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Raghavan P. Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke. Phys Med Rehabil Clin N Am 2024; 35:235-257. [PMID: 38514216 DOI: 10.1016/j.pmr.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.
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Affiliation(s)
- Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Akaguchi R, Takamura Y, Okuno H, Morioka S, Kawashima N. Relative contribution of sensory and motor deficits on grip force control in patients with chronic stroke. Clin Neurophysiol 2024; 161:231-241. [PMID: 38522269 DOI: 10.1016/j.clinph.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This study aimed to characterize grasping behavior in static (weight-dependent modulation and stability of control) and dynamic (predictive control) aspects specifically focusing on the relative contribution of sensory and motor deficits to grip force control in patients with chronic stroke. METHODS Twenty-four chronic stroke patients performed three manipulative tasks: five trials of 5-s grasp-lift-holding, 30-s static holding, and vertical dynamic/cyclic oscillation of holding the object. RESULTS Exerted static grip force on the paretic side exhibited statistically greater than that on the non-paretic side. Spearman's rank correlation coefficient revealed that the contribution to static grip force control was larger in sensory deficits than in motor deficits. In addition, the sensory deficit is related to the reduced coupling between grip force and load force, suggesting difficulty in predictive control due to the absence of sensory feedback. CONCLUSIONS Given that grip force control involves predictive feedforward and online feedback control, the evaluation of grip force might be an important and feasible evaluation manner for the assessment of sensorimotor control in patients post-stroke. SIGNIFICANCE Detailed evaluation of grip force control would help to understand the mechanisms underlying hand dysfunction in stroke patients.
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Affiliation(s)
- Ryo Akaguchi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan; Depart of Rehabilitation, Setsunan General Hospital, Osaka, Japan
| | - Yusaku Takamura
- Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Hiroyuki Okuno
- Depart of Rehabilitation, Setsunan General Hospital, Osaka, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan.
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3
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Dos Santos M, Yahya A, Kluding P, Pasnoor M, Wick J, Liu W. The effect of type 2 diabetes and diabetic peripheral neuropathy on predictive grip force control. Exp Brain Res 2023; 241:2605-2616. [PMID: 37730970 DOI: 10.1007/s00221-023-06705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
This study investigated the impact of type 2 diabetes and diabetic peripheral neuropathy on grip force control during object manipulation. The study included three age-matched groups: type 2 diabetes alone (n = 11), type 2 diabetes with neuropathy (n = 13), and healthy controls (n = 12). Grip force control variables derived from lifting and holding an experimental cup were the ratio between grip force and load forces during lifting (GFR), latency 1 and latency 2, which represented the time between the object's grip and its lift-off from the table, and the period between object's lift-off and the grip force peak, respectively; time lag, which denoted the time difference between the grip and load force peaks during the lifting phase, and finally static force, which was the grip force average during the holding phase. Grip force control variables were compared between groups using one-way ANOVA and Kruskal-Wallis test. Post-hoc analysis was used to compare differences between groups. GFR and latency 1 showed significant differences between groups; the type 2 diabetes with neuropathy group showed larger GFR than the type 2 diabetes alone and healthy control groups. The latency 1was longer for the group with neuropathy in comparison with the health control group. There were no significant differences between groups for latency 2, time lag, and static force. Our results showed impaired GFR and latency 1 in participants with type 2 diabetes with neuropathy while the time lag was preserved. People with type 2 diabetes alone might not have any deficits in grip force control. Higher grip forces might expose people with type 2 diabetes and diabetic peripheral neuropathy to the risk of fatigue and injuring their hands. Future studies should investigate strategies to help people with type 2 diabetes with neuropathy adjust grip forces during object manipulation.
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Affiliation(s)
- Marcio Dos Santos
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, Miami, 800 S. Douglas Road, Suite 149, Coral Gables, FL, 33134, USA.
| | - Abdalghani Yahya
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia Kluding
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Potts CA, Kantak SS. Post-stroke deficits in the anticipatory control and bimanual coordination during naturalistic cooperative bimanual action. J Neuroeng Rehabil 2023; 20:153. [PMID: 37950249 PMCID: PMC10638820 DOI: 10.1186/s12984-023-01257-x] [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: 08/26/2022] [Accepted: 09/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Unilateral stroke leads to asymmetric deficits in movement performance; yet its effects on naturalistic bimanual actions, a key aspect of everyday functions, are understudied. Particularly, how naturalistic bimanual actions that require the two hands to cooperatively interact with each other while manipulating a single common object are planned, executed, and coordinated after stroke is not known. In the present study, we compared the anticipatory planning, execution, and coordination of force between individuals with left and right hemisphere stroke and neurotypical controls in a naturalistic bimanual common-goal task, lifting a box. METHOD Thirty-three individuals with chronic stroke (15 LCVA, 18 RCVA) and 8 neurotypical age-matched controls used both hands to lift a box fitted with force transducers under unweighted and weighted conditions. Primary dependent variables included measures of anticipation (peak grip and load force rate), execution (peak grip force, load force), and measures of within-hand (grip-load force coordination) and between-hand coordination (force rate cross-correlations). Primary analyses were performed using linear mixed effects modeling. Exploratory backward stepwise regression examined predictors of individual variability within participants with stroke. RESULTS Participants with stroke, particularly the RCVA group, showed impaired scaling of grip and load force rates with the addition of weight, indicating deficits in anticipatory control. While there were no group differences in peak grip force, participants with stroke showed significant impairments in peak load force and in grip-load force coordination with specific deficits in the evolution of load force prior to object lift-off. Finally, there were differences in spatial coordination of load force rates for participants with stroke, and especially the RCVA group, as compared to controls. Unimanual motor performance of the paretic arm and hemisphere of lesion (right hemisphere) were the key predictors of impairments in anticipatory planning of grip force and bimanual coordination among participants with stroke. CONCLUSIONS These results suggest that individuals with stroke, particularly those with right hemisphere damage, have impairments in anticipatory planning and interlimb coordination of symmetric cooperative bimanual tasks.
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Affiliation(s)
- Cory A Potts
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Department of Psychology, State University of New York at Plattsburgh, Plattsburgh, USA
| | - Shailesh S Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.
- Department of Physical Therapy, Arcadia University, Elkins Park, PA, USA.
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Gutterman J, Gordon AM. Neural Correlates of Impaired Grasp Function in Children with Unilateral Spastic Cerebral Palsy. Brain Sci 2023; 13:1102. [PMID: 37509032 PMCID: PMC10377617 DOI: 10.3390/brainsci13071102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Unilateral spastic cerebral palsy (USCP) is caused by damage to the developing brain and affects motor function, mainly lateralized to one side of the body. Children with USCP have difficulties grasping objects, which can affect their ability to perform daily activities. Although cerebral palsy is typically classified according to motor function, sensory abnormalities are often present as well and may contribute to motor impairments, including grasping. In this review, we show that the integrity and connectivity pattern of the corticospinal tract (CST) is related to execution and anticipatory control of grasping. However, as this may not explain all the variance of impairments in grasping function, we also describe the potential roles of sensory and sensorimotor integration deficits that contribute to grasp impairments. We highlight studies measuring fingertip forces during object manipulation tasks, as this approach allows for the dissection of the close association of sensory and motor function and can detect the discriminant use of sensory information during a complex, functional task (i.e., grasping). In addition, we discuss the importance of examining the interactions of the sensory and motor systems together, rather than in isolation. Finally, we suggest future directions for research to understand the underlying mechanisms of grasp impairments.
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Affiliation(s)
- Jennifer Gutterman
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
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Fu J, Jiang Z, Shu X, Chen S, Jia J. Correlation between the ERD in grasp/open tasks of BCIs and hand function of stroke patients: a cross-sectional study. Biomed Eng Online 2023; 22:36. [PMID: 37061673 PMCID: PMC10105926 DOI: 10.1186/s12938-023-01091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/02/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND AND AIMS Brain-computer interfaces (BCIs) are emerging as a promising tool for upper limb recovery after stroke, and motor tasks are an essential part of BCIs for patient training and control of rehabilitative/assistive BCIs. However, the correlation between brain activation with different levels of motor impairment and motor tasks in BCIs is still not so clear. Thus, we aim to compare the brain activation of different levels of motor impairment in performing the hand grasping and opening tasks in BCIs. METHODS We instructed stroke patients to perform motor attempts (MA) to grasp and open the affected hand for 30 trials, respectively. During this period, they underwent EEG acquisition and BCIs accuracy recordings. They also received detailed history records and behavioral scale assessments (the Fugl-Meyer assessment of upper limb, FMA-UE). RESULTS The FMA-UE was negatively correlated with the event-related desynchronization (ERD) of the affected hemisphere during open MA (R = - 0.423, P = 0.009) but not with grasp MA (R = - 0.058, P = 0.733). Then we divided the stroke patients into group 1 (Brunnstrom recovery stages between I to II, n = 19) and group 2 (Brunnstrom recovery stages between III to VI, n = 23). No difference during the grasping task (t = 0.091, P = 0.928), but a significant difference during the open task (t = 2.156, P = 0.037) was found between the two groups on the affected hemisphere. No significant difference was found in the unaffected hemisphere. CONCLUSIONS The study indicated that brain activation is positively correlated with the hand function of stroke in open-hand tasks. In the grasping task, the patients in the different groups have a similar brain response, while in the open task, mildly injured patients have more brain activation in open the hand than the poor hand function patients.
