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Winterbottom L, Chen A, Mendonca R, Nilsen DM, Ciocarlie M, Stein J. Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis. Disabil Rehabil 2024:1-10. [PMID: 38975689 DOI: 10.1080/09638288.2024.2375056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. METHODS In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. RESULTS 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. CONCLUSIONS Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.
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Affiliation(s)
- Lauren Winterbottom
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Ava Chen
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Rochelle Mendonca
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matei Ciocarlie
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Proud EL, Miller KJ, Morris ME, McGinley JL, Blennerhassett JM. Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1375-1387. [PMID: 38042246 DOI: 10.1016/j.apmr.2023.11.009] [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: 04/25/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD). DATA SOURCES We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022. STUDY SELECTION Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion. DATA EXTRACTION Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function. RESULTS Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training. CONCLUSIONS There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.
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Affiliation(s)
- Elizabeth L Proud
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Kimberly J Miller
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Meg E Morris
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Australia; Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
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Penalver-Andres JA, Buetler KA, Koenig T, Müri RM, Marchal-Crespo L. Resting-State Functional Networks Correlate with Motor Performance in a Complex Visuomotor Task: An EEG Microstate Pilot Study on Healthy Individuals. Brain Topogr 2024; 37:590-607. [PMID: 36566448 PMCID: PMC11199229 DOI: 10.1007/s10548-022-00934-9] [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: 07/10/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022]
Abstract
Developing motor and cognitive skills is needed to achieve expert (motor) performance or functional recovery from a neurological condition, e.g., after stroke. While extensive practice plays an essential role in the acquisition of good motor performance, it is still unknown whether certain person-specific traits may predetermine the rate of motor learning. In particular, learners' functional brain organisation might play an important role in appropriately performing motor tasks. In this paper, we aimed to study how two critical cognitive brain networks-the Attention Network (AN) and the Default Mode Network (DMN)-affect the posterior motor performance in a complex visuomotor task: virtual surfing. We hypothesised that the preactivation of the AN would affect how participants divert their attention towards external stimuli, resulting in robust motor performance. Conversely, the excessive involvement of the DMN-linked to internally diverted attention and mind-wandering-would be detrimental for posterior motor performance. We extracted seven widely accepted microstates-representing participants mind states at rest-out of the Electroencephalography (EEG) resting-state recordings of 36 healthy volunteers, prior to execution of the virtual surfing task. By correlating neural biomarkers (microstates) and motor behavioural metrics, we confirmed that the preactivation of the posterior DMN was correlated with poor posterior performance in the motor task. However, we only found a non-significant association between AN preactivation and the posterior motor performance. In this EEG study, we propose the preactivation of the posterior DMN-imaged using EEG microstates-as a neural trait related to poor posterior motor performance. Our findings suggest that the role of the executive control system is to preserve an homeostasis between the AN and the DMN. Therefore, neurofeedback-based downregulation of DMN preactivation could help optimise motor training.
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Affiliation(s)
- Joaquin A Penalver-Andres
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Karin A Buetler
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Department of Biomedical Research (DBMR) and Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, The Netherlands
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Krishnan C, Augenstein TE, Claflin ES, Hemsley CR, Washabaugh EP, Ranganathan R. Rest the Brain to Learn New Gait Patterns after Stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.01.24304938. [PMID: 38633786 PMCID: PMC11023642 DOI: 10.1101/2024.04.01.24304938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these prior studies could have been confounded by the presence of significant motor impairments and/or have not focused on motor acuity tasks (i.e., tasks focusing on the quality of executed actions) that have direct functional relevance to rehabilitation. Methods Twenty-five participants (10 stroke; 15 controls) were recruited for this prospective, case-control study. Participants learned a novel foot-trajectory tracking task on two consecutive days while walking on a treadmill. On day 1, participants learned a new gait pattern by performing a task that necessitated greater hip and knee flexion during the swing phase of the gait. On day 2, participants repeated the task with their training leg to test retention. An average tracking error was computed to determine online and offline learning and was compared between stroke survivors and uninjured controls. Results Stroke survivors were able to improve their tracking performance on the first day (p=0.033); however, the amount of learning in stroke survivors was lower in comparison with the control group on both days (p≤0.05). Interestingly, the offline gains in motor learning were higher in stroke survivors when compared with uninjured controls (p=0.011). Conclusions The results suggest that even high-functioning stroke survivors may have difficulty acquiring new motor skills related to walking, which may be related to the underlying neural damage caused at the time of stroke. Furthermore, it is likely that stroke survivors may require longer training with adequate rest to acquire new motor skills, and rehabilitation programs should target motor skill learning to improve outcomes after stroke.
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Affiliation(s)
- Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
- Department of Mechanical Engineering, University of Michigan
- School of Kinesiology, University of Michigan
- Biomedical Engineering, University of Michigan
- Department of Physical Therapy, University of Michigan-Flint
| | - Thomas E. Augenstein
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
| | - Edward S. Claflin
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
| | | | - Edward P. Washabaugh
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Biomedical Engineering, Wayne State University
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Kasturirangan S, Nancarrow DJ, Shah A, Lagisetty KH, Lawrence TS, Beer DG, Ray D. Isoform alterations in the ubiquitination machinery impacting gastrointestinal malignancies. Cell Death Dis 2024; 15:194. [PMID: 38453895 PMCID: PMC10920915 DOI: 10.1038/s41419-024-06575-z] [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: 06/07/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
The advancement of RNAseq and isoform-specific expression platforms has led to the understanding that isoform changes can alter molecular signaling to promote tumorigenesis. An active area in cancer research is uncovering the roles of ubiquitination on spliceosome assembly contributing to transcript diversity and expression of alternative isoforms. However, the effects of isoform changes on functionality of ubiquitination machineries (E1, E2, E3, E4, and deubiquitinating (DUB) enzymes) influencing onco- and tumor suppressor protein stabilities is currently understudied. Characterizing these changes could be instrumental in improving cancer outcomes via the identification of novel biomarkers and targetable signaling pathways. In this review, we focus on highlighting reported examples of direct, protein-coded isoform variation of ubiquitination enzymes influencing cancer development and progression in gastrointestinal (GI) malignancies. We have used a semi-automated system for identifying relevant literature and applied established systems for isoform categorization and functional classification to help structure literature findings. The results are a comprehensive snapshot of known isoform changes that are significant to GI cancers, and a framework for readers to use to address isoform variation in their own research. One of the key findings is the potential influence that isoforms of the ubiquitination machinery have on oncoprotein stability.
