialist apparatus to measure childhood posture. Thus, our system has the potential to allow screening of children for gross postural deficits in a manner that has never previously been possible. It follows that our system opens up the possibility of conducting large-scale behavioral studies concerning the development of posture.

The 'Goldilocks Zone': getting the measure of manual asymmetries

Some studies have shown that manual asymmetries decrease in older age. These results have often been explained with reference to models of reduced hemispheric specialisation. An alternative explanation, however, is that hand differences are subtle, and capturing them requires tasks that yield optimal performance with both hands. Whereas the hemispheric specialisation account implies that reduced manual asymmetries should be reliably observed in older adults, the ‘measurement difficulty’ account suggests that manual asymmetries will be hard to detect unless a task has just the right level of difficulty—i.e. within the ‘Goldilocks Zone’, where it is not too easy or too hard, but just right. Experiment One tested this hypothesis and found that manual asymmetries were only detected when participants performed in this zone; specifically, performance on a tracing task was only superior in the preferred hand when task constraints were high (i.e. fast speed tracing). Experiment Two used three different tasks to examine age differences in manual asymmetries; one task produced no asymmetries, whilst two tasks revealed asymmetries in both younger and older groups (with poorer overall performance in the old group across all tasks). Experiment Three revealed task-dependent asymmetries in both age groups, but highlighted further detection difficulties linked with the metric of performance and compensatory strategies used by participants. Results are discussed with reference to structural learning theory, whereby we suggest that the processes of inter-manual transfer lead to relatively small performance differences between the hands (despite a strong phenomenological sense of performance disparities).

Test-retest reliability and convergent validity of a computer based hand function test protocol in people with arthritis

OBJECTIVES

A computer based hand function assessment tool has been developed to provide a standardized method for quantifying task performance during manipulations of common objects/tools/utensils with diverse physical properties and grip/grasp requirements for handling. The study objectives were to determine test-retest reliability and convergent validity of the test protocol in people with arthritis.

METHODS

Three different object manipulation tasks were evaluated twice in forty people with rheumatoid arthritis (RA) or hand osteoarthritis (HOA). Each object was instrumented with a motion sensor and moved in concert with a computer generated visual target. Self-reported joint pain and stiffness levels were recorded before and after each task. Task performance was determined by comparing the object movement with the computer target motion. This was correlated with grip strength, nine hole peg test, Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, and the Health Assessment Questionnaire (HAQ) scores.

RESULTS

The test protocol indicated moderate to high test-retest reliability of performance measures for three manipulation tasks, intraclass correlation coefficients (ICCs) ranging between 0.5 to 0.84, p<0.05. Strength of association between task performance measures with self- reported activity/participation composite scores was low to moderate (Spearman rho <0.7). Low correlations (Spearman rho < 0.4) were observed between task performance measures and grip strength; and between three objects' performance measures. Significant reduction in pain and joint stiffness (p<0.05) was observed after performing each task.

CONCLUSION

The study presents initial evidence on the test retest reliability and convergent validity of a computer based hand function assessment protocol in people with rheumatoid arthritis or hand osteoarthritis. The novel tool objectively measures overall task performance during a variety of object manipulation tasks done by tracking a computer based visual target. This allows an innovative method of assessing performance than considering the time taken to complete a task or relying on subjective measures of self-reports on a limited range of objects and tasks covered. In addition, joint pain and stiffness levels before and after a manipulation task are tracked, which is lacking in other hand outcome measures. Performance measures during a broad range of object manipulation tasks relate to many activities relevant to life role participation. Therefore, task performance evaluation of common objects, utensils, or tools would be more valuable to gauge the difficulties encountered in daily life by people with arthritis. Future studies should consider a few revisions of the present protocol and evaluate a number of different objects targeting strength, fine, and gross dexterity based tasks for a broader application of the tool in arthritis populations.

Methods for transition toward computer assisted cognitive examination

INTRODUCTION

We present a software framework which enables the extension of current methods for the assessment of cognitive fitness using recent technological advances.

BACKGROUND

Screening for cognitive impairment is becoming more important as the world's population grows older. Current methods could be enhanced by use of computers. Introduction of new methods to clinics requires basic tools for collection and communication of collected data.

OBJECTIVES

To develop tools that, with minimal interference, offer new opportunities for the enhancement of the current interview based cognitive examinations.

