Theories and control models and motor learning: clinical applications in neuro-rehabilitation

Natural Semantic Networks of the Neurorehabilitation Concept by Spanish Physiotherapists-A Qualitative Phenomenological Representational Study

The Natural Semantic Networks (NSN) model is highly useful in analyzing the words that define a concept in terms of the value, strength, weight, or density that a specific population assigns to the construction of a learned concept. The main objective of this study was to describe the conceptualization of the concept of neurorehabilitation by Spanish physiotherapists specializing in this field using NSN. A phenomenological study is presented. The participants were physiotherapy professionals who graduated from three Spanish universities and were working in the field of neurorehabilitation. A questionnaire was administered via Google Forms, which was constructed using the NSN technique. A total of 191 physiotherapists participated in this study. The Spanish physiotherapists interviewed used a total of 1247 defining words for the concept of neurorehabilitation. The semantic core of the concept was mainly formed by the words 'treatment', 'recovery', 'functionality', 'neuroplasticity', and 'learning', which carried significant weight. Results were also presented taking into account the academic level and years of professional experience of the sample. The semantic network observed in this study allows us to elucidate the polysemy of the concept of neurorehabilitation, which is composed not only of certain associated words but also the meanings they imply.

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article

AIM

This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration.

METHODS

Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework.

CONCLUSIONS AND IMPLICATIONS

As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

Effects of the radio electric asymmetric conveyer (REAC) on motor disorders: An integrative review

Introduction

The radio electric asymmetric conveyer (REAC) is a technology that has the purpose of restoring the cellular polarity triggering the rebalancing of the endogenous bioelectric field, which considering the neurological dysfunctions, affects the neural communication mechanisms. The studies published so far show that the REAC neuromodulation technology has positive effects in treating these dysfunctions, with the principles of endogenous bioelectricity as a basis to achieve these effects.

Objectives

This study aims to review the literature that explored the effects of REAC protocols on motor control and to identify which mechanisms would be involved.

Materials and methods

This integrative review considered studies that used REAC as a therapeutic intervention directed at human motor control and experimental research with animals that applied REAC to obtain effects related to motor behavior.

Results

Ten articles were included, eight clinical and two experimental studies. The clinical studies used the neuro postural optimization (NPO) protocol in 473 patients, of which 53 were healthy subjects, 91 were Alzheimer's disease patients, 128 were patients with atypical swallowing, 12 subjects with neurological diseases, and 189 were without the specification of disease. The experimental studies used the antalgic neuromodulation and neurodegeneration protocols in animal models.

Conclusion

The information integrated in this review made it possible to consider REAC technology a promising resource for treating motor control dysfunctions. It is possible to infer that the technology promotes functional optimization of neuronal circuits that may be related to more efficient strategies to perform motor tasks.

Effect of an augmented reality active video game for gait training in children with cerebral palsy following single-event multilevel surgery: protocol for a randomised controlled trial

INTRODUCTION

In paediatric rehabilitation, fun and motivation are also critical keys to successful therapy. A variety of interventions have shown positive effects, high level of interest, compliance and engagement with active video game (AVG).This seems to be an interesting approach for the postoperative gait rehabilitation of children with cerebral palsy (CP). In this study, we will investigate if an overground gait training (GT) delivered through an AVG can improve walking capacity and anaerobic performance.

METHODS AND ANALYSIS

This study is a randomised clinical controlled trial. A total of 14 children and adolescents in the age of 10-18 years with CP will be included. The minimum time between surgery and inclusion will be 7 weeks. The test group will participate in the GT programme with Augmented Reality Rehabilitation of Walking-Cerebral Palsy AVG, control group will receive GT on a treadmill. The primary outcome is the 6-Min Walk Test assessing walking capacity; secondary outcomes are the Muscle Power Sprint Test for anaerobic performance and Shuttle Run Test for physical fitness level. Satisfaction is tested with the Physical Activity Enjoyment Scale.

ETHICS AND DISSEMINATION

The findings will be disseminated by publications in peer-reviewed journals and conferences. This study received agreement from French ethic committee (Comité de Protection des Personnes Sud-Est VI-Number 2020-A02959-30).

TRIAL REGISTRATION NUMBER

NCT04837105.