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Affiliation(s)
| | - Derek J Nancarrow
- Surgery - Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ayush Shah
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kiran H Lagisetty
- Surgery - Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Theodore S Lawrence
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - David G Beer
- Surgery - Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Dipankar Ray
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA.
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Varas-Diaz G, Bhatt T, Oken B, Roth E, Hayes J, Cordo P. Concurrent ankle-assisted movement, biofeedback, and proprioceptive stimulation reduces lower limb motor impairment and improves gait in persons with stroke. Physiother Theory Pract 2024; 40:477-486. [PMID: 36102364 DOI: 10.1080/09593985.2022.2122763] [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: 10/07/2021] [Revised: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Persons with stroke live with residual sensorimotor impairments in their lower limbs (LL), which affects their gait. PURPOSE We investigated whether these residual impairments and resulting gait deficits can be reduced through concurrently applied assisted movement, biofeedback, and proprioceptive stimulation. METHODS A robotic device provided impairment-oriented training to the affected LL of 24 persons with stroke (PwS) with moderate-to-severe LL impairment. Participants were given 22-30 training sessions over 2-3 months. During training, the interventional device cyclically dorsiflexed and plantarflexed the ankle at 5 deg/s through ±15 deg for 30 min while the participant assisted with the imposed movement. Concurrently, participants received visual biofeedback of assistive joint torque or agonist EMG while mechanical vibration was applied to the currently lengthening (i.e. antagonist) tendon. RESULTS Sensorimotor impairment significantly decreased over the training period, which was sustained over 3 months, based on the Fugl-Meyer Assessment (FMA-LL) (p < .001), modified Ashworth scale in dorsiflexors (p < .05), and an ankle strength test (dorsiflexors and plantarflexors) (p < .05). Balance and gait also improved, based on the Tinetti Performance Oriented Mobility Assessment (POMA) (p < .05). CONCLUSION Impairment-oriented training using a robotic device capable of applying assisted movement, biofeedback, and proprioceptive stimulation significantly reduces LL impairment and improves gait in moderately-to-severely impaired PwS.
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Affiliation(s)
- Gonzalo Varas-Diaz
- School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Barry Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
| | - John Hayes
- College of Optometry, Pacific University, Forest Grove, OR, USA
| | - Paul Cordo
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- AMES Technology Inc, Portland, OR, USA
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Weightman M, Robinson B, Mitchell MP, Garratt E, Teal R, Rudgewick-Brown A, Demeyere N, Fleming MK, Johansen-Berg H. Sleep and motor learning in stroke (SMiLES): a longitudinal study investigating sleep-dependent consolidation of motor sequence learning in the context of recovery after stroke. BMJ Open 2024; 14:e077442. [PMID: 38355178 PMCID: PMC10868290 DOI: 10.1136/bmjopen-2023-077442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION There is growing evidence that sleep is disrupted after stroke, with worse sleep relating to poorer motor outcomes. It is also widely acknowledged that consolidation of motor learning, a critical component of poststroke recovery, is sleep-dependent. However, whether the relationship between disrupted sleep and poor outcomes after stroke is related to direct interference of sleep-dependent motor consolidation processes, is currently unknown. Therefore, the aim of the present study is to understand whether measures of motor consolidation mediate the relationship between sleep and clinical motor outcomes post stroke. METHODS AND ANALYSIS We will conduct a longitudinal observational study of up to 150 participants diagnosed with stroke affecting the upper limb. Participants will be recruited and assessed within 7 days of their stroke and followed up at approximately 1 and 6 months. The primary objective of the study is to determine whether sleep in the subacute phase of recovery explains the variability in upper limb motor outcomes after stroke (over and above predicted recovery potential from the Predict Recovery Potential algorithm) and whether this relationship is dependent on consolidation of motor learning. We will also test whether motor consolidation mediates the relationship between sleep and whole-body clinical motor outcomes, whether motor consolidation is associated with specific electrophysiological sleep signals and sleep alterations during subacute recovery. ETHICS AND DISSEMINATION This trial has received both Health Research Authority, Health and Care Research Wales and National Research Ethics Service approval (IRAS: 304135; REC: 22/LO/0353). The results of this trial will help to enhance our understanding of the role of sleep in recovery of motor function after stroke and will be disseminated via presentations at scientific conferences, peer-reviewed publication, public engagement events, stakeholder organisations and other forms of media where appropriate. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05746260, registered on 27 February 2023.