METHODS

We suggest methods and discuss process by which established cognitive tests can be adapted for data collection through digitization by pen enabled tablets. We discuss a number of methods for evaluation of collected data, which promise to increase the resolution and objectivity of the common scoring strategy based on visual inspection. By involving computers in the roles of both instructing and scoring, we aim to increase the precision and reproducibility of cognitive examination.

RESULTS

The tools provided in Python framework CogExTools available at http://bsp. brain.riken.jp/cogextools/ enable the design, application and evaluation of screening tests for assessment of cognitive impairment. The toolbox is a research platform; it represents a foundation for further collaborative development by the wider research community and enthusiasts. It is free to download and use, and open-source.

CONCLUSION

We introduce a set of open-source tools that facilitate the design and development of new cognitive tests for modern technology. We provide these tools in order to enable the adaptation of technology for cognitive examination in clinical settings. The tools provide the first step in a possible transition toward standardized mental state examination using computers.

Minimally invasive surgery training using multiple port sites to improve performance

BACKGROUND

Structural learning theory suggests that experiencing motor task variation enables the central nervous system to extract general rules regarding tasks with a similar structure - rules that can subsequently be applied to novel situations. Complex minimally invasive surgery (MIS) requires different port sites, but switching ports alters the limb movements required to produce the same endpoint control of the surgical instrument. The purpose of the present study was to determine if structural learning theory can be applied to MIS to inform training methods.

METHODS

A tablet laptop running bespoke software was placed within a laparoscopic box trainer and connected to a monitor situated at eye level. Participants (right-handed, non-surgeons, mean age = 23.2 years) used a standard laparoscopic grasper to move between locations on the screen. There were two training groups: the M group (n = 10) who trained using multiple port sites, and the S group (n = 10) who trained using a single port site. A novel port site was used as a test of generalization. Performance metrics were a composite of speed and accuracy (SACF) and normalized jerk (NJ; a measure of movement 'smoothness').

RESULTS

The M group showed a statistically significant performance advantage over the S group at test, as indexed by improved SACF (p < 0.05) and NJ (p < 0.05).

CONCLUSIONS

This study has demonstrated the potential benefits of incorporating a structural learning approach within MIS training. This may have practical applications when training junior surgeons and developing surgical simulation devices.

The Cerebral Palsy Kinematic Assessment Tool (CPKAT): feasibility testing of a new portable tool for the objective evaluation of upper limb kinematics in children with cerebral palsy in the non-laboratory setting

PURPOSE

Efficacy of treatment to improve upper-limb activity of children with cerebral palsy (CP) is typically evaluated outside clinical/laboratory environments through functional outcome measures (e.g. ABILHAND kids). This study evaluates CPKAT, a new portable laptop-based tool designed to objectively measure upper-limb kinematics in children with CP.

METHODS

Seven children with unilateral CP (2 females; mean age 10 years 2 months (SD 2 years 3 months), median age 9 years 6 months, range 6 years 5 months, MACS II-IV) were evaluated on copying, tracking and tracing tasks at their homes using CPKAT. CPKAT recorded parameters relating to spatiotemporal hand movement: path length, movement time, smoothness, path accuracy and root mean square error. The Wilcoxon signed ranks test explored whether CPKAT could detect differences between the affected and less-affected limb.

RESULTS

CPKAT detected intra-limb differences for movement time and smoothness (aiming), and path length (tracing). No intra-limb tracking differences were found, as hypothesised. These findings are consistent with other studies showing that movements of the impaired upper limb in unilateral CP are slower and less smooth.

CONCLUSION

CPKAT provides a potential solution for home-based assessment of upper limb kinematics in children with CP to supplement other measures and assess functional intervention outcomes. Further validation is required. Implications for Rehabilitation This paper demonstrates the feasibility of evaluating upper limb kinematics in home using CPKAT, a portable laptop-based evaluation tool. We found that CPKAT is easy to set-up and use in home environments and yields useful kinematic measures of upper limb function. CPKAT can complement less responsive patient reported or subjectively evaluated functional measures for a more complete evaluation of children with cerebral palsy. Thus, CPKAT can help guide a multi-disciplinary team to more effective intervention and rehabilitation for children with cerebral palsy.