Therapeutic exercise to improve motor function among children with Down Syndrome aged 0 to 3 years: a systematic literature review and meta‑analysis

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of therapeutic exercises on the motor function of children with Down Syndrome (DS) aged 0 to 3 years. The present study is systematic review and meta-analysis of effectiveness outcomes in this population: gait, balance, motor development, fine motor skills, and executive functions. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from January to December 2019. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. Six studies and 151 participants were included. Two types of therapeutic exercises, aerobic and neuromuscular, were identified. Both types of exercise were effective in improving outcomes. There were no differences between the modes of application of the exercise. No differences were identified between the treadmill and the physiotherapy plan for the reduction of the time to reach independent walking, Mean Difference (MD) 46.79, 95% Confidence Interval (IC) (- 32.60, 126.19), nor for the increase in walking speed MD 0.10 IC (- 0.02, 0.21) m/s. This study suggests that aerobic exercise therapy has a potentially effective role to promote the gait and motor development of children with DS aged 0 to 3 years when it is applied using a treadmill with a frequency of 5 days, a duration of 6-8 min, and an intensity of between 0.2 and 0.5 m/s. Studies with less heterogeneity and larger sample sizes are required.

Neurologic Music Therapy Improves Participation in Children With Severe Cerebral Palsy

Positive effects after neurologic music therapy (NMT) have been described regarding the motor function of children with severe cerebral palsy (CP). This study aimed to quantify improvements in participation, as well as complexity on task-related manual activities in children with severe bilateral CP. This analytic quasi-experimental study exposed 17 children with severe cerebral palsy to 13 NMT sessions to improve motor learning through therapeutic instrumental music performance (TIMP), using principally percussion musical instruments. Hoisan software video recording was used to quantify participation involved in creating music. In addition, the number of active movements performed in each NMT session was quantified. Significant improvements were found in the participation variables “visual contact,” “motor participation” and “motor participation repetitions.” Significant differences were also found in the subcategory “reaching and stroke,” “hitting with the hand” and “grasping and hitting.” The use of therapeutic of TIMP in children with severe CP improves participation during manual activities utilizing percussion instruments, therefore increasing the intensity of the psychomotor intervention.

Closed-loop Modulation of the Self-regulating Brain: A Review on Approaches, Emerging Paradigms, and Experimental Designs

Closed-loop approaches, setups, and experimental designs have been applied within the field of neuroscience to enhance the understanding of basic neurophysiology principles (closed-loop neuroscience; CLNS) and to develop improved procedures for modulating brain circuits and networks for clinical purposes (closed-loop neuromodulation; CLNM). The contents of this review are thus arranged into the following sections. First, we describe basic research findings that have been made using CLNS. Next, we provide an overview of the application, rationale, and therapeutic aspects of CLNM for clinical purposes. Finally, we summarize methodological concerns and critics in clinical practice of neurofeedback and novel applications of closed-loop perspective and techniques to improve and optimize its experiments. Moreover, we outline the theoretical explanations and experimental ideas to test animal models of neurofeedback and discuss technical issues and challenges associated with implementing closed-loop systems. We hope this review is helpful for both basic neuroscientists and clinical/ translationally-oriented scientists interested in applying closed-loop methods to improve mental health and well-being.

Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study

INTRODUCTION

Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders.

AIM

This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH.

METHODS

Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up.

RESULTS

A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP.

CONCLUSION

The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.

Hemispheric Difference of Regional Brain Function Exists in Patients With Acute Stroke in Different Cerebral Hemispheres: A Resting-State fMRI Study

Objective

To explore the different compensatory mechanisms of brain function between the patients with brain dysfunction after acute ischemic stroke (AIS) in the dominant hemisphere and the non-dominant hemisphere based on Resting-state Functional Magnetic Resonance Imaging (Rs-fMRI).

Methods

In this trial, 15 healthy subjects (HS) were used as blank controls. In total, 30 hemiplegic patients with middle cerebral artery acute infarction of different dominant hemispheres were divided into the dominant hemisphere group (DH) and the non-dominant hemisphere group (NDH), scanned by a 3.0 T MRI scanner, to obtain the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) and compare the differences.

Results

Compared with the HS, increased ALFF values in the brain areas, such as the bilateral midbrain, were observed in DH. Meanwhile decreased ReHo values in the brain areas, such as the right postcentral gyrus (BA3), were also observed. Enhanced ALFF values in the brain areas, such as the left BA6, and enhanced ReHo values in the brain areas, such as the left precuneus, were observed in the NDH. The ALFF and ReHo values of the right BA9 and precentral gyrus were both increased. Compared with DH, the NDH group showed lower ALFF values in the left supplementary motor area and lower ReHo values in the right BA10.