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Affiliation(s)
- Matthew Weightman
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Morgan P Mitchell
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Emma Garratt
- Buckinghamshire Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), Oxford, Oxfordshire, UK
| | - Rachel Teal
- MRC Stroke Unit, Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Rudgewick-Brown
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Alt Murphy M, Pradhan S, Levin MF, Hancock NJ. Uptake of Technology for Neurorehabilitation in Clinical Practice: A Scoping Review. Phys Ther 2024; 104:pzad140. [PMID: 37856528 PMCID: PMC10851848 DOI: 10.1093/ptj/pzad140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake. METHODS This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers. RESULTS Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake. CONCLUSION Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development. IMPACT This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
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Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Rojo A, Castrillo Calvillo A, López C, Raya R, Moreno JC. Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis: Pilot Randomized Controlled Trial. JMIR Serious Games 2024; 12:e39286. [PMID: 38180843 PMCID: PMC10786335 DOI: 10.2196/39286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Abstract
Background New interventions based on motor learning principles and neural plasticity have been tested among patients with ataxia and hemiparesis. Therapies of pedaling exercises have also shown their potential to induce improvements in muscle activity, strength, and balance. Virtual reality (VR) has been demonstrated as an effective tool for improving the adherence to physical therapy, but it is still undetermined if it promotes greater improvements than conventional therapy. Objective Our objective was to compare the effect on lower limb range of motion (ROM) when using VR technology for cycling exercise versus not using VR technology. Methods A randomized controlled trial with 20 patients with ataxia and hemiparesis was carried out. The participants were divided into 2 groups: the experimental group (n=10, 50%) performed pedaling exercises using the VR system and the control group (n=10, 50%) performed pedaling exercises without using VR. Measurements of the active and passive ROM of the hip and knee joint were taken before and after a cycling intervention, which consisted of 3 sessions of the same duration but with progressively increasing speeds (4, 5, and 6 km/h). Repeated measures ANOVAs were conducted to compare the preintervention (Ti) and postintervention (Te) assessments within each group. Additionally, the improvement effect of using the VR system was analyzed by comparing the variation coefficient (Δ = 1 - [Te / Ti]) between the preintervention and postintervention assessments for each group. Group comparisons were made using independent 1-tailed t tests. Results Significant improvements were shown in active left hip flexion (P=.03) over time, but there was no group-time interaction effect (P=.67). Passive left hip flexion (P=.93) did not show significant improvements, and similar results were observed for active and passive right hip flexion (P=.39 and P=.83, respectively). Neither assessments of knee flexion (active left: P=.06; passive left: P=.76; active right: P=.34; passive right: P=.06) nor knee extension showed significant changes (active left: P=.66; passive left: P=.92; active right: P=.12; passive right: P=.38). However, passive right knee extension (P=.04) showed a significant improvement over time. Overall, although active and passive ROM of the knee and hip joints showed a general improvement, no statistically significant differences were found between the groups. Conclusions In this study, participants who underwent the cycling intervention using the VR system showed similar improvement in lower limb ROM to the participants who underwent conventional training. Ultimately, the VR system can be used to engage participants in physical activity.
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Affiliation(s)
- Ana Rojo
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute, Madrid, Spain
| | | | | | - Rafael Raya
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute, Madrid, Spain
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Alfredo L, David R, Juan‐José B, Sergio L, Raúl F. Combination of different noninvasive brain stimulation treatments for upper limb recovery in stroke patients: A systematic review. Brain Behav 2024; 14:e3370. [PMID: 38376018 PMCID: PMC10823455 DOI: 10.1002/brb3.3370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 02/21/2024] Open
Abstract
We report a review of Pubmed (Medline), CENTRAL, Web of Science, and Scopus to test the effectiveness of the combined application of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in the improvement of different functional variables of the upper limb in people with stroke. Two independent reviewers assessed eligibility and evaluated the quality of the studies. Five articles were included in the final review according to the inclusion criteria: Most show statistically significant differences in motor function improvement in favor of the experimental group, but not in activity. Due to the heterogeneity of the observed studies, the results should be interpreted with caution-more high-quality studies are needed to investigate the effectiveness of these interventions in different stages of stroke patients.
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Affiliation(s)
- Lerín‐Calvo Alfredo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Clínica Neuron Madrid RíoMadridSpain
- Grupo de Investigación Clínico‐Docente sobre Ciencias de la Rehabilitación (INDOCLIN)CSEU La Salle, UAMAravacaMadridSpain
| | | | | | - Lerma‐Lara Sergio
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Motion in Brains Research GroupAravacaMadridSpain
| | - Ferrer‐Peña Raúl
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Grupo de Investigación Clínico‐Docente sobre Ciencias de la Rehabilitación (INDOCLIN)CSEU La Salle, UAMAravacaMadridSpain
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Spomer AM, Conner BC, Schwartz MH, Lerner ZF, Steele KM. Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy. J Neuroeng Rehabil 2023; 20:164. [PMID: 38062454 PMCID: PMC10704679 DOI: 10.1186/s12984-023-01279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is currently unclear how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care. METHODS In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation. RESULTS Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained. CONCLUSIONS This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.
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Affiliation(s)
- Alyssa M Spomer
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
- Gillette Children's, 200 University Avenue East, Stop 490105, St. Paul, MN, 55101, USA.
| | - Benjamin C Conner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Michael H Schwartz
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Gillette Children's, 200 University Avenue East, Stop 490105, St. Paul, MN, 55101, USA
| | - Zachary F Lerner
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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12
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Ben M, Glinsky JV, Chu J, Spooren AI, Roberts S, Chen LW, Denis S, Lorusso M, Jorgensen V, Gollan EJ, Agostinello J, Van Laake-Geelen CCM, Lincoln C, Stolwijk JM, Bell C, Paddison S, Rainey D, Tranter K, Ilha J, Oostra K, Sherrington C, Harvey LA. Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention. Spinal Cord 2023; 61:600-607. [PMID: 37468607 PMCID: PMC10645584 DOI: 10.1038/s41393-023-00911-4] [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: 02/21/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Descriptive. OBJECTIVES The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.
