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Cheng KY, Rehani M, Hebert JS. A scoping review of eye tracking metrics used to assess visuomotor behaviours of upper limb prosthesis users. J Neuroeng Rehabil 2023; 20:49. [PMID: 37095489 PMCID: PMC10127019 DOI: 10.1186/s12984-023-01180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/19/2023] [Indexed: 04/26/2023] Open
Abstract
Advanced upper limb prostheses aim to restore coordinated hand and arm function. However, this objective can be difficult to quantify as coordinated movements require an intact visuomotor system. Eye tracking has recently been applied to study the visuomotor behaviours of upper limb prosthesis users by enabling the calculation of eye movement metrics. This scoping review aims to characterize the visuomotor behaviours of upper limb prosthesis users as described by eye tracking metrics, to summarize the eye tracking metrics used to describe prosthetic behaviour, and to identify gaps in the literature and potential areas for future research. A review of the literature was performed to identify articles that reported eye tracking metrics to evaluate the visual behaviours of individuals using an upper limb prosthesis. Data on the level of amputation, type of prosthetic device, type of eye tracker, primary eye metrics, secondary outcome metrics, experimental task, aims, and key findings were extracted. Seventeen studies were included in this scoping review. A consistently reported finding is that prosthesis users have a characteristic visuomotor behaviour that differs from that of individuals with intact arm function. Visual attention has been reported to be directed more towards the hand and less towards the target during object manipulation tasks. A gaze switching strategy and delay to disengage gaze from the current target has also been reported. Differences in the type of prosthetic device and experimental task have revealed some distinct gaze behaviours. Control factors have been shown to be related to gaze behaviour, while sensory feedback and training interventions have been demonstrated to reduce the visual attention associated with prosthesis use. Eye tracking metrics have also been used to assess the cognitive load and sense of agency of prosthesis users. Overall, there is evidence that eye tracking is an effective tool to quantitatively assess the visuomotor behaviour of prosthesis users and the recorded eye metrics are sensitive to change in response to various factors. Additional studies are needed to validate the eye metrics used to assess cognitive load and sense of agency in upper limb prosthesis users.
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Affiliation(s)
- Kodi Y Cheng
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Science, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, College of Health Science, University of Alberta, Edmonton, AB, Canada
| | - Mayank Rehani
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Science, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline S Hebert
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Science, University of Alberta, Edmonton, AB, Canada.
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, College of Health Science, University of Alberta, Edmonton, AB, Canada.
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada.
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Alterman BL, Keeton E, Ali S, Binkley K, Hendrix W, Lee PJ, Wang S, Kling J, Johnson JT, Wheaton LA. Partial-Hand Prosthesis Users Show Improved Reach-to-Grasp Behaviour Compared to Transradial Prosthesis Users with Increased Task Complexity. J Mot Behav 2022; 54:706-718. [PMID: 35485303 PMCID: PMC9627513 DOI: 10.1080/00222895.2022.2070122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Approaches to improve outcomes after upper-extremity amputation remain poorly understood. Examining prosthesis-use at different levels of loss elucidates motor control challenges. Non-amputated participants completed simple and complex reach-to-grasp actions using a body-powered transradial or partial-hand prosthesis simulator. We hypothesised that increased task complexity and participants using a partial-hand device would show greater functional adaptation compared to participants using a transradial device. Partial-hand users demonstrated variable grasp postures and higher reach peak velocities in the complex, but not simple, task. All groups showed decreases in movement duration in the complex task, but only partial-hand users improved in the simple task. These behavioural changes suggest how device level and task may influence prosthesis-use, with relevance to amputation rehabilitation.
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Affiliation(s)
- Bennett L Alterman
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Emily Keeton
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Saif Ali
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Katrina Binkley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - William Hendrix
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Perry J Lee
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Shuo Wang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - James Kling
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - John T Johnson
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Lewis A Wheaton
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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Rydland J, Spiegel S, Wolfe O, Alterman B, Johnson JT, Wheaton LA. Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review. Neurorehabil Neural Repair 2021; 36:208-216. [PMID: 34967259 DOI: 10.1177/15459683211070277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses. OBJECTIVE This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings. METHODS We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss. CONCLUSIONS There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.