Conclusion

After acute infarction in the middle cerebral artery of the dominant hemisphere, a compensation mechanism is triggered in brain areas of the ipsilateral cortex regulating motor-related pathways, while some brain areas related to cognition, sensation, and motor in the contralateral cortex are suppressed, and the connection with the peripheral brain regions is weakened. After acute infarction in the middle cerebral artery of the non-dominant hemisphere, compensatory activation appears in motor control-related brain areas of the dominant hemisphere. After acute middle cerebral artery infarction in the dominant hemisphere, compared with the non-dominant hemisphere, functional specificity in the bilateral supplementary motor area weakens. After acute middle cerebral artery infarction in different hemispheres, there are hemispheric differences in the compensatory mechanism of brain function.

EEG hyperscanning in motor rehabilitation: a position paper

Studying the human brain during interpersonal interaction allows us to answer many questions related to motor control and cognition. For instance, what happens in the brain when two people walking side by side begin to change their gait and match cadences? Adapted from the neuroimaging techniques used in single-brain measurements, hyperscanning (HS) is a technique used to measure brain activity from two or more individuals simultaneously. Thus far, HS has primarily focused on healthy participants during social interactions in order to characterize inter-brain dynamics. Here, we advocate for expanding the use of this electroencephalography hyperscanning (EEG-HS) technique to rehabilitation paradigms in individuals with neurological diagnoses, namely stroke, spinal cord injury (SCI), Parkinson's disease (PD), and traumatic brain injury (TBI). We claim that EEG-HS in patient populations with impaired motor function is particularly relevant and could provide additional insight on neural dynamics, optimizing rehabilitation strategies for each individual patient. In addition, we discuss future technologies related to EEG-HS that could be developed for use in the clinic as well as technical limitations to be considered in these proposed settings.

Customizing Robot-Assisted Passive Neurorehabilitation Exercise Based on Teaching Training Mechanism

Passive movement is an important mean of rehabilitation for stroke survivors in the early stage or with greater paralysis. The upper extremity robot is required to assist therapists with passive movement during clinical rehabilitation, while customizing is one of the crucial issues for robot-assisted upper extremity training, which fits the patient-centeredness. Robot-assisted teaching training could address the need well. However, the existing control strategies of teaching training are usually commanded by position merely, having trouble to achieve the efficacy of treatment by therapists. And deficiency of flexibility and compliance comes to the training trajectory. This research presents a novel motion control strategy for customized robot-assisted passive neurorehabilitation. The teaching training mechanism is developed to coordinate the movement of the shoulder and elbow, ensuring the training trajectory correspondence with human kinematics. Furthermore, the motion trajectory is adjusted by arm strength to realize dexterity and flexibility. Meanwhile, the torque sensor employed in the human-robot interactive system identifies movement intention of human. The goal-directed games and feedbacks promote the motor positivity of stroke survivors. In addition, functional experiments and clinical experiments are investigated with a healthy adult and five recruited stroke survivors, respectively. The experimental results present that the suggested control strategy not only serves with safety training but also presents rehabilitation efficacy.

Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial

INTRODUCTION

Neuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.

METHODS AND ANALYSIS

This is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).

ETHICS AND DISSEMINATION

This protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04163666).

Prior cortical activity differences during an action observation plus motor imagery task related to motor adaptation performance of a coordinated multi-limb complex task

Motor adaptation is the ability to develop new motor skills that makes performing a consolidated motor task under different psychophysical conditions possible. There exists a proven relationship between prior brain activity at rest and motor adaptation. However, the brain activity at rest is highly variable both between and within subjects. Here we hypothesize that the cortical activity during the original task to be later adapted is a more reliable and stronger determinant of motor adaptation. Consequently, we present a study to find cortical areas whose activity, both at rest and during first-person virtual reality simulation of bicycle riding, characterizes the subjects who did and did not adapt to ride a reverse steering bicycle, a complex motor adaptation task involving all limbs and balance. The results showed that cortical activity differences during the simulated task were higher, more significant, spatially larger, and spectrally wider than at rest for good performers. In this sense, the activity of the left anterior insula, left dorsolateral and ventrolateral inferior prefrontal areas, and left inferior premotor cortex (action understanding hub of the mirror neuron circuit) during simulated bicycle riding are the areas with the most descriptive power for the ability of adapting the motor task. Trials registration Trial was registered with the NIH Clinical Trials Registry (clinicaltrials.gov), with the registration number NCT02999516 (21/12/2016).