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Affiliation(s)
- Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - ZeWu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Xiaokang Shu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
- National Center for Neurological Disorders, Shanghai, China.
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Lafe CW, Liu F, Simpson TW, Moon CH, Collinger JL, Wittenberg GF, Urbin MA. Force oscillations underlying precision grip in humans with lesioned corticospinal tracts. Neuroimage Clin 2023; 38:103398. [PMID: 37086647 PMCID: PMC10173012 DOI: 10.1016/j.nicl.2023.103398] [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: 01/07/2023] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 04/24/2023]
Abstract
Stability of precision grip depends on the ability to regulate forces applied by the digits. Increased frequency composition and temporal irregularity of oscillations in the force signal are associated with enhanced force stability, which is thought to result from increased voluntary drive along the corticospinal tract (CST). There is limited knowledge of how these oscillations in force output are regulated in the context of dexterous hand movements like precision grip, which are often impaired by CST damage due to stroke. The extent of residual CST volume descending from primary motor cortex may help explain the ability to modulate force oscillations at higher frequencies. Here, stroke survivors with longstanding hand impairment (n = 17) and neurologically-intact controls (n = 14) performed a precision grip task requiring dynamic and isometric muscle contractions to scale and stabilize forces exerted on a sensor by the index finger and thumb. Diffusion spectrum imaging was used to quantify total white matter volume within the residual and intact CSTs of stroke survivors (n = 12) and CSTs of controls (n = 14). White matter volumes within the infarct region and an analogous portion of overlap with the CST, mirrored onto the intact side, were also quantified in stroke survivors. We found reduced ability to stabilize force and more restricted frequency ranges in force oscillations of stroke survivors relative to controls; though, more broadband, irregular output was strongly related to force-stabilizing ability in both groups. The frequency composition and temporal irregularity of force oscillations observed in stroke survivors did not correlate with maximal precision grip force, suggesting that it is not directly related to impaired force-generating capacity. The ratio of residual to intact CST volumes contained within infarct and mirrored compartments was associated with more broadband, irregular force oscillations in stroke survivors. Our findings provide insight into granular aspects of dexterity altered by corticospinal damage and supply preliminary evidence to support that the ability to modulate force oscillations at higher frequencies is explained, at least in part, by residual CST volume in stroke survivors.
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Affiliation(s)
- Charley W Lafe
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA
| | - Fang Liu
- Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Tyler W Simpson
- Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Chan Hong Moon
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jennifer L Collinger
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - George F Wittenberg
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Michael A Urbin
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA; Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Kosugi A, Saga Y, Kudo M, Koizumi M, Umeda T, Seki K. Time course of recovery of different motor functions following a reproducible cortical infarction in non-human primates. Front Neurol 2023; 14:1094774. [PMID: 36846141 PMCID: PMC9947718 DOI: 10.3389/fneur.2023.1094774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
A major challenge in human stroke research is interpatient variability in the extent of sensorimotor deficits and determining the time course of recovery following stroke. Although the relationship between the extent of the lesion and the degree of sensorimotor deficits is well established, the factors determining the speed of recovery remain uncertain. To test these experimentally, we created a cortical lesion over the motor cortex using a reproducible approach in four common marmosets, and characterized the time course of recovery by systematically applying several behavioral tests before and up to 8 weeks after creation of the lesion. Evaluation of in-cage behavior and reach-to-grasp movement revealed consistent motor impairments across the animals. In particular, performance in reaching and grasping movements continued to deteriorate until 4 weeks after creation of the lesion. We also found consistent time courses of recovery across animals for in-cage and grasping movements. For example, in all animals, the score for in-cage behaviors showed full recovery at 3 weeks after creation of the lesion, and the performance of grasping movement partially recovered from 4 to 8 weeks. In addition, we observed longer time courses of recovery for reaching movement, which may rely more on cortically initiated control in this species. These results suggest that different recovery speeds for each movement could be influenced by what extent the cortical control is required to properly execute each movement.
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Affiliation(s)
- Akito Kosugi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yosuke Saga
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Moeko Kudo
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masashi Koizumi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tatsuya Umeda
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,Department of Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiko Seki
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,*Correspondence: Kazuhiko Seki ✉
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O'Keeffe R, Shirazi SY, Bilaloglu S, Jahed S, Bighamian R, Raghavan P, Atashzar SF. Nonlinear functional muscle network based on information theory tracks sensorimotor integration post stroke. Sci Rep 2022; 12:13029. [PMID: 35906239 PMCID: PMC9338017 DOI: 10.1038/s41598-022-16483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Sensory information is critical for motor coordination. However, understanding sensorimotor integration is complicated, especially in individuals with impairment due to injury to the central nervous system. This research presents a novel functional biomarker, based on a nonlinear network graph of muscle connectivity, called InfoMuNet, to quantify the role of sensory information on motor performance. Thirty-two individuals with post-stroke hemiparesis performed a grasp-and-lift task, while their muscle activity from 8 muscles in each arm was measured using surface electromyography. Subjects performed the task with their affected hand before and after sensory exposure to the task performed with the less-affected hand. For the first time, this work shows that InfoMuNet robustly quantifies changes in functional muscle connectivity in the affected hand after exposure to sensory information from the less-affected side. > 90% of the subjects conformed with the improvement resulting from this sensory exposure. InfoMuNet also shows high sensitivity to tactile, kinesthetic, and visual input alterations at the subject level, highlighting its potential use in precision rehabilitation interventions.
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Affiliation(s)
- Rory O'Keeffe
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Seyed Yahya Shirazi
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Seda Bilaloglu
- Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Shayan Jahed
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Ramin Bighamian
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Preeti Raghavan
- Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - S Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA.
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, USA.
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Laurin R, Renard-Moulard M, Cometti C. Stereotype Threat Effect on a Simple Motor Task: An Investigation of the Visuo-Spatial Working Memory. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022; 93:423-428. [PMID: 33074065 DOI: 10.1080/02701367.2020.1826391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Purpose: Based on the Chalabaev et al. (2013) study showing that in a Stereotype Threat (ST) situation the velocity of force production in a simple motor task can be affected, this study aimed to replicate this result and tested the role of Visuo-Spatial Working Memory (VSWM) in the ST effect. Method: Twenty one female athletes performed maximum voluntary contractions of the knee extensor muscles on an isokinetic dynamometer (Biodex), under neutral, ST, and ST with mental imagery conditions. The Rate Force of Development (RFD), a velocity indicator, was measured under each condition. VSWM and avoidance-related processes were measured in at a separate time. Results: Data confirmed that the RFD decreased when the stereotype threat was introduced, but also that mental imagery of the movement in the pre-contraction stage prevented this effect. Moreover, in the ST condition avoidance-related processes did not affect the RFD. In contrast, higher VSWM performance was associated with higher RFD. Conclusion: These findings suggest that the ST effects on a simple motor task can be explained by an alteration of working memory which impairs movement preparatory processes in the pre-contraction stage.
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Ossmy O, Mansano L, Frenkel-Toledo S, Kagan E, Koren S, Gilron R, Reznik D, Soroker N, Mukamel R. Motor learning in hemi-Parkinson using VR-manipulated sensory feedback. Disabil Rehabil Assist Technol 2022; 17:349-361. [PMID: 32657187 DOI: 10.1080/17483107.2020.1785561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation. METHODS We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training. RESULTS Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity. DISCUSSION Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia.Implications for rehabilitationAssistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel - constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.
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Affiliation(s)
- Ori Ossmy
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Evgeny Kagan
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Koren
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Roee Gilron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Reznik
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mukamel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Gardner EP, Putrino DF, Chen Van Daele J. Neural representation in M1 and S1 cortex of bilateral hand actions during prehension. J Neurophysiol 2022; 127:1007-1025. [PMID: 35294304 PMCID: PMC8993539 DOI: 10.1152/jn.00374.2021] [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: 08/19/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 11/22/2022] Open
Abstract
Bimanual movements that require coordinated actions of the two hands may be coordinated by synchronous bilateral activation of somatosensory and motor cortical areas in both hemispheres, by enhanced activation of individual neurons specialized for bimanual actions, or by both mechanisms. To investigate cortical neural mechanisms that mediate unimanual and bimanual prehension, we compared actions of the left and right hands in a reach to grasp-and-pull instructed-delay task. Spike trains were recorded with multiple electrode arrays placed in the hand area of primary motor (M1) and somatosensory (S1) cortex of the right hemisphere in macaques, allowing us to measure and compare the relative timing, amplitude, and synchronization of cortical activity in these areas as animals grasped and manipulated objects that differed in shape and location. We report that neurons in the right hemisphere show common task-related firing patterns for the two hands but actions of the ipsilateral hand elicited weaker and shorter-duration responses than those of the contralateral hand. We report significant bimanual activation of neurons in M1 but not in S1 cortex when animals have free choice of hand use in prehension tasks. Population ensemble responses in M1 thereby provide an accurate depiction of hand actions during skilled manual tasks. These studies also demonstrate that somatosensory cortical areas serve important cognitive and motor functions in skilled hand actions. Bilateral representation of hand actions may serve an important role in "motor equivalence" when the same movements are performed by either hand and in transfer of skill learning between the hands.NEW & NOTEWORTHY Humans can manipulate small objects with the right or left hand but typically select the dominant hand to handle them. We trained monkeys to grasp and manipulate objects with either hand, while recording neural activity in primary motor (M1) and somatosensory (S1) cortex. Actions of both hands activate M1 neurons, but S1 neurons respond only to the contralateral hand. Bilateral sensitivity in M1 may aid skill transfer between hands after stroke or head injury.