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Affiliation(s)
- Jake Rydland
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Spiegel
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Wolfe
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | | | - John T Johnson
- School of Biological Sciences, Georgia Tech, Atlanta, GA, USA
| | - Lewis A Wheaton
- School of Biological Sciences, Georgia Tech, Atlanta, GA, USA
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Bayani KY, Lawson RR, Levinson L, Mitchell S, Atawala N, Otwell M, Rickerson B, Wheaton LA. Implicit development of gaze strategies support motor improvements during action encoding training of prosthesis use. Neuropsychologia 2019; 127:75-83. [PMID: 30807755 DOI: 10.1016/j.neuropsychologia.2019.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/06/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Action observation training has been suggested to facilitate motor improvements in the lives of persons with neural injury. Previous studies have shown that for persons with upper limb amputation, matched limb training, where prosthesis users emulate each other, has shown promise above mismatched training where a prosthesis user emulates actions of a person with sound limbs (most commonly that of a therapist). OBJECTIVE The mechanism underlying the matched limb training benefit is unclear. Gaze strategies may reveal unique patterns between matched and mismatched training which could explain improvements in motor function in matched limb training. METHODS Twenty persons with sound limbs were trained on how to use a prosthesis simulator using matched or mismatched limb training in a single session. Eye movements were recorded during the training phase. Kinematics were recorded as persons performed the task. RESULTS Gaze patterns showed differences between the training groups. The mismatched group demonstrated a higher probability of gaze on the path between the start and end of the action, while the matched group demonstrated a significantly higher probability of focusing on the elements of the path of the action and a trend of focusing on the shoulders. Kinematics also revealed overall improvements in motor control for the matched group. CONCLUSIONS This study proposes a putative mechanism that may explain improvements in matched limb training through shifting gaze strategies. Further work is needed to understand whether implicit visual strategies seen during matched limb training might encourage motor learning during functional training with prostheses.
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Affiliation(s)
- Kristel Y Bayani
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Regan R Lawson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Lauren Levinson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Sarah Mitchell
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Neel Atawala
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Malone Otwell
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Beth Rickerson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Lewis A Wheaton
- School of Biological Sciences Georgia Institute of Technology, United States.
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Wheaton LA. Neurorehabilitation in upper limb amputation: understanding how neurophysiological changes can affect functional rehabilitation. J Neuroeng Rehabil 2017; 14:41. [PMID: 28532464 PMCID: PMC5441064 DOI: 10.1186/s12984-017-0256-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background Significant advances have been made in developing new prosthetic technologies with the goal of restoring function to persons that suffer partial or complete loss of the upper limb. Despite these technological advances, many challenges remain in understanding barriers in patient adoption of technology, and what critical factors should be of focus in prosthetics development from a motor control perspective. This points to a potential opportunity to improve our understanding of amputation using neurophysiology and plasticity, and integrate this knowledge into the development of prosthetics technology in novel ways. Here, argument will be made to include a stronger focus on the neural and behavioral changes that result from amputation, and a better appreciation of the time-scale of changes which may significantly affect device adaptation, functional device utility, and motor learning implemented in rehabilitation environments. Conclusion By strengthening our understanding of the neuroscience of amputation, we may improve the ability to couple neurorehabilitation with neuroengineering to support clinician needs in yielding improved outcomes in patients.
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Affiliation(s)
- Lewis A Wheaton
- School of Biological Sciences, Georgia Institute of Technology, 555 14th Street, Atlanta, GA, 30332-0356, USA.
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Lawson RR, Gayle JO, Wheaton LA. Novel behavioral indicator of explicit awareness reveals temporal course of frontoparietal neural network facilitation during motor learning. PLoS One 2017; 12:e0175176. [PMID: 28410404 PMCID: PMC5391991 DOI: 10.1371/journal.pone.0175176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/21/2017] [Indexed: 11/29/2022] Open
Abstract
Deficits in sequential motor learning have been observed in many patient populations. Having an understanding of the individual neural progression associated with sequential learning in healthy individuals may provide valuable insights for effective interventions with these patients. Due to individual variability in motor skill acquisition, the temporal course of such learning will be vary, suggesting a need for a more individualized approach. Knowing when a subject becomes aware of movement patterns may provide a marker with which to identify each individual’s learning time course. To avoid interfering with the incidental nature of discovery during learning, such an indicator requires an indirect, behaviorally-based approach. In Part I, our study aimed to identify a reliable behavioral indicator predictive of the presence of incidental explicit awareness in a sequential motor learning task. Part II, utilized the predictive indicator and EEG to provide neural validation of perceptual processing changes temporally correlated with the indicator. Results of Part I provide a reliable predictive indicator for the timing of explicit awareness development. Results from Part II demonstrates strong classification reliability, as well as a significant neural correlation with behavior for subjects developing awareness (EXP), not observed with subjects without awareness (NOEXP). Additionally, a temporal correlation of peak activation between neural regions was noted over frontoparietal regions, suggesting that the incidental discovery of motor patterns may involve a facilitative network during awareness development. The proposed indicator provides a tool in which to further examine potential impacts of awareness associated with incidental, or exploratory, motor learning, while the individual nature of the indicator provides a tool for monitoring progress in rehabilitative, exploratory motor learning paradigms.
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Affiliation(s)
- Regan R. Lawson
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Jordan O. Gayle
- School of Psychology, Morehouse College, Atlanta, Georgia, United States of America
| | - Lewis A. Wheaton
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail:
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