[Effectiveness of robotic assistance for gait training in children with cerebral palsy. a systematic review]

INTRODUCTION

In recent years, the use of gait training using robotic assistance systems has progressively increased in the paediatric population with cerebral palsy.

OBJECTIVE

To systematically assess the effects of robotic assistance for gait training compared with physical rehabilitation therapy in children with cerebral palsy (CP), based on the International Classification of Functioning, Health and Disability (ICF).

MATERIALS AND METHODS

A systematic review was carried out according to the recommendations of the Cochrane Collaboration. We included randomised or quasi-randomised clinical trials that analysed children with CP classified according to The Gross Motor Function Classification System (GMFCS) I-III. The search was carried out in PubMed, PEDro, CENTRAL, CINALH, Cochrane, Embase, Europe PMC, LILACS and Science Direct. The selection and extraction of data from the studies was carried out by two independent researchers. Disagreements were resolved by consensus. A descriptive analysis of the selected studies was performed. Assessment of risk of bias was performed with the Cochrane Collaboration tool.

RESULTS

Four studies met the eligibility criteria. Most of the temporal-spatial, kinetic and kinematic parameters of gait were evaluated, all corresponding to the activity component of the ICF.

CONCLUSIONS

Due to the methodological variability of the studies, it is not possible to determine whether robot-assisted gait training is effective for treatment in children with CP.

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

BACKGROUND

Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales.

METHODS

Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM).

RESULTS

R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019).

CONCLUSIONS

Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings.

TRIAL REGISTRATION

www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.

The Role of Movement Representation Techniques in the Motor Learning Process: A Neurophysiological Hypothesis and a Narrative Review

We present a neurophysiological hypothesis for the role of motor imagery (MI) and action observation (AO) training in the motor learning process. The effects of movement representation in the brain and those of the cortical–subcortical networks related to planning, executing, adjusting, and automating real movements share a similar neurophysiological activity. Coupled with the influence of certain variables related to the movement representation process, this neurophysiological activity is a key component of the present hypothesis. These variables can be classified into four domains: physical, cognitive–evaluative, motivational–emotional, and direct-modulation. The neurophysiological activity underlying the creation and consolidation of mnemonic representations of motor gestures as a prerequisite to motor learning might differ between AO and MI. Together with variations in cognitive loads, these differences might explain the differing results in motor learning. The mirror neuron system appears to function more efficiently through AO training than MI, and AO is less demanding in terms of cognitive load than MI. AO might be less susceptible to the influence of variables related to movement representation.

HYBRID: Ambulatory Robotic Gait Trainer with Movement Induction and Partial Weight Support

Robotic exoskeletons that induce leg movement have proven effective for lower body rehabilitation, but current solutions offer limited gait patterns, lack stabilization, and do not properly stimulate the proprioceptive and balance systems (since the patient remains in place). Partial body weight support (PBWS) systems unload part of the patient’s body weight during rehabilitation, improving the locomotive capabilities and minimizing the muscular effort. HYBRID is a complete system that combines a 6DoF lower body exoskeleton (H1) with a PBWS system (REMOVI) to produce a solution apt for clinical practice that offers improves on existing devices, moves with the patient, offers a gait cycle extracted from the kinematic analysis of healthy users, records the session data, and can easily transfer the patient from a wheelchair to standing position. This system was developed with input from therapists, and its response times have been measured to ensure it works swiftly and without a perceptible delay.

Co-Contraction of Lower Limb Muscles Contributes to Knee Stability During Stance Phase in Hemiplegic Stroke Patients

Background

Knee stability has an important role in the gait of hemiplegic stroke patients. However, factors affecting knee stability have not been assessed concerning gait. The purpose of this study was to explore whether co-contraction of the lower limb muscles contributes to the knee stability during the stance phase of the gait cycle in hemiplegic stroke patients.

Material/Methods

A total of 30 hemiplegic stroke patients, ages 36–79 years, were instructed to walk at their natural speed. The root mean square of surface electromyography was used to measure activities of the biceps femoris and rectus femoris muscles, while the co-contraction ratio was computed based on the root mean squares. The peak angle of knee extension was acquired in the stance phase by 3D kinematic analyses. Lower limb function was evaluated using the Fugl-Meyer scale for lower limb motor assessment.