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Affiliation(s)
- Esther P Gardner
- Department of Neuroscience and Physiology and NYU Neuroscience Institute, New York University Grossman School of Medicine Public Health Research Institute, New York, New York
| | - David F Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
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13
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Badi M, Wurth S, Scarpato I, Roussinova E, Losanno E, Bogaard A, Delacombaz M, Borgognon S, C Vanc Ara P, Fallegger F, Su DK, Schmidlin E, Courtine G, Bloch J, Lacour SP, Stieglitz T, Rouiller EM, Capogrosso M, Micera S. Intrafascicular peripheral nerve stimulation produces fine functional hand movements in primates. Sci Transl Med 2021; 13:eabg6463. [PMID: 34705521 DOI: 10.1126/scitranslmed.abg6463] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marion Badi
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Sophie Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Ilaria Scarpato
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Evgenia Roussinova
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Elena Losanno
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
| | - Andrew Bogaard
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Maude Delacombaz
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Simon Borgognon
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland
| | - Paul C Vanc Ara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - David K Su
- Neurological Surgery, Harborview Medical Center, Seattle, WA 98104, USA
| | - Eric Schmidlin
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Eric M Rouiller
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Department of Neurological Surgery, Rehabilitation and Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.,Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
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14
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Does the Neurological Examination Correlate with Patient-Perceived Outcomes in Degenerative Cervical Myelopathy? World Neurosurg 2019; 132:e885-e890. [PMID: 31382071 DOI: 10.1016/j.wneu.2019.07.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM. METHODS A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes. RESULTS The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01). CONCLUSIONS Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.
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15
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Referent control of anticipatory grip force during reaching in stroke: an experimental and modeling study. Exp Brain Res 2019; 237:1655-1672. [PMID: 30976821 DOI: 10.1007/s00221-019-05498-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
To evaluate normal and impaired control of anticipatory grip force (GF) modulation, we compared GF production during horizontal arm movements in healthy and post-stroke subjects, and, based on a physiologically feasible dynamic model, determined referent control variables underlying the GF-arm motion coordination in each group. 63% of 13 healthy and 48% of 13 stroke subjects produced low sustained initial force (< 10 N) and increased GF prior to arm movement. Movement-related GF increases were higher during fast compared to self-paced arm extension movements only in the healthy group. Differences in the patterns of anticipatory GF increases before the arm movement onset between groups occurred during fast extension arm movement only. In the stroke group, longer delays between the onset of GF change and elbow motion were related to clinical upper limb deficits. Simulations showed that GFs could emerge from the difference between the actual and the referent hand aperture (Ra) specified by the CNS. Similarly, arm movement could result from changes in the referent elbow position (Re) and could be affected by the co-activation (C) command. A subgroup of stroke subjects, who increased GF before arm movement, could specify different patterns of the referent variables while reproducing the healthy typical pattern of GF-arm coordination. Stroke subjects, who increased GF after arm movement onset, also used different referent strategies than controls. Thus, altered anticipatory GF behavior in stroke subjects may be explained by deficits in referent control.
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16
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Parry R, Macias Soria S, Pradat-Diehl P, Marchand-Pauvert V, Jarrassé N, Roby-Brami A. Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis. Front Neurol 2019; 10:240. [PMID: 30941091 PMCID: PMC6433942 DOI: 10.3389/fneur.2019.00240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/22/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object. Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task. Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm. Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release.
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Affiliation(s)
- Ross Parry
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France.,Centre de Recherche sur le Sport et le Mouvement, EA 2931, Université Paris Nanterre, Nanterre, France
| | - Sandra Macias Soria
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Pascale Pradat-Diehl
- Service de Médecine Physique et de Réadaptation, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,AP-HP, GRC n°18 Handicap cognitif et réadaptation (HanCRe), Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | | | - Nathanaël Jarrassé
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Agnès Roby-Brami
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
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17
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Ding L, Wang X, Guo X, Chen S, Wang H, Jiang N, Jia J. Camera-Based Mirror Visual Feedback: Potential to Improve Motor Preparation in Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1897-1905. [PMID: 30106735 DOI: 10.1109/tnsre.2018.2864990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mirror visual feedback (MVF) is used widely for motor recovery after stroke, but an optimal training setup and systematic procedure are lacking. New optimization strategies have been proposed, one of which is a camera technique. We investigated the effects of a camera-based MVF setup on motor function and motor processes upstream for upper-limb rehabilitation. Seventy-nine stroke patients were assigned randomly to the MVF group (MG; ${N} = {38}$ ) or conventional group (CG; ${N} = {41}$ ), which, respectively, received camera-based MVF and dosage-equivalent physiotherapy or/and occupational therapy for 1 h/day and five days/week for four weeks. Two clinical scales were used to quantify the effect of the intervention methods: the Fugl-Meyer assessment-upper limb (FMA-UL) subscale and Barthel index. The hand laterality task was used to evaluate the ability of mental rotation, including the reaction time and accuracy. All measurements were improved significantly for both groups following intervention. FMA-UL was improved significantly in the MG compared with that in the CG. In lateralization tasks, the RT of the MG was significantly shorter than that of the CG at the endpoint. For all patients, judgments for the affected side were significantly slower and less accurate than for the less-affected side. Subgroup analyses suggested greater benefits of motor function, the activities of daily life, and mental rotation were achieved in subacute patients after MVF. A trend toward greater improvements in motor function for patients with severe-moderate motor impairment and patients with right-hemisphere damage were also revealed. Camera-based MVF has improved the motor function and ability of mental rotation for stroke patients, especially for patients in the subacute stage, which indicates the potential to improve motor preparation. Further studies might combine mental rotation with electroencephalography to investigate the neuro-mechanism of MVF.
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18
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García Álvarez A, Roby-Brami A, Robertson J, Roche N. Functional classification of grasp strategies used by hemiplegic patients. PLoS One 2017; 12:e0187608. [PMID: 29125855 PMCID: PMC5695285 DOI: 10.1371/journal.pone.0187608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022] Open
Abstract
This study aimed to identify and qualify grasp-types used by patients with stroke and determine the clinical parameters that could explain the use of each grasp. Thirty-eight patients with chronic stroke-related hemiparesis and a range of motor and functional capacities (17 females and 21 males, aged 25–78), and 10 healthy subjects were included. Four objects were used (tissue packet, teaspoon, bottle and tennis ball). Participants were instructed to “grasp the object as if you are going to use it”. Three trials were video-recorded for each object. A total of 456 grasps were analysed and rated using a custom-designed Functional Grasp Scale. Eight grasp-types were identified from the analysis: healthy subjects used Multi-pulpar, Pluri-digital, Lateral-pinch and Palmar grasps (Standard Grasps). Patients used the same grasps with in addition Digito-palmar, Raking, Ulnar and Interdigital grasps (Alternative Grasps). Only patients with a moderate or relatively good functional ability used Standard grasps. The correlation and regression analyses showed this was conditioned by sufficient finger and elbow extensor strength (Pluri-digital grasp); thumb extensor and wrist flexor strength (Lateral pinch) or in forearm supinator strength (Palmar grasp). By contrast, the patients who had severe impairment used Alternative grasps that did not involve the thumb. These strategies likely compensate specific impairments. Regression and correlation analyses suggested that weakness had a greater influence over grasp strategy than spasticity. This would imply that treatment should focus on improving hand strength and control although reducing spasticity may be useful in some cases.
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Affiliation(s)
- Alicia García Álvarez
- Department of Physical Medicine and Rehabilitation, CHU Raymond Poincare - APHP, Garches, France
- * E-mail:
| | - Agnès Roby-Brami
- Institut des Systèmes Intelligents et de Robotique, CNRS, University Pierre et Marie Curie - Sorbonne Universities, Paris, France
| | - Johanna Robertson
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes, France
| | - Nicolas Roche
- Department of Physiology, University of Versailles Saint-Quentin-en-Yvelines U1179, Garches, France
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19
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Bracht MA, Coan ACB, Yahya A, Dos Santos MJ. Effects of cervical manipulation on pain, grip force control, and upper extremity muscle activity: a randomized controlled trial. J Man Manip Ther 2017; 26:78-88. [PMID: 29686481 DOI: 10.1080/10669817.2017.1393177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives Individuals with neck pain experience disrupted grip force control when performing manipulative tasks. Manipulative physical therapy might decrease pain and change the activity of surrounding muscles; however, its effect on upper limb motor control remains undetermined. This study aims to analyze the effects of cervical manipulation on pressure pain threshold (PPT), upper extremity muscle activity along with grip force control in individuals with neck pain. Methods Thirty subjects with neck pain were instructed to grasp and lift an object before and after cervical (n = 15) or sham (n = 15) manipulation. The patients' PPT, electromyographic (EMG) activity of the upper extremity/scapular muscles, and grip force control were analyzed before and after one session of manipulation. Results No significant differences were found in the grip force control, PPT and EMG activity variables between groups. Discussion These results suggest that a single session of cervical manipulation may not modify upper limb motor control, more specifically grip force control and EMG activity, in patients with cervical pain. Future studies should investigate potential changes in grip force control in patients with different features of neck pain and/or by applying long-term treatment. Level of Evidence 1b.