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Affiliation(s)
- M Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | | | - S Roberts
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - L W Chen
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Denis
- The Prince of Wales Hospital, Wales, NSW, Australia
| | - M Lorusso
- I.R.C.C.S. Foundation Santa Lucia, Rome, Italy
| | - V Jorgensen
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - E J Gollan
- The Princess Alexandra Hospital, Harlow, QLD, Australia
| | - J Agostinello
- The Royal Talbot Rehabilitation Centre, Kew Vic, VIC, Australia
| | - C C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C Lincoln
- Queen Elizabeth National Spinal Injures Unit, Glasgow, Scotland
| | - J M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C Bell
- Spinal Cord Injury Rehabilitation, Repat Health Precinct, Daw Park, SA, Australia
| | - S Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Middlesex, UK
| | - D Rainey
- Royal Rehab, Ryde, NSW, Australia
| | - K Tranter
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Ilha
- Universidade do Estado de Santa Catarina - UDESC, College of Health and Sport Science, Florianopolis, SC, Brazil
| | - K Oostra
- Ghent University Hospital, Ghent, Belgium
| | - C Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - L A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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13
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Barth J, Geed S, Mitchell A, Brady KP, Giannetti ML, Dromerick AW, Edwards DF. The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol. Arch Rehabil Res Clin Transl 2023; 5:100282. [PMID: 37744191 PMCID: PMC10517370 DOI: 10.1016/j.arrct.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To present the development of a novel upper extremity (UE) treatment and assess how it was delivered in the Critical Periods After Stroke Study (CPASS), a phase II randomized controlled trial (RCT). Design Secondary analysis of data from the RCT. Setting Inpatient and outpatient settings the first year after stroke. Participants Of the 72 participants enrolled in CPASS (N=72), 53 were in the study groups eligible to receive the treatment initiated at ≤30 days (acute), 2-3 months (subacute), or ≥6 months (chronic) poststroke. Individuals were 65.1±10.5 years of age, 55% were women, and had mild to moderate UE motor capacity (Action Research Arm Test=17.2±14.3) at baseline. Intervention The additional 20 hours of treatment began using the Activity Card Sort (ACS), a standardized assessment of activities and participation after stroke, to identify UE treatment goals selected by the participants that were meaningful to them. Treatment activities were broken down into smaller components from a standardized protocol and process that operationalized the treatments essential elements. Main Outcome Measures Feasibility of performing the treatment in a variety of clinical settings in an RCT and contextual factors that influenced adherence. Results A total of 49/53 participants fully adhered to the CPASS treatment. The duration and location of the treatment sessions and the UE activities practiced during therapy are presented for the total sample (n=49) and per study group as an assessment of feasibility and the contextual factors that influenced adherence. Conclusions The CPASS treatment and therapy goals were explicitly based on the meaningful activities identified by the participants using the ACS as a treatment planning tool. This approach provided flexibility to customize UE motor therapy without sacrificing standardization or quantification of the data regardless of the location and UE impairments of participants within the first year poststroke.
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Affiliation(s)
- Jessica Barth
- Veterans Affairs Medical Center, Center of Innovation for Long-Term Supports and Services, Providence, RI
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Shashwati Geed
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Abigail Mitchell
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Kathaleen P. Brady
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Margot L. Giannetti
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Alexander W. Dromerick
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Dorothy F. Edwards
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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14
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Chu J, Glinsky JV, Liu H, Ben M, Spooren AI, Roberts S, Chen LW, Di Natal F, Tamburella F, Jørgensen V, Gollan EJ, Agostinello J, van Laake-Geelen C, Lincoln C, van der Lede J, Stolwijk JM, Bell C, Paddison S, Rainey D, Scivoletto G, Oostra KM, Jan S, Sherrington C, Harvey LA. Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation. BMJ Open 2023; 13:e072219. [PMID: 37643854 PMCID: PMC10465915 DOI: 10.1136/bmjopen-2023-072219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION People with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical rehabilitation is motor training. There is initial evidence to suggest that motor training can enhance neurological recovery if it is provided soon after injury and in a high dosage. The Early and Intensive Motor Training Trial is a pragmatic randomised controlled trial to determine whether 10 weeks of intensive motor training enhances neurological recovery for people with spinal cord injury. This pragmatic randomised controlled trial will recruit 220 participants from 15 spinal injury units in Australia, Scotland, Italy, Norway, England, Belgium and the Netherlands. This protocol paper describes the process evaluation that will run alongside the Early and Intensive Motor Training Trial. This process evaluation will help to explain the trial results and explore the potential facilitators and barriers to the possible future rollout of the trial intervention. METHODS AND ANALYSIS The UK Medical Research Council process evaluation framework and the Implementation Research Logic Model will be used to explain the trial outcomes and inform future implementation. Key components of the context, implementation and mechanism of impact, as well as the essential elements of the intervention and outcomes, will be identified and analysed. Qualitative and quantitative data will be collected and triangulated with the results of the Early and Intensive Motor Training Trial to strengthen the findings of this process evaluation. ETHICS AND DISSEMINATION Ethical approval for the Early and Intensive Motor Training Trial and process evaluation has been obtained from the Human Research Ethics Committee at the Northern Sydney Local Health District (New South Wales) in Australia (project identifier: 2020/ETH02540). All participants are required to provide written consent after being informed about the trial and the process evaluation. The results of this process evaluation will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621000091808); Universal Trial Number (U1111-1264-1689).