Results

A statistically significant increase of the muscle co-contraction ratio of the involved extremity was observed compared with that of the uninvolved extremity (t=−4.066, P<0.05). The muscle co-contraction ratio was significantly correlated with the peak angle of knee extension (r=0.387, P=0.035), Fugl-Meyer scale (r=−0.522, P=0.003), and Modified Ashworth Scale (r=0.404, P=0.027) during the stance phase of the gait cycle.

Conclusions

Our results showed that co-contraction of the rectus femoris muscle contributes to the stability of the knee and lower limb function in hemiplegic stroke patients, and suggests that co-contraction should be considered in the rehabilitation of knee stability during gait in hemiplegic stroke patients. Appropriate rehabilitation assessment planning with hemiplegic stroke patients, such as muscle co-contraction or knee stability of, might be created based on our results.

Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury

OBJECTIVE

To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT.

METHODS

After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions.

RESULTS

A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore.

CONCLUSION

Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

Important Movement Concepts: Clinical Versus Neuroscience Perspectives

Human movement is complex, presenting clinical and research challenges regarding how it is described and investigated. This paper discusses the commonalities and differences on how human movement is conceptualized from neuroscientific and clinical perspectives with respect to postural control; the limitations of linear measures; movement efficiency with respect to metabolic energy cost and selectivity; and, how muscle synergy analysis may contribute to our understanding of movement variability. We highlight the role of sensory information on motor performance with respect to the base of support and alignment, illustrating a potential disconnect between the clinical and neuroscientific perspectives. The purpose of this paper is to discuss the commonalities and differences in how movement concepts are defined and operationalized by Bobath clinicians and the neuroscientific community to facilitate a common understanding and open the dialogue on the research practice gap.

Balance Training in Virtual Reality Promotes Performance Improvement but Not Transfer to Postural Control in People with Chronic Stroke

Objective: In people with chronic stroke, we investigated the transfer of gains obtained after balance training with virtual reality (VR) to an untrained task with similar balance demands. Materials and Methods: This study included 29 people with chronic stroke randomized into two groups: experimental (EG, n = 16) and control (CG, n = 13). The EG performed three sessions of balance training with VR using a platform-based videogame (Nintendo Wii Fit system™) for 1 week. The CG received no intervention. Transfer was evaluated through balance tests on the force platform Balance Master™, performed before and after the intervention period, for both groups. Results: The analysis of variance for repeated measures for game performance in the EG showed statistically significant improvement in scores in all five games after training (AT). In contrast, similar analysis for balance tests for the EG and CG showed no significant differences in performance index scores derived from the Balance Master tests after the intervention period for both groups. Conclusion: People with chronic stroke showed performance improvement AT with VR, but there was no transfer of the gains obtained to an untrained task with similar balance demands.

A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson's disease

OBJECTIVE:

To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson's disease.

DESIGN:

Randomized controlled trial.

SETTING:

Home-based.

PARTICIPANTS:

Fifty patients with a clinical diagnosis of Parkinson's disease acknowledging impaired manual ability were randomized into two groups.

INTERVENTIONS:

Patients in the experimental group ( n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group ( n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups.

MAIN OUTCOME MEASURES:

The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer.

RESULTS:

After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement ( P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010).

CONCLUSIONS:

Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson's disease.

Neurologic music therapy in upper-limb rehabilitation in children with severe bilateral cerebral palsy: a randomized controlled trial

BACKGROUND

After receiving neurologic music therapy, functional improvements in children with severe bilateral cerebral palsy have not been found in the literature. Musical training with instruments allows interrelationships between movement, emotions and cognition for task-based learning, in order to improve motor control.

AIM

To understand whether neurologic music therapy has an impact on the functionality of children with severe cerebral palsy.

DESIGN

A randomized controlled assessor-blind trial was carried out.

SETTING

Children were recruited and treated in their own community center.

POPULATION

Eighteen children with severe bilateral cerebral palsy between 4 and 16 years old were studied.

METHODS

The intervention group (N.=18) received music therapy for 16 weeks, in addition to its usual physiotherapy input. Two music therapists implemented a neurologic music therapy program of therapeutic instrumental music performance. The control group (N.=9) received its usual therapeutic input, similar to the intervention group, but not neurologic music therapy. Overall and specific "Chailey levels of Ability" were quantified, as well as the locomotor stages.