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Affiliation(s)
- Marcelo Anderson Bracht
- Department of Physical Therapy, Center of Health Sciences and Sport, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Ana Carina Buogo Coan
- Department of Physical Therapy, Center of Health Sciences and Sport, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Abdalghani Yahya
- Department of Physical Therapy and Rehabilitation Sciences, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Marcio José Dos Santos
- Department of Physical Therapy, Center of Health Sciences and Sport, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil.,Department of Physical Therapy and Rehabilitation Sciences, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
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20
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Hussain I, Spagnoletti G, Salvietti G, Prattichizzo D. Toward wearable supernumerary robotic fingers to compensate missing grasping abilities in hemiparetic upper limb. Int J Rob Res 2017. [DOI: 10.1177/0278364917712433] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This paper presents the design, analysis, fabrication, experimental characterization, and evaluation of two prototypes of robotic extra fingers that can be used as grasp compensatory devices for a hemiparetic upper limb. The devices are the results of experimental sessions with chronic stroke patients and consultations with clinical experts. Both devices share a common principle of work, which consists in opposing the device to the paretic hand or wrist so to restrain the motion of an object. They can be used by chronic stroke patients to compensate for grasping in several activities of daily living (ADLs) with a particular focus on bimanual tasks. The robotic extra fingers are designed to be extremely portable and wearable. They can be wrapped as bracelets when not being used, to further reduce the encumbrance. Both devices are intrinsically compliant and driven by a single actuator through a tendon system. The motion of the robotic devices can be controlled using an electromyography-based interface embedded in a cap. The interface allows the user to control the device motion by contracting the frontalis muscle. The performance characteristics of the devices have been measured experimentally and the shape adaptability has been confirmed by grasping various objects with different shapes. We tested the devices through qualitative experiments based on ADLs involving five chronic stroke patients. The prototypes successfully enabled the patients to complete various bimanual tasks. Results show that the proposed robotic devices improve the autonomy of patients in ADLs and allow them to complete tasks that were previously impossible to perform.
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Affiliation(s)
- Irfan Hussain
- Department of Information Engineering, Università degli Studi Siena, Italy
| | | | - Gionata Salvietti
- Department of Information Engineering, Università degli Studi Siena, Italy
- Istituto Italiano di Tecnologia, Italy
| | - Domenico Prattichizzo
- Department of Information Engineering, Università degli Studi Siena, Italy
- Istituto Italiano di Tecnologia, Italy
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21
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Rizzo JR, Fung JK, Hosseini M, Shafieesabet A, Ahdoot E, Pasculli RM, Rucker JC, Raghavan P, Landy MS, Hudson TE. Eye Control Deficits Coupled to Hand Control Deficits: Eye-Hand Incoordination in Chronic Cerebral Injury. Front Neurol 2017; 8:330. [PMID: 28769866 PMCID: PMC5512342 DOI: 10.3389/fneur.2017.00330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/23/2017] [Indexed: 11/13/2022] Open
Abstract
It is widely accepted that cerebral pathology can impair ocular motor and manual motor control. This is true in indolent and chronic processes, such as neurodegeneration and in acute processes such as stroke or those secondary to neurotrauma. More recently, it has been suggested that disruptions in these control systems are useful markers for prognostication and longitudinal monitoring. The utility of examining the relationship or the coupling between these systems has yet to be determined. We measured eye and hand-movement control in chronic, middle cerebral artery stroke, relative to healthy controls, in saccade-to-reach paradigms to assess eye-hand coordination. Primary saccades were initiated significantly earlier by stroke participants relative to control participants. However, despite these extremely early initial saccades to the target, reaches were nevertheless initiated at approximately the same time as those of control participants. Control participants minimized the time period between primary saccade onset and reach initiation, demonstrating temporal coupling between eye and hand. In about 90% of all trials, control participants produced no secondary, or corrective, saccades, instead maintaining fixation in the terminal position of the primary saccade until the end of the reach. In contrast, participants with stroke increased the time period between primary saccade onset and reach initiation. During this temporal decoupling, multiple saccades were produced in about 50% of the trials with stroke participants making between one and five additional saccades. Reaches made by participants with stroke were both longer in duration and less accurate. In addition to these increases in spatial reach errors, there were significant increases in saccade endpoint errors. Overall, the magnitude of the endpoint errors for reaches and saccades were correlated across participants. These findings suggest that in individuals with otherwise intact visual function, the spatial and temporal relationships between the eye and hand are disrupted poststroke, and may need to be specifically targeted during neurorehabilitation. Eye-hand coupling may be a useful biomarker in individuals with cerebral pathology in the setting of neurovascular, neurotraumatic, and neurodegenerative pathology.
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Affiliation(s)
- John-Ross Rizzo
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States.,Department of Neurology, New York University Langone Medical Center, New York, NY, United States
| | - James K Fung
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Maryam Hosseini
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Azadeh Shafieesabet
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Edmond Ahdoot
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Rosa M Pasculli
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Janet C Rucker
- Department of Neurology, New York University Langone Medical Center, New York, NY, United States.,Department of Ophthalmology, New York University Langone Medical Center, New York, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Michael S Landy
- Department of Psychology & Center for Neural Science, New York University, New York, NY, United States
| | - Todd E Hudson
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States.,Department of Neurology, New York University Langone Medical Center, New York, NY, United States
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22
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Rizzo JR, Hosseini M, Wong EA, Mackey WE, Fung JK, Ahdoot E, Rucker JC, Raghavan P, Landy MS, Hudson TE. The Intersection between Ocular and Manual Motor Control: Eye-Hand Coordination in Acquired Brain Injury. Front Neurol 2017; 8:227. [PMID: 28620341 PMCID: PMC5451505 DOI: 10.3389/fneur.2017.00227] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Acute and chronic disease processes that lead to cerebral injury can often be clinically challenging diagnostically, prognostically, and therapeutically. Neurodegenerative processes are one such elusive diagnostic group, given their often diffuse and indolent nature, creating difficulties in pinpointing specific structural abnormalities that relate to functional limitations. A number of studies in recent years have focused on eye-hand coordination (EHC) in the setting of acquired brain injury (ABI), highlighting the important set of interconnected functions of the eye and hand and their relevance in neurological conditions. These experiments, which have concentrated on focal lesion-based models, have significantly improved our understanding of neurophysiology and underscored the sensitivity of biomarkers in acute and chronic neurological disease processes, especially when such biomarkers are combined synergistically. To better understand EHC and its connection with ABI, there is a need to clarify its definition and to delineate its neuroanatomical and computational underpinnings. Successful EHC relies on the complex feedback- and prediction-mediated relationship between the visual, ocular motor, and manual motor systems and takes advantage of finely orchestrated synergies between these systems in both the spatial and temporal domains. Interactions of this type are representative of functional sensorimotor control, and their disruption constitutes one of the most frequent deficits secondary to brain injury. The present review describes the visually mediated planning and control of eye movements, hand movements, and their coordination, with a particular focus on deficits that occur following neurovascular, neurotraumatic, and neurodegenerative conditions. Following this review, we also discuss potential future research directions, highlighting objective EHC as a sensitive biomarker complement within acute and chronic neurological disease processes.
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Affiliation(s)
- John-Ross Rizzo
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States.,Department of Neurology, New York University Langone Medical Center, New York, NY, United States
| | - Maryam Hosseini
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Eric A Wong
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Wayne E Mackey
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - James K Fung
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Edmond Ahdoot
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Janet C Rucker
- Department of Neurology, New York University Langone Medical Center, New York, NY, United States.,Department of Ophthalmology, New York University Langone Medical Center, New York, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States
| | - Michael S Landy
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Todd E Hudson
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, United States.,Department of Neurology, New York University Langone Medical Center, New York, NY, United States
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23
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Shishov N, Melzer I, Bar-Haim S. Parameters and Measures in Assessment of Motor Learning in Neurorehabilitation; A Systematic Review of the Literature. Front Hum Neurosci 2017; 11:82. [PMID: 28286474 PMCID: PMC5324661 DOI: 10.3389/fnhum.2017.00082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Nataliya Shishov
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
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24
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Rizzo JR, Hudson TE, Abdou A, Lui YW, Rucker JC, Raghavan P, Landy MS. Disrupted Saccade Control in Chronic Cerebral Injury: Upper Motor Neuron-Like Disinhibition in the Ocular Motor System. Front Neurol 2017; 8:12. [PMID: 28184211 PMCID: PMC5266728 DOI: 10.3389/fneur.2017.00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022] Open
Abstract
Saccades rapidly direct the line of sight to targets of interest to make use of the high acuity foveal region of the retina. These fast eye movements are instrumental for scanning visual scenes, foveating targets, and, ultimately, serve to guide manual motor control, including eye-hand coordination. Cerebral injury has long been known to impair ocular motor control. Recently, it has been suggested that alterations in control may be useful as a marker for recovery. We measured eye movement control in a saccade task in subjects with chronic middle cerebral artery stroke with both cortical and substantial basal ganglia involvement and in healthy controls. Saccade latency distributions were bimodal, with an early peak at 60 ms (anticipatory saccades) and a later peak at 250 ms (regular saccades). Although the latencies corresponding to these peaks were the same in the two groups, there were clear differences in the size of the peaks. Classifying saccade latencies relative to the saccade "go signal" into anticipatory (latencies up to 80 ms), "early" (latencies between 80 and 160 ms), and "regular" types (latencies longer than 160 ms), stroke subjects displayed a disproportionate number of anticipatory saccades, whereas control subjects produced the majority of their saccades in the regular range. We suggest that this increase in the number of anticipatory saccade events may result from a disinhibition phenomenon that manifests as an impairment in the endogenous control of ocular motor events (saccades) and interleaved fixations. These preliminary findings may help shed light on the ocular motor deficits of neurodegenerative conditions, results that may be subclinical to an examiner, but clinically significant secondary to their functional implications.