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Affiliation(s)
- Jackie Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marsha Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sharon Roberts
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lydia W Chen
- Physiotherapy Department, Roayl North Shore Hospital, St Leonards, New South Wales, Australia
| | - Fernanda Di Natal
- Physiotherapy Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | - Vivien Jørgensen
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Emilie J Gollan
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jacqui Agostinello
- Physiotherapy Department, Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
| | - Charlotte van Laake-Geelen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Claire Lincoln
- Physiotherapy Department, Queen Elizabeth National Spinal Injuries Unit, Glasgow, Scotland
| | - Jessica van der Lede
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Janneke M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chris Bell
- Physiotherapy Department, Repat Health Precinct, Daw Park, South Australia, Australia
| | - Sue Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Stanmore, UK
| | - Donna Rainey
- Spinal Injury Unit, Royal Rehab, Ryde, New South Wales, Australia
| | | | - Kristine M Oostra
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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15
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Schweighofer N, Ye D, Luo H, D’Argenio DZ, Winstein C. Long-term forecasting of a motor outcome following rehabilitation in chronic stroke via a hierarchical bayesian dynamic model. J Neuroeng Rehabil 2023; 20:83. [PMID: 37386512 PMCID: PMC10311775 DOI: 10.1186/s12984-023-01202-y] [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: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Given the heterogeneity of stroke, it is important to determine the best course of motor therapy for each patient, i.e., to personalize rehabilitation based on predictions of long-term outcomes. Here, we propose a hierarchical Bayesian dynamic (i.e., state-space) model (HBDM) to forecast long-term changes in a motor outcome due to rehabilitation in the chronic phase post-stroke. METHODS The model incorporates the effects of clinician-supervised training, self-training, and forgetting. In addition, to improve forecasting early in rehabilitation, when data are sparse or unavailable, we use the Bayesian hierarchical modeling technique to incorporate prior information from similar patients. We use HBDM to re-analyze the Motor Activity Log (MAL) data of participants with chronic stroke included in two clinical trials: (1) the DOSE trial, in which participants were assigned to a 0, 15, 30, or 60-h dose condition (data of 40 participants analyzed), and (2) the EXCITE trial, in which participants were assigned a 60-h dose, in either an immediate or a delayed condition (95 participants analyzed). RESULTS For both datasets, HBDM accounts well for individual dynamics in the MAL during and outside of training: mean RMSE = 0.28 for all 40 DOSE participants (participant-level RMSE 0.26 ± 0.19-95% CI) and mean RMSE = 0.325 for all 95 EXCITE participants (participant-level RMSE 0.32 ± 0.31), which are small compared to the 0-5 range of the MAL. Bayesian leave-one-out cross-validation shows that the model has better predictive accuracy than static regression models and simpler dynamic models that do not account for the effect of supervised training, self-training, or forgetting. We then showcase model's ability to forecast the MAL of "new" participants up to 8 months ahead. The mean RMSE at 6 months post-training was 1.36 using only the baseline MAL and then decreased to 0.91, 0.79, and 0.69 (respectively) with the MAL following the 1st, 2nd, and 3rd bouts of training. In addition, hierarchical modeling improves prediction for a patient early in training. Finally, we verify that this model, despite its simplicity, can reproduce previous findings of the DOSE trial on the efficiency, efficacy, and retention of motor therapy. CONCLUSIONS In future work, such forecasting models can be used to simulate different stages of recovery, dosages, and training schedules to optimize rehabilitation for each person. Trial registration This study contains a re-analysis of data from the DOSE clinical trial ID NCT01749358 and the EXCITE clinical trial ID NCT00057018.
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Affiliation(s)
- Nicolas Schweighofer
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
| | - Dongze Ye
- Computer Science, University of Southern California, Los Angeles, USA
| | - Haipeng Luo
- Computer Science, University of Southern California, Los Angeles, USA
| | - David Z. D’Argenio
- Biomedical Engineering, University of Southern California, Los Angeles, USA
| | - Carolee Winstein
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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16
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Shaikh A, Bhardwaj S, Vashista V. Learning complex upper-limb movements through practicing movement elements. Hum Mov Sci 2023; 90:103121. [PMID: 37390768 DOI: 10.1016/j.humov.2023.103121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Accepted: 06/17/2023] [Indexed: 07/02/2023]
Abstract
Upper-limb complex movements constitute a major part of our daily activities. Research shows complex movements are generated by sequences of movement elements represented by a unimodal bell-shaped velocity curve. We utilized this understanding in the field of motor skill acquisition and hypothesized that practicing a movement element of a complex movement trajectory will facilitate the performance on the respective complex movement trajectory. To test this, we designed an experiment where the control group learned a full complex trajectory, whereas the two elemental groups learned two different movement elements of the complex trajectory. The two main outcome measures explaining the performance were accuracy and speed. The elemental groups, after training on movement elements, significantly improved their speed and accuracy when tested on the full complex trajectory. The result illustrated that training on a movement element of a complex trajectory benefited the performance of the full complex trajectory. The two elemental groups showed similar improvements in the performance of the complex motor skill, despite obtaining training on different movement elements of the same complex movement. The findings show that complex movements can be learned by practicing their movement elements.
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Affiliation(s)
- Azba Shaikh
- Centre for Cognitive and Brain Sciences, Indian Institute of Technology Gandhinagar, Palaj 382355, India.
| | - Siddharth Bhardwaj
- Department of Mechanical Engineering, Indian Institute of Technology Gandhinagar, Palaj 382355, India.
| | - Vineet Vashista
- Centre for Cognitive and Brain Sciences, Indian Institute of Technology Gandhinagar, Palaj 382355, India; Department of Mechanical Engineering, Indian Institute of Technology Gandhinagar, Palaj 382355, India.