RESULTS

Significant improvements in the overall and specific "arm and hand position" as well as "activities" from the Chailey Levels of Ability and the locomotor stages were observed (P<0.05) in the group which received the music therapy. All these improvements persisted after 4 months. The control group showed no improvements after a four-month follow-up.

CONCLUSIONS

Optimized intervention of neurologic music therapy can improve the functionality of children with severe bilateral cerebral palsy.

CLINICAL REHABILITATION IMPACT

Music therapy is a useful tool in rehabilitation and its positive effects remain four months after completing the treatment.

Parameters and Measures in Assessment of Motor Learning in Neurorehabilitation; A Systematic Review of the Literature

Upper limb function, essential for daily life, is often impaired in individuals after stroke and cerebral palsy (CP). For an improved upper limb function, learning should occur, and therefore training with motor learning principles is included in many rehabilitation interventions. Despite accurate measurement being an important aspect for examination and optimization of treatment outcomes, there are no standard algorithms for outcome measures selection. Moreover, the ability of the chosen measures to identify learning is not well established. We aimed to review and categorize the parameters and measures utilized for identification of motor learning in stroke and CP populations. PubMed, Pedro, and Web of Science databases were systematically searched between January 2000 and March 2016 for studies assessing a form of motor learning following upper extremity training using motor control measures. Thirty-two studies in persons after stroke and 10 studies in CP of any methodological quality were included. Identified outcome measures were sorted into two categories, “parameters,” defined as identifying a form of learning, and “measures,” as tools measuring the parameter. Review's results were organized as a narrative synthesis focusing on the outcome measures. The included studies were heterogeneous in their study designs, parameters and measures. Parameters included adaptation (n = 6), anticipatory control (n = 2), after-effects (n = 3), de-adaptation (n = 4), performance (n = 24), acquisition (n = 8), retention (n = 8), and transfer (n = 14). Despite motor learning theory's emphasis on long-lasting changes and generalization, the majority of studies did not assess the retention and transfer parameters. Underlying measures included kinematic analyses in terms of speed, geometry or both (n = 39), dynamic metrics, measures of accuracy, consistency, and coordination. There is no exclusivity of measures to a specific parameter. Many factors affect task performance and the ability to measure it—necessitating the use of several metrics to examine different features of movement and learning. Motor learning measures' applicability to clinical setting can benefit from a treatment-focused approach, currently lacking. The complexity of motor learning results in various metrics, utilized to assess its occurrence, making it difficult to synthesize findings across studies. Further research is desirable for development of an outcome measures selection algorithm, while considering the quality of such measurements.

Cognitive Representation of Human Action: Theory, Applications, and Perspectives

In this perspective article, we propose a cognitive architecture model of human action that stresses the importance of cognitive representations stored in long-term memory as reference structures underlying and guiding voluntary motor performance. We introduce an experimental approach to ascertain cognitive representation structures and provide evidence from a variety of different studies, ranging from basic research in manual action to application-oriented research, such as athlete performance and rehabilitation. As results from these studies strongly support the presence of functional links between cognitive and motor processes, we regard this approach as a suitable and valuable tool for a variety of different disciplines related to cognition and movement. We conclude this article by highlighting current advances in ongoing research projects aimed at improving interaction capabilities in technical systems, particularly for rehabilitation and everyday support of the elderly, and outline future research directions.

Upper limb posture estimation in robotic and virtual reality-based rehabilitation

New motor rehabilitation therapies include virtual reality (VR) and robotic technologies. In limb rehabilitation, limb posture is required to (1) provide a limb realistic representation in VR games and (2) assess the patient improvement. When exoskeleton devices are used in the therapy, the measurements of their joint angles cannot be directly used to represent the posture of the patient limb, since the human and exoskeleton kinematic models differ. In response to this shortcoming, we propose a method to estimate the posture of the human limb attached to the exoskeleton. We use the exoskeleton joint angles measurements and the constraints of the exoskeleton on the limb to estimate the human limb joints angles. This paper presents (a) the mathematical formulation and solution to the problem, (b) the implementation of the proposed solution on a commercial exoskeleton system for the upper limb rehabilitation, (c) its integration into a rehabilitation VR game platform, and (d) the quantitative assessment of the method during elbow and wrist analytic training. Results show that this method properly estimates the limb posture to (i) animate avatars that represent the patient in VR games and (ii) obtain kinematic data for the patient assessment during elbow and wrist analytic rehabilitation.