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Affiliation(s)
- John-Ross Rizzo
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Todd E. Hudson
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Andrew Abdou
- Rutgers School of Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Yvonne W. Lui
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Janet C. Rucker
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Michael S. Landy
- Department of Psychology and Center for Neural Science, New York University, New York, NY, USA
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25
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Orihuela-Espina F, Roldán GF, Sánchez-Villavicencio I, Palafox L, Leder R, Sucar LE, Hernández-Franco J. Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial. J Hand Ther 2016; 29:51-7; quiz 57. [PMID: 26847320 DOI: 10.1016/j.jht.2015.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/17/2015] [Accepted: 11/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful. AIM To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (<4 months from event) in a Mexican adult population diagnosed with stroke. HYPOTHESIS Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages. TRIAL DESIGN A randomized clinical trial. METHODS A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI). RESULTS Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred. CONCLUSIONS Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.
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Affiliation(s)
| | | | | | - Lorena Palafox
- National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico
| | - Ronald Leder
- National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Luis Enrique Sucar
- National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico
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26
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Anticipation in Object Manipulation: Behavioral and Neural Correlates. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 957:173-194. [DOI: 10.1007/978-3-319-47313-0_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Rizzo JR, Hudson TE, Abdou A, Rashbaum IG, George AE, Raghavan P, Landy MS. Motor planning poststroke: impairment in vector-coded reach plans. Physiol Rep 2015; 3:3/12/e12650. [PMID: 26660558 PMCID: PMC4760446 DOI: 10.14814/phy2.12650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Healthy individuals appear to use both vector‐coded reach plans that encode movements in terms of their desired direction and extent, and target‐coded reach plans that encode the desired endpoint position of the effector. We examined whether these vector and target reach‐planning codes are differentially affected after stroke. Participants with stroke and healthy controls made blocks of reaches that were grouped by target location (providing target‐specific practice) and by movement vector (providing vector‐specific practice). Reach accuracy was impaired in the more affected arm after stroke, but not distinguishable for target‐ versus vector‐grouped reaches. Reach velocity and acceleration were not only impaired in both the less and more affected arms poststroke, but also not distinguishable for target‐ versus vector‐grouped reaches. As previously reported in controls, target‐grouped reaches yielded isotropic (circular) error distributions and vector‐grouped reaches yielded error distributions elongated in the direction of the reach. In stroke, the pattern of variability was similar. However, the more affected arm showed less elongated error ellipses for vector‐grouped reaches compared to the less affected arm, particularly in individuals with right‐hemispheric stroke. The results suggest greater impairment to the vector‐coded movement‐planning system after stroke, and have implications for the development of personalized approaches to poststroke rehabilitation: Motor learning may be enhanced by practice that uses the preserved code or, conversely, by retraining the more impaired code to restore function.
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Affiliation(s)
- John-Ross Rizzo
- Rusk Rehabilitation, Langone Medical Center, New York University, New York, New York Department of Psychology and Center for Neural Science, New York University, New York, New York
| | - Todd E Hudson
- Department of Psychology and Center for Neural Science, New York University, New York, New York
| | - Andrew Abdou
- School of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Ira G Rashbaum
- Rusk Rehabilitation, Langone Medical Center, New York University, New York, New York
| | - Ajax E George
- Neuroradiology Section Department of Radiology, Langone Medical Center, New York University, New York, New York
| | - Preeti Raghavan
- Rusk Rehabilitation, Langone Medical Center, New York University, New York, New York
| | - Michael S Landy
- Department of Psychology and Center for Neural Science, New York University, New York, New York
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28
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Abstract
Understanding poststroke upper limb impairment is essential to planning therapeutic efforts to restore function. However, determining which upper limb impairment to treat and how is complex because the impairments are not static and multiple impairments may be present simultaneously. How impairments contribute to upper limb dysfunction may be understood by examining them from the perspective of their functional consequences. There are 3 main functional consequences of impairments on upper limb function: (1) learned nonuse, (2) learned bad use, and (3) forgetting as determined by behavioral analysis of tasks. The impairments that contribute to each of these functional limitations are described.
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Affiliation(s)
- Preeti Raghavan
- Motor Recovery Research Laboratory, Department of Rehabilitation Medicine, Rusk Rehabilitation, New York University School of Medicine, 240 East 38th Street, 17th Floor, New York, NY 10016, USA.
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29
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Térémetz M, Colle F, Hamdoun S, Maier MA, Lindberg PG. A novel method for the quantification of key components of manual dexterity after stroke. J Neuroeng Rehabil 2015; 12:64. [PMID: 26233571 PMCID: PMC4522286 DOI: 10.1186/s12984-015-0054-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high degree of manual dexterity is a central feature of the human upper limb. A rich interplay of sensory and motor components in the hand and fingers allows for independent control of fingers in terms of timing, kinematics and force. Stroke often leads to impaired hand function and decreased manual dexterity, limiting activities of daily living and impacting quality of life. Clinically, there is a lack of quantitative multi-dimensional measures of manual dexterity. We therefore developed the Finger Force Manipulandum (FFM), which allows quantification of key components of manual dexterity. The purpose of this study was (i) to test the feasibility of using the FFM to measure key components of manual dexterity in hemiparetic stroke patients, (ii) to compare differences in dexterity components between stroke patients and controls, and (iii) to describe individual profiles of dexterity components in stroke patients. METHODS 10 stroke patients with mild-to-moderate hemiparesis and 10 healthy subjects were recruited. Clinical measures of hand function included the Action Research Arm Test and the Moberg Pick-Up Test. Four FFM tasks were used: (1) Finger Force Tracking to measure force control, (2) Sequential Finger Tapping to measure the ability to perform motor sequences, (3) Single Finger Tapping to measure timing effects, and (4) Multi-Finger Tapping to measure the ability to selectively move fingers in specified combinations (independence of finger movements). RESULTS Most stroke patients could perform the tracking task, as well as the single and multi-finger tapping tasks. However, only four patients performed the sequence task. Patients showed less accurate force control, reduced tapping rate, and reduced independence of finger movements compared to controls. Unwanted (erroneous) finger taps and overflow to non-tapping fingers were increased in patients. Dexterity components were not systematically related among each other, resulting in individually different profiles of deficient dexterity. Some of the FFM measures correlated with clinical scores. CONCLUSIONS Quantifying some of the key components of manual dexterity with the FFM is feasible in moderately affected hemiparetic patients. The FFM can detect group differences and individual profiles of deficient dexterity. The FFM is a promising tool for the measurement of key components of manual dexterity after stroke and could allow improved targeting of motor rehabilitation.
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Affiliation(s)
- Maxime Térémetz
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.
| | - Florence Colle
- Service de Médecine Physique et de Réadaptation, Université Paris Descartes, Hôpital Sainte-Anne, 75014, Paris, France. .,Centre de Psychiatrie et Neurosciences, Inserm U894, 75014, Paris, France.
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, Université Paris Descartes, Hôpital Sainte-Anne, 75014, Paris, France.
| | - Marc A Maier
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, 75013, Paris, France.
| | - Påvel G Lindberg
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France. .,Centre de Psychiatrie et Neurosciences, Inserm U894, 75014, Paris, France.
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30
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Viviani P, Lacquaniti F. Grip forces during fast point-to-point and continuous hand movements. Exp Brain Res 2015. [DOI: 10.1007/s00221-015-4388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Lu Y, Bilaloglu S, Aluru V, Raghavan P. Quantifying feedforward control: a linear scaling model for fingertip forces and object weight. J Neurophysiol 2015; 114:411-8. [PMID: 25878151 DOI: 10.1152/jn.00065.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 11/22/2022] Open
Abstract
The ability to predict the optimal fingertip forces according to object properties before the object is lifted is known as feedforward control, and it is thought to occur due to the formation of internal representations of the object's properties. The control of fingertip forces to objects of different weights has been studied extensively by using a custom-made grip device instrumented with force sensors. Feedforward control is measured by the rate of change of the vertical (load) force before the object is lifted. However, the precise relationship between the rate of change of load force and object weight and how it varies across healthy individuals in a population is not clearly understood. Using sets of 10 different weights, we have shown that there is a log-linear relationship between the fingertip load force rates and weight among neurologically intact individuals. We found that after one practice lift, as the weight increased, the peak load force rate (PLFR) increased by a fixed percentage, and this proportionality was common among the healthy subjects. However, at any given weight, the level of PLFR varied across individuals and was related to the efficiency of the muscles involved in lifting the object, in this case the wrist and finger extensor muscles. These results quantify feedforward control during grasp and lift among healthy individuals and provide new benchmarks to interpret data from neurologically impaired populations as well as a means to assess the effect of interventions on restoration of feedforward control and its relationship to muscular control.