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17
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Kafri M, Levron Y, Atun-Einy O. Assessing the impact of a knowledge translation intervention on physical therapists' self-efficacy and implementation of motor learning practice. BMC MEDICAL EDUCATION 2023; 23:369. [PMID: 37221530 DOI: 10.1186/s12909-023-04304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice. METHODS A total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists' Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre-post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes. RESULTS Comparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience. CONCLUSIONS Findings support the positive effect of an educational tool, most prominently on physical therapists' ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Yasmin Levron
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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18
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Asín-Prieto G, Oliveira Barroso F, Martínez-Expósito A, Urendes E, Gonzalez-Vargas J, Moreno JC. Mechanical disturbances applied by motorized ankle foot orthosis to adapt ankle muscles activation—A validation study. Front Bioeng Biotechnol 2023; 11:1079027. [PMID: 37008040 PMCID: PMC10060880 DOI: 10.3389/fbioe.2023.1079027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Reduced function of ankle muscles usually leads to impaired gait. Motorized ankle foot orthoses (MAFOs) have shown potential to improve neuromuscular control and increase volitional engagement of ankle muscles. In this study, we hypothesize that specific disturbances (adaptive resistance-based perturbations to the planned trajectory) applied by a MAFO can be used to adapt the activity of ankle muscles. The first goal of this exploratory study was to test and validate two different ankle disturbances based on plantarflexion and dorsiflexion resistance while training in standing still position. The second goal was to assess neuromuscular adaptation to these approaches, namely, in terms of individual muscle activation and co-activation of antagonists.Methods: Two ankle disturbances were tested in ten healthy subjects. For each subject, the dominant ankle followed a target trajectory while the contralateral leg was standing still: a) dorsiflexion torque during the first part of the trajectory (Stance Correlate disturbance—StC), and b) plantarflexion torque during the second part of the trajectory (Swing Correlate disturbance—SwC). Electromyography was recorded from the tibialis anterior (TAnt) and gastrocnemius medialis (GMed) during MAFO and treadmill (baseline) trials.Results: GMed (plantarflexor muscle) activation decreased in all subjects during the application of StC, indicating that dorsiflexion torque did not enhance GMed activity. On the other hand, TAnt (dorsiflexor muscle) activation increased when SwC was applied, indicating that plantarflexion torque succeeded in enhancing TAnt activation. For each disturbance paradigm, there was no antagonist muscle co-activation accompanying agonist muscle activity changes.Conclusion: We successfully tested novel ankle disturbance approaches that can be explored as potential resistance strategies in MAFO training. Results from SwC training warrant further investigation to promote specific motor recovery and learning of dorsiflexion in neural-impaired patients. This training can potentially be beneficial during intermediate phases of rehabilitation prior to overground exoskeleton-assisted walking. Decreased activation of GMed during StC might be attributed to the unloaded body weight in the ipsilateral side, which typically decreases activation of anti-gravity muscles. Neural adaptation to StC needs to be studied thoroughly in different postures in futures studies.
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Affiliation(s)
- Guillermo Asín-Prieto
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- Gogoa Mobility Robots, Abadiño, Spain
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Filipe Oliveira Barroso,
| | - Aitor Martínez-Expósito
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Eloy Urendes
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
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Muccio M, Atun-Einy O, Kafri M, Kaplan SL. Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article. Phys Occup Ther Pediatr 2023; 43:741-758. [PMID: 36922700 DOI: 10.1080/01942638.2023.2186198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/13/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
AIM This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.
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Affiliation(s)
- Marissa Muccio
- Division of PRNY PC, Scoliosis Specialty Center, Totowa, NJ, USA
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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20
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Hocking J, Oster C, Maeder A, Lange B. Design, development, and use of conversational agents in rehabilitation for adults with brain-related neurological conditions: a scoping review. JBI Evid Synth 2023; 21:326-372. [PMID: 35976047 DOI: 10.11124/jbies-22-00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to identify how conversational agents are designed and used in rehabilitation for adults with brain-related neurological conditions. INTRODUCTION Adults with brain-related neurological conditions experience varied cognitive and functional challenges that can persist long term. However, rehabilitation services are time- and resource-limited, and novel rehabilitation approaches are warranted. Conversational agents provide a human-computer interface with which the user can converse. A conversational agent can be designed to meet specific user needs, such as rehabilitation and support. INCLUSION CRITERIA Studies focused on the design and use of conversational agents for rehabilitation for people aged 18 years or older with brain-related neurological conditions were considered for inclusion. Eligible publication types included peer-reviewed publications (quantitative, qualitative, and/or mixed methods study designs; research protocols; peer-reviewed expert opinion papers; clinical studies, including pilot trials; systematic or scoping reviews), full conference papers, and master's or PhD theses. Eligible types of research included prototype development, feasibility testing, and clinical trials. METHODS Online databases, including MEDLINE, Scopus, ProQuest (all databases), Web of Science, and gray literature sources were searched with no date limit. Only English publications were considered due to a lack of resourcing available for translations. Title and abstract screening and full-text review were conducted by two independent reviewers. Data extraction was shared by three independent reviewers. The data extraction instrument was iteratively refined to meet the requirements of all included papers, and covered details for technological aspects and the clinical context. Results are presented narratively and in tabular format, with emphasis on participants, concept and context, and data extraction instrument components. RESULTS Eleven papers were included in the review, which represented seven distinct conversational agent prototypes. Methodologies included technology description (n = 9) and initial user testing (n = 6). The intended clinical cohorts for the reported conversational agents were people with dementia (n = 5), Parkinson disease (n = 2), stroke (n = 1), traumatic brain injury (n = 1), mixed dementia and mild cognitive impairment (n = 1), and mixed dementia and Parkinson disease (n = 1). Two studies included participants who were healthy or otherwise from the general community. The design of the conversational agents considered technology aspects and clinical purposes. Two conversational agent prototypes incorporated a speaking humanoid avatar as reported in five of the papers. Topics of conversation focused on subjects enjoyable to the user (life history, hobbies, where they lived). The clinical purposes reported in the 11 papers were to increase the amount of conversation the user has each day (n = 4), reminiscence (n = 2), and one study each for anxiety management and education, Parkinson disease education, to obtain and analyze a recording of the user's voice, to monitor well-being, and to build rapport before providing daily task prompts. One study reported clinician oversight of the conversational agent use. The studies had low sample sizes (range: 1-33). No studies undertook effectiveness testing. Outcome measures focused on usability, language detection and production, and technological performance. No health-related outcomes were measured. No adverse events were reported, and only two studies reported safety considerations. CONCLUSIONS Current literature reporting the design and use of conversational agents for rehabilitation for adults with brain-related neurological conditions is heterogeneous and represents early stages of conversational agent development and testing. We recommend, as per our customized data extraction instrument, that studies of conversational agents for this population clearly define technical aspects, methodology for developing the conversation content, recruitment methods, safety issues, and requirements for clinician oversight.