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Affiliation(s)
- Ying Lu
- Center for the Promotion of Research Involving Innovative Statistical Methodology, Steinhardt School of Culture, Education and Human Development, New York University; New York, New York
| | - Seda Bilaloglu
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York; and
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York; and
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York; and Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, New York
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32
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Claudino R, Mazo GZ, Santos MJ. Age-related changes of grip force control in physically active adults. Percept Mot Skills 2014; 116:859-71. [PMID: 24175459 DOI: 10.2466/10.06.pms.116.3.859-871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The age-related changes for controlling grip force in adults who practice regular and supervised physical activity have not been investigated. Fifty-five physically active adults ages 50 years and older and a group of 20 young adults (18-30 years old) performed a task of grasping and lifting an object. The grip force and the object's acceleration were recorded and used to calculate the parameters of grip force control. The levels of daily physical activities were also examined in all age groups. There were no differences in grip force control between the age groups. Conversely, the group over 76 years old used stronger grip force and increased latency (the time from grip force application to the time the object is lifted off the table) to manipulate the object. The results of this study suggest that middle-aged and older adults who exercise regularly can reduce or delay the possible grip force control deficits associated with aging.
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Affiliation(s)
- Renato Claudino
- Department of Physical Therapy, Center of Sports and Health Sciences, Santa Catarina State University, USA
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33
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Slota GP, Enders LR, Seo NJ. Improvement of hand function using different surfaces and identification of difficult movement post stroke in the Box and Block Test. APPLIED ERGONOMICS 2014; 45:833-838. [PMID: 24239565 DOI: 10.1016/j.apergo.2013.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/03/2013] [Accepted: 10/22/2013] [Indexed: 06/02/2023]
Abstract
This study determined the impact of changing block surfaces on hand function, as well as identified particularly time-consuming movement components post stroke, measured by the Box and Block Test (BBT). Eight chronic stroke survivors and eight age- and gender-matched control subjects participated in this study. The BBT score (number of blocks moved) and time for seven movement components were compared for three different block surfaces (wood, paper, and rubber). The rubber blocks improved BBT scores 8% (compared to all other conditions) not only for control subjects but also for the paretic and non-paretic hands of stroke survivors, by reducing movement time for finger closing and contact-to-lift. Modifying daily objects' surfaces with rubber could help stroke survivors' hand function. The paretic hand displayed notably slower movement for contact-to-lift, transport-release, reach before barrier, and reach after barrier suggesting that therapies may focus on goal directed reaching and object grasping/releasing.
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Affiliation(s)
- Gregory P Slota
- Department of Industrial and Manufacturing Engineering, University of Wisconsin - Milwaukee, USA
| | - Leah R Enders
- Department of Industrial and Manufacturing Engineering, University of Wisconsin - Milwaukee, USA
| | - Na Jin Seo
- Department of Industrial and Manufacturing Engineering, University of Wisconsin - Milwaukee, USA.
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34
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Bleyenheuft Y, Gordon AM. Precision grip in congenital and acquired hemiparesis: similarities in impairments and implications for neurorehabilitation. Front Hum Neurosci 2014; 8:459. [PMID: 25071502 PMCID: PMC4074995 DOI: 10.3389/fnhum.2014.00459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/05/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with congenital and acquired hemiparesis incur long-term functional deficits, among which the loss of prehension that may impact their functional independence. Identifying, understanding, and comparing the underlying mechanisms of prehension impairments represent an opportunity to better adapt neurorehabilitation. Objective: The present review aims to provide a better understanding of precision grip deficits in congenital and acquired hemiparesis and to determine whether the severity and type of fine motor control impairments depend on whether or not the lesions are congenital or acquired in adulthood. Methods: Using combinations of the following key words: fingertip force, grip force, precision grip, cerebral palsy, stroke, PubMed, and Scopus databases were used to search studies from 1984 to 2013. Results: Individuals with both congenital and acquired hemiparesis were able to some extent to use anticipatory motor control in precision grip tasks, even if this control was impaired in the paretic hand. In both congenital and acquired hemiparesis, the ability to plan efficient anticipatory motor control when the less-affected hand is used provides a possibility to remediate impairments in anticipatory motor control of the paretic hand. Conclusion: Surprisingly, we observed very few differences between the results of studies in children with congenital hemiplegia and stroke patients. We suggest that the underlying specific strategies of neurorehabilitation developed for each one could benefit the other.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain , Brussels , Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University , New York, NY , USA
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35
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The effect of finger joint hypomobility on precision grip force. J Hand Ther 2014; 26:323-9; quiz 329. [PMID: 23867072 DOI: 10.1016/j.jht.2013.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/14/2013] [Accepted: 05/19/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Repeated measures experiment. INTRODUCTION Traumatic injuries and certain other diseases of the hand typically affect mobility of the finger joints. Decreased mobility may alter grip force control while one is grasping and lifting objects. However, the effect of finger joint hypomobility on grip force control has not yet been systematically investigated. PURPOSE OF THE STUDY The aim of this study was to investigate the effects of limited finger joint mobility, without other associated symptoms like pain, or sensory/proprioceptive deficits, on precision grip force control. METHODS Fifteen healthy subjects performed a pinching and lifting task of an object equipped with a force sensor and an accelerometer, via opposition of the thumb and index finger, in the following experimental conditions: unrestricted finger joint movement (UJM), restricted finger flexion (RFF), restricted finger extension (RFE), mock restricted flexion (MRF), mock restricted extension (MRE). The following pinch force variables were measured and analyzed: grip force at lift off, grip force peak, load force peak, latency, and static force. RESULTS A significant increase in latency (F = 4.41, p < 0.01) was noted during RFE relative to UJM and MRF conditions. There were no statistically-significant differences between the conditions among the other variables of precision grip force control. CONCLUSIONS Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, which can lead to reduced manual dexterity. Restoring range of motion might be an important priority to improve thumb-index pinch force control during manipulative tasks.
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36
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Aluru V, Lu Y, Leung A, Verghese J, Raghavan P. Effect of auditory constraints on motor performance depends on stage of recovery post-stroke. Front Neurol 2014; 5:106. [PMID: 25002859 PMCID: PMC4066443 DOI: 10.3389/fneur.2014.00106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/10/2014] [Indexed: 01/24/2023] Open
Abstract
In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.
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Affiliation(s)
- Viswanath Aluru
- Department of Rehabilitation Medicine, New York University School of Medicine , New York, NY , USA
| | - Ying Lu
- Center for the Promotion of Research Involving Innovative Statistical Methodology, Steinhardt School of Culture, Education and Human Development, New York University , New York, NY , USA
| | - Alan Leung
- University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine , Bronx, NY , USA
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine , New York, NY , USA ; Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University , New York, NY , USA
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Kamper DG, Fischer HC, Conrad MO, Towles JD, Rymer WZ, Triandafilou KM. Finger-thumb coupling contributes to exaggerated thumb flexion in stroke survivors. J Neurophysiol 2014; 111:2665-74. [PMID: 24671534 DOI: 10.1152/jn.00413.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The purpose of this study was to investigate altered finger-thumb coupling in individuals with chronic hemiparesis poststroke. First, an external device stretched finger flexor muscles by passively rotating the metacarpophalangeal (MCP) joints. Subjects then performed isometric finger or thumb force generation. Forces/torques and electromyographic signals were recorded for both the thumb and finger muscles. Stroke survivors with moderate (n = 9) and severe (n = 9) chronic hand impairment participated, along with neurologically intact individuals (n = 9). Stroke survivors exhibited strong interactions between finger and thumb flexors. The stretch reflex evoked by stretch of the finger flexors of stroke survivors led to heteronymous reflex activity in the thumb, while attempts to produce isolated voluntary finger MCP flexion torque/thumb flexion force led to increased and undesired thumb force/finger MCP torque production poststroke with a striking asymmetry between voluntary flexion and extension. Coherence between the long finger and thumb flexors estimated using intermuscular electromyographic correlations, however, was small. Coactivation of thumb and finger flexor muscles was common in stroke survivors, whether activation was evoked by passive stretch or voluntary activation. The coupling appears to arise from subcortical or spinal sources. Flexor coupling between the thumb and fingers seems to contribute to undesired thumb flexor activity after stroke and may impact rehabilitation outcomes.
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Affiliation(s)
- Derek G Kamper
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and
| | - Heidi C Fischer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and
| | - Megan O Conrad
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and
| | - Joseph D Towles
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and Rehabilitation R&D Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
| | - William Z Rymer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and Rehabilitation R&D Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Kristen M Triandafilou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and
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Parikh P, Davare M, McGurrin P, Santello M. Corticospinal excitability underlying digit force planning for grasping in humans. J Neurophysiol 2014; 111:2560-9. [PMID: 24501267 DOI: 10.1152/jn.00815.2013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Control of digit forces for grasping relies on sensorimotor memory gained from prior experience with the same or similar objects and on online sensory feedback. However, little is known about neural mechanisms underlying digit force planning. We addressed this question by quantifying the temporal evolution of corticospinal excitability (CSE) using single-pulse transcranial magnetic stimulation (TMS) during two reach-to-grasp tasks. These tasks differed in terms of the magnitude of force exerted on the same points on the object to isolate digit force planning from reach and grasp planning. We also addressed the role of intracortical circuitry within primary motor cortex (M1) by quantifying the balance between short intracortical inhibition and facilitation using paired-pulse TMS on the same tasks. Eighteen right-handed subjects were visually cued to plan digit placement at predetermined locations on the object and subsequently to exert either negligible force ("low-force" task, LF) or 10% of their maximum pinch force ("high-force" task, HF) on the object. We found that the HF task elicited significantly smaller CSE than the LF task, but only when the TMS pulse coincided with the signal to initiate the reach. This force planning-related CSE modulation was specific to the muscles involved in the performance of both tasks. Interestingly, digit force planning did not result in modulation of M1 intracortical inhibitory and facilitatory circuitry. Our findings suggest that planning of digit forces reflected by CSE modulation starts well before object contact and appears to be driven by inputs from frontoparietal areas other than M1.
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Affiliation(s)
- Pranav Parikh
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | - Marco Davare
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Patrick McGurrin
- School of Life Sciences, Arizona State University, Tempe, Arizona; and
| | - Marco Santello
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona;
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Kawashima N, Popovic MR, Zivanovic V. Effect of intensive functional electrical stimulation therapy on upper-limb motor recovery after stroke: case study of a patient with chronic stroke. Physiother Can 2014; 65:20-8. [PMID: 24381377 DOI: 10.3138/ptc.2011-36] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Motivated by a prior successful randomized controlled trial showing that functional electrical stimulation (FES) therapy can restore voluntary arm and hand function in people with severe stroke, this study was designed to examine neuromuscular changes in the upper limb following intensive FES therapy, consisting of task-specific upper-limb movements with a combination of preprogrammed FES and manual assisted motion. METHODS The patient was a 22-year-old woman who had suffered a haemorrhagic stroke 2 years earlier. FES therapy was administered for 1 hour twice daily for 12 weeks, for a total of 108 treatment sessions. RESULTS While maximal voluntary contraction level of the upper-limb muscles did not show significant improvement, the ability to initiate and stop the muscle contraction voluntarily was regained in several upper-limb muscles (approx. 5%-15% of the maximum voluntary contraction of the same muscle in the less-affected arm). A reduction in arm spasticity was also observed, as indicated by the reduction of H-reflex in the wrist flexor muscle (82.1% to 45.0% in Hmax/Mmax) and decreased Modified Ashworth Scale scores (from 3 to 2 for the hand and 4 to 3 for the arm). Coordination between shoulder and elbow joints during the circle-drawing test improved considerably over the course of FES therapy: the patient was unable to draw a circle at all at baseline but was able to do so proficiently at discharge. CONCLUSION Improvements in upper-limb function observed in people with severe stroke following intensive FES therapy can be attributed to (a) regained ability to voluntarily contract muscles of the affected arm, (b) reduced spasticity and improved muscle tone in the same muscles, and (c) increased range of motion of all joints.
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Affiliation(s)
- Noritaka Kawashima
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disability, Saitama, Japan ; Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto ; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto ; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto
| | - Vera Zivanovic
- Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto ; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto
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40
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Task specific grip force control in writer's cramp. Clin Neurophysiol 2013; 125:786-797. [PMID: 24239452 DOI: 10.1016/j.clinph.2013.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/11/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Writer's cramp is defined as a task specific focal dystonia generating hypertonic muscle co-contractions during handwriting resulting in impaired writing performance and exaggerated finger force. However, little is known about the generalisation of grip force across tasks others than writing. The aim of the study was to directly compare regulation of grip forces during handwriting with force regulation in other fine-motor tasks in patients and control subjects. METHODS Handwriting, lifting and cyclic movements of a grasped object were investigated in 21 patients and 14 controls. The applied forces were registered in all three tasks and compared between groups and tasks. In addition, task-specific measures of fine-motor skill were assessed. RESULTS As expected, patients generated exaggerated forces during handwriting compared to control subjects. However there were no statistically significant group differences during lifting and cyclic movements. The control group revealed a generalisation of grip forces across manual tasks whereas in patients there was no such correlation. CONCLUSION We conclude that increased finger forces during handwriting are a task-specific phenomenon that does not necessarily generalise to other fine-motor tasks. SIGNIFICANCE Force control of patients with writer's cramp in handwriting and other fine-motor tasks is characterised by individualised control strategies.
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Bleyenheuft Y, Gordon AM. Precision grip control, sensory impairments and their interactions in children with hemiplegic cerebral palsy: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3014-3028. [PMID: 23816634 DOI: 10.1016/j.ridd.2013.05.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 06/02/2023]
Abstract
Children with hemiplegic cerebral palsy (HCP) exhibit long-term functional deficits. One of the most debilitating is the loss of prehension since this may impair functional independence. This loss of prehension could be partly due to sensory deficits. Identifying the underlying causes of prehension deficits and their potential link with sensory disorders is important to better adapt neurorehabilitation. Here we provide an overview of precision grip and sensory impairments in individuals with HCP, and the relation between them, in order to determine whether the sensory impairments influence the type and magnitude of deficits as measured by studies of prehensile force control. Pubmed and Scopus databases were used to search studies from 1990 to 2012, using combinations of the following keywords: fingertip force; grip force; precision grip; sensory deficit; sensory impairment; tactile discrimination; with cerebral palsy. Of the 190 studies detected through the systematic search; 38 were finally included in the systematic part of this review. This review shows that sensory deficits are common and are likely underestimated using standard clinical assessments in HCP. Some studies suggest these deficits are the basis of predictive motor control impairments in these individuals. However, children with HCP retain some ability to use predictive control, even if it is impaired in the more affected hand. Intensive practice and initial use of the less affected hand, which has only subtle sensory deficits, has been shown to remediate impairments in anticipatory motor control during subsequent use of the more affected hand. Implications for motor and sensory rehabilitation of individuals with HCP are discussed.
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42
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Claudino R, Mazo GZ, Santos MJ. AGE-RELATED CHANGES OF GRIP FORCE CONTROL IN PHYSICALLY ACTIVE ADULTS 1. Percept Mot Skills 2013. [DOI: 10.2466/10.06.pms.116.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee SW, Triandafilou K, Lock BA, Kamper DG. Impairment in task-specific modulation of muscle coordination correlates with the severity of hand impairment following stroke. PLoS One 2013; 8:e68745. [PMID: 23874745 PMCID: PMC3712930 DOI: 10.1371/journal.pone.0068745] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/31/2013] [Indexed: 12/04/2022] Open
Abstract
Significant functional impairment of the hand is commonly observed in stroke survivors. Our previous studies suggested that the inability to modulate muscle coordination patterns according to task requirements may be substantial after stroke, but these limitations have not been examined directly. In this study, we aimed to characterize post-stroke impairment in the ability to modulate muscle coordination patterns across tasks and its correlation with hand impairment. Fourteen stroke survivors, divided into a group with severe hand impairment (8 subjects) and a group with moderate hand impairment (6 subjects) according to their clinical functionality score, participated in the experiment. Another four neurologically intact subjects participated in the experiment to serve as a point of comparison. Activation patterns of nine hand and wrist muscles were recorded using surface electromyography while the subjects performed six isometric tasks. Patterns of covariation in muscle activations across tasks, i.e., muscle modules, were extracted from the muscle activation data. Our results showed that the degree of reduction in the inter-task separation of the multi-muscle activation patterns was indicative of the clinical functionality score of the subjects (mean value = 26.2 for severely impaired subjects, 38.1 for moderately impaired subjects). The values for moderately impaired subjects were much closer to those of the impaired subjects (mean value = 46.1). The number of muscle modules extracted from the muscle activation patterns of a subject across six tasks, which represents the degree of motor complexity, was found to be correlated with the clinical functionality score (R = 0.68). Greater impairment was also associated with a change in the muscle module patterns themselves, with greater muscle coactivation. A substantial reduction in the degrees-of-freedom of the multi-muscle coordination post-stroke was apparent, and the extent of the reduction, assessed by the stated metrics, was strongly associated with the level of clinical impairment.
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Affiliation(s)
- Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, United States of America.