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Affiliation(s)
- Judith Hocking
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Anthony Maeder
- Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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21
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Almarwani M, Aldawsary N. Is it only nice in theory? Implementation of motor learning principles in neurorehabilitation among Saudi physical therapists. NeuroRehabilitation 2023; 53:385-395. [PMID: 37638455 DOI: 10.3233/nre-230071] [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: 08/29/2023]
Abstract
BACKGROUND Despite earlier recognition of the importance of motor learning principles in neurorehabilitation, research suggests that the motor learning principle is not being entirely utilized in neurorehabilitation. Implementation of motor learning principles has been associated with functional recovery and patient satisfaction. OBJECTIVE To examine implementation of motor learning principles in neurorehabilitation among Saudi physical therapists including self-efficacy, current practice, attitude and barriers. METHODS A cross-sectional survey of physical therapists managing patients with neurological conditions was conducted (n = 345). The survey questionnaire contained items to evaluate self-efficacy, current practice, attitude and barriers toward implementing motor learning principles in neurorehabilitation. RESULTS The data from the respondents indicated that they had moderate self-efficacy to implement motor learning in neurorehabilitation. Only 30.2% of respondents implement motor learning in their practice to a high degree and some respondents were unaware of the concepts of motor learning. The most reported perceived barriers to motor learning implementation in neurorehabilitation were at the level of the physical therapist (lack of knowledge) and the organization (lack of time). CONCLUSION Implementation of motor learning principles among Saudi physical therapists managing patients with neurological conditions was moderate. Self-efficacy, positive attitudes, academic training and organizational support are potential strategies to enhance implementation.
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Affiliation(s)
- Maha Almarwani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nada Aldawsary
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Rehabilitation, Physical Therapy Department, Ministry of Health, Riyadh, Saudi Arabia
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22
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Beroukhim-Kay D, Kim B, Monterosso J, Lewthwaite R, Winstein C. Different Patterns of Neural Activity Characterize Motor Skill Performance During Acquisition and Retention. Front Hum Neurosci 2022; 16:900405. [PMID: 35769253 PMCID: PMC9234574 DOI: 10.3389/fnhum.2022.900405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Motor performance and learning have distinct behavioral and neural signatures and can be uniquely modulated by various informational and motivational factors. Contemporary frameworks describe four different motor learning mechanisms mapped onto specific neural regions which are key for motor skill acquisition: error-based learning (cerebellum), reinforcement learning (basal ganglia), cognitive strategies (prefrontal cortex), and use-dependent learning (motor cortex). However, little is known about the neural circuits engaged during skill acquisition that are modulated specifically by practice-based performance improvement and those that predict recall performance. Based on previous work, we hypothesize that brain activity during practice in primary motor cortex and basal ganglia (1) is associated with trial-by-trial practice performance and (2) is predictive of immediate recall performance. Leveraging the contemporary framework, we use a well-known task paradigm that primarily relies upon cognitive strategy, reinforcement, and use-based learning mechanisms to test our hypotheses. Forty neurotypical young adults were asked to practice a pinch force tracking task. Participants received performance feedback after each trial during practice. We used whole brain analysis of functional magnetic resonance imaging (fMRI) and behavioral performance measures (i.e., time-on-target and self-efficacy) during the practice phase to determine which brain activation patterns are (1) associated with trial-by-trial tracking performance and (2) predictive of immediate no-feedback retention performance. We observed brain activations in the frontal orbital cortex, putamen, amygdala, and insula correlated with tracking performance improvement during practice. In contrast, a different set of performance-related activated regions were observed that were associated with immediate retention performance that included the primary motor cortex, superior frontal gyrus, somatosensory cortex, angular gyrus, and parietal gyrus. Our findings demonstrate that improved practice performance and recall of a sensorimotor skill are correlated with distinct neural activity patterns during acquisition, drawing on different motor learning mechanisms during encoding. While motor performance improvements depend on both cortical and subcortical regions, motor skill recall depends primarily on prefrontal and motor cortices. We discuss possible interpretations for why our hypothesis regarding basal ganglia activity and retention performance was not supported. Understanding the different neural mechanisms engaged in motor performance and learning may inform novel interventions to enhance motor skill learning.