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Joiner WM, Brayanov JB, Smith MA. The training schedule affects the stability, not the magnitude, of the interlimb transfer of learned dynamics. J Neurophysiol 2013; 110:984-98. [PMID: 23719204 DOI: 10.1152/jn.01072.2012] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The way that a motor adaptation is trained, for example, the manner in which it is introduced or the duration of the training period, can influence its internal representation. However, recent studies examining the gradual versus abrupt introduction of a novel environment have produced conflicting results. Here we examined how these effects determine the effector specificity of motor adaptation during visually guided reaching. After adaptation to velocity-dependent dynamics in the right arm, we estimated the amount of adaptation transferred to the left arm, using error-clamp measurement trials to directly measure changes in learned dynamics. We found that a small but significant amount of generalization to the untrained arm occurs under three different training schedules: a short-duration (15 trials) abrupt presentation, a long-duration (160 trials) abrupt presentation, and a long-duration gradual presentation of the novel dynamic environment. Remarkably, we found essentially no difference between the amount of interlimb generalization when comparing these schedules, with 9-12% transfer of the trained adaptation for all three. However, the duration of training had a pronounced effect on the stability of the interlimb transfer: The transfer elicited from short-duration training decayed rapidly, whereas the transfer from both long-duration training schedules was considerably more persistent (<50% vs. >90% retention over the first 20 trials). These results indicate that the amount of interlimb transfer is similar for gradual versus abrupt training and that interlimb transfer of learned dynamics can occur after even a brief training period but longer training is required for an enduring effect.
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Affiliation(s)
- Wilsaan M Joiner
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA
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45
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Lefebvre S, Thonnard JL, Laloux P, Peeters A, Jamart J, Vandermeeren Y. Single session of dual-tDCS transiently improves precision grip and dexterity of the paretic hand after stroke. Neurorehabil Neural Repair 2013; 28:100-10. [PMID: 23486918 DOI: 10.1177/1545968313478485] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND After stroke, deregulated interhemispheric interactions influence residual paretic hand function. Anodal or cathodal transcranial direct current stimulation (tDCS) can rebalance these abnormal interhemispheric interactions and improve motor function. OBJECTIVE We explored whether dual-hemisphere tDCS (dual-tDCS) in participants with chronic stroke can improve fine hand motor function in 2 important aspects: precision grip and dexterity. METHODS In all, 19 chronic hemiparetic individuals with mild to moderate impairment participated in a double-blind, randomized trial. During 2 separate cross-over sessions (real/sham), they performed 10 precision grip movements with a manipulandum and the Purdue Pegboard Test (PPT) before, during, immediately after, and 20 minutes after dual-tDCS applied simultaneously over the ipsilesional (anodal) and contralateral (cathodal) primary motor cortices. RESULTS The precision grip performed with the paretic hand improved significantly 20 minutes after dual-tDCS, with reduction of the grip force/load force ratio by 7% and in the preloading phase duration by 18% when compared with sham. The dexterity of the paretic hand started improving during dual-tDCS and culminated 20 minutes after the end of dual-tDCS (PPT score +38% vs +5% after sham). The maximal improvements in precision grip and dexterity were observed 20 minutes after dual-tDCS. These improvements correlated negatively with residual hand function quantified with ABILHAND. CONCLUSIONS One bout of dual-tDCS improved the motor control of precision grip and digital dexterity beyond the time of stimulation. These results suggest that dual-tDCS should be tested in longer protocols for neurorehabilitation and with moderate to severely impaired patients. The precise timing of stimulation after stroke onset and associated training should be defined.
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Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 110:93-103. [PMID: 23312633 DOI: 10.1016/b978-0-444-52901-5.00008-3] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neurorehabilitation is based on the assumption that motor learning contributes to motor recovery after injury. However, little is known about how learning itself is affected by brain injury, how learning mechanisms interact with spontaneous biological recovery, and how best to incorporate learning principles into rehabilitation training protocols. Here we distinguish between two types of motor learning, adaptation and skill acquisition, and discuss how they relate to neurorehabilitation. Functional recovery can occur through resolution of impairment (reacquisition of premorbid movement patterns) and through compensation (use of alternative movements or effectors to accomplish the same goal); both these forms of recovery respond to training protocols. The emphasis in current neurorehabilitation practice is on the rapid establishment of independence in activities of daily living through compensatory strategies, rather than on the reduction of impairment. Animal models, however, show that after focal ischemic damage there is a brief, approximately 3-4-week, window of heightened plasticity, which in combination with training protocols leads to large gains in motor function. Analogously, almost all recovery from impairment in humans occurs in the first 3 months after stroke, which suggests that targeting impairment in this time-window with intense motor learning protocols could lead to gains in function that are comparable in terms of effect size to those seen in animal models.
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Affiliation(s)
- Tomoko Kitago
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Balasubramanian S, Colombo R, Sterpi I, Sanguineti V, Burdet E. Robotic assessment of upper limb motor function after stroke. Am J Phys Med Rehabil 2012; 91:S255-69. [PMID: 23080041 DOI: 10.1097/phm.0b013e31826bcdc1] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditional assessment of a stroke subject's motor ability, carried out by a therapist who observes and rates the subject's motor behavior using ordinal measurements scales, is subjective, time consuming and lacks sensitivity. Rehabilitation robots, which have been the subject of intense inquiry over the last decade, are equipped with sensors that are used to develop objective measures of motor behaviors in a semiautomated way during therapy. This article reviews the current contributions of robot-assisted motor assessment of the upper limb. It summarizes the various measures related to movement performance, the models of motor recovery in stroke subjects and the relationship of robotic measures to standard clinical measures. It analyses the possibilities offered by current robotic assessment techniques and the aspects to address to make robotic assessment a mainstream motor assessment method.
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Affiliation(s)
- Sivakumar Balasubramanian
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
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48
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Afifi M, Santello M, Johnston JA. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object texture. Clin Neurophysiol 2012; 123:2281-90. [PMID: 22627019 DOI: 10.1016/j.clinph.2012.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 04/09/2012] [Accepted: 04/15/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The ability to adapt digit forces to object properties requires both anticipatory and feedback-driven control mechanisms which can be disrupted in individuals with a compromised sensorimotor system. Carpal tunnel syndrome (CTS) is a median nerve compression neuropathy affecting sensory and motor function in a subset of digits in the hand. Our objective was to examine how CTS patients coordinate anticipatory and feedback-driven control for multi-digit grip force adaptation. METHODS We asked CTS patients and healthy controls to grasp, lift, and hold an object with different textures. RESULTS CTS patients effectively adapted their digit forces to changes in object texture, but produced excessive grip forces. CTS patients also produced larger peak force rate profiles with fewer modulations of normal force prior to lift onset than did controls and continued to increase grip force throughout the lift whereas forces were set at lift onset for the controls. CONCLUSIONS These findings suggest that CTS patients use less online sensory feedback for fine-tuning their grip forces, relying more on anticipatory control than do healthy controls. SIGNIFICANCE These characteristics in force adaptation in CTS patients indicate impaired sensorimotor control which leads to excessive grip forces with the potential to further exacerbate their median nerve compression.
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Affiliation(s)
- Mostafa Afifi
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Abstract
To make an accurate movement, the CNS has to overcome the inherent complexities of the multijoint limb. For example, interaction torques arise when motion of individual arm segments propagates to adjacent segments causing their movement without any muscle contractions. Since these passive joint torques significantly add to the overall torques generated by active muscular contractions, they must be taken into account during planning or execution of goal-directed movements. We investigated the role of the corticospinal tract in compensating for the interaction torques during arm movements in humans. Twelve subjects reached to visual targets with their arm supported by a robotic exoskeleton. Reaching to one target was accompanied by interaction torques that assisted the movement, while reaching to the other target was accompanied by interaction torques that resisted the movement. Corticospinal excitability was assessed at different times during movement using single-pulse transcranial magnetic stimulation (TMS) over the upper-arm region of M1 (primary motor cortex). We found that TMS responses in shoulder monoarticular and elbow-shoulder biarticular muscles changed together with the interaction torques during movements in which the interaction torques were resistive. In contrast, TMS responses did not correlate with assistive interaction torques or with co-contraction. This suggests that the descending motor command includes compensation for passive limb dynamics. Furthermore, our results suggest that compensation for interaction torques involves the biarticular muscles, which span both shoulder and elbow joints and are in a biomechanically advantageous position to provide such compensation.
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Mawase F, Bar-Haim S, Karniel A. Lack of predictive control in lifting series of virtual objects by individuals with diplegic cerebral palsy. IEEE Trans Neural Syst Rehabil Eng 2011; 19:686-95. [PMID: 21984525 DOI: 10.1109/tnsre.2011.2170589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To date, research on the motor control of hand function in cerebral palsy has focused on children with hemiplegia, although many persons with diplegic cerebral palsy (dCP) have asymmetrically decreased hand function. We explored the predictive capabilities of the motor system in a simple motor task of lifting a series of virtual objects for five persons with spastic dCP and five age-matched controls. When a person lifts an object, s/he uses an expectation of the weight of the object to generate a motor command. We asked the study subjects to lift a series of increasing weights and determined whether they extrapolated from past experience to predict the next weight in the series, even though that weight had never been experienced. Planning of precision grasp was assessed by measurement of the grip force at the beginning of the lifting task and by estimating the motor command. Execution of precision grasp was assessed by measurement of the time interval between the onset of grip and the onset of movement. We found that persons with dCP demonstrated a lack of predictive feed-forward control in their lifting movements: they exhibited a significantly longer time between onset of grip and onset of movement than the control subjects and they did not predict the weight of the next object in the lifting task. In addition, for subjects with dCP, the time between the onset of grip and the onset of movement of the dominant hand correlated strongly with the outcome of a hand function test. We postulate that a higher-order motor planning deficit in addition to execution deficit are evident in the subjects with spastic diplegic.
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Affiliation(s)
- Firas Mawase
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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