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Affiliation(s)
- Dorsa Beroukhim-Kay
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Bokkyu Kim
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - John Monterosso
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Rehabilitation Therapies Division, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Carolee Winstein
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Carolee Winstein,
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23
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Ranganathan R, Doherty C, Gussert M, Kaplinski E, Koje M, Krishnan C. Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation. Restor Neurol Neurosci 2022; 40:97-107. [DOI: 10.3233/rnn-211243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. Objective: To understand the content of current therapeutic interventions in terms of their active ingredients. Methods: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. Results: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. Conclusion: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Carson Doherty
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michael Gussert
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Eva Kaplinski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Mary Koje
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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24
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Taghizadeh A, Webster KE, Bhopti A, Carey L, Hoare B. Are they really motor learning therapies? A scoping review of evidence-based, task-focused models of upper limb therapy for children with unilateral cerebral palsy. Disabil Rehabil 2022; 45:1536-1548. [PMID: 35468016 DOI: 10.1080/09638288.2022.2063414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify the specific motor learning (ML) theories underpinning evidence-based, task-focused upper limb models of therapy for children with unilateral cerebral palsy; and to document the strategies used in the operationalisation of these theories. MATERIAL AND METHOD This scoping review searched for relevant studies using eight electronic databases. A list of 68 ML strategies and accompanying definitions was developed for data extraction. Three classifications; adequate, inadequate or not described were used to rate the description of ML strategies. A corresponding colour-coding system was used to provide a visual summary. RESULTS There is a limited description of the ML theories and strategies used to operationalise these theories in existing models of evidence-based upper limb therapy. Of 103 therapy protocols included, only 24 explicitly described the guiding ML theory. When described, there was significant variation in the underlying theories, leading to significantly different focus and content of therapy. Of the 68 ML strategies, only three were adequately described. CONCLUSIONS To support treatment fidelity and the implementation of evidence-based, task-focused models of upper limb therapy in clinical practice, future research needs to provide explicit details about the underlying theories and strategies used in the operationalisation of these theories.Implications for rehabilitationEvidence-based models of upper limb therapy purport to be based on motor learning theory, however, most provide a very limited description of the theories and strategies used.Dosage of practice is only one element that is specific to a therapy approach and other elements guided by the principles of type of task and type of feedback should be considered.To support the implementation of evidence-based approaches in clinical practice, and improve treatment fidelity, it is important for researchers to define the theories that guide therapy approaches and explicitly describe the strategies used to operationalise these theories.
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Affiliation(s)
- Atefeh Taghizadeh
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Kate E Webster
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Leeanne Carey
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Brian Hoare
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
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25
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Brown EL, Gannotti ME, Veneri DA. Including Arts in Rehabilitation Enhances Outcomes in the Psychomotor, Cognitive, and Affective Domains: A Scoping Review. Phys Ther 2022; 102:6515752. [PMID: 35084031 DOI: 10.1093/ptj/pzac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/25/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to analyze the published literature regarding the use of art in the context of rehabilitation for consideration in physical therapy. METHODS The CINAHL, PsycArticles, APA PsycInfo, Art Index, Music Index, Cochrane Reviews, and PubMed electronic databases were accessed. Inclusion and exclusion criteria were established and utilized to determine study eligibility. Study details were extracted from each article by researchers using a systematic format. Summation of journal type, participants, dosing and type of intervention, setting and interventionist, outcome domains, and study results were included. RESULTS Out of 1452 studies, 76 were included for extraction. Of these studies, most had outcome measures aligned with the psychomotor and affective domains of learning (n = 66). Very few studies had outcome measures with psychomotor and cognitive domains (n = 2) or psychomotor, affective, and cognitive outcome measures (n = 8). Regarding the arts used, music, dance, or both were used in 77 instances. Fewer studies reported using creative arts therapy, singing, theater, writing, and rhythm (n = 17). Of the 76 studies analyzed, 74 reported a within-group treatment effect. CONCLUSION The arts effectively enhance physical therapist practice; therefore, it is recommended that physical therapists continue to seek collaboration with art professionals and explore the use of arts in practice. IMPACT Findings demonstrate that combining the arts with physical therapist practice amplifies not only psychomotor but affective and cognitive outcomes as well. The arts have applicability across broad populations (eg, chronic pain, neurologic dysfunction, respiratory conditions). This study supports that physical therapist education and practice should embrace the arts as a collaborative modality to promote enhanced psychomotor, affective, and cognitive outcomes.
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Affiliation(s)
- Emma L Brown
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, USA
| | - Mary E Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, USA
| | - Diana A Veneri
- Department of Physical Therapy, Sacred Heart University, Fairfield, Connecticut, USA
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26
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Gangwani R, Cain A, Collins A, Cassidy JM. Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery. Front Neurol 2022; 13:823202. [PMID: 35280288 PMCID: PMC8907401 DOI: 10.3389/fneur.2022.823202] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.
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Affiliation(s)
- Rachana Gangwani
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Sciences Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amelia Cain
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy Collins
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica M. Cassidy
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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27
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Abuín-Porras V, Martinez-Perez C, Romero-Morales C, Cano-de-la-Cuerda R, Martín-Casas P, Palomo-López P, Sánchez-Tena MÁ. Citation Network Study on the Use of New Technologies in Neurorehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:26. [PMID: 35010288 PMCID: PMC8751120 DOI: 10.3390/ijerph19010026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
New technologies in neurorehabilitation is a wide concept that intends to find solutions for individual and collective needs through technical systems. Analysis through citation networks is used to search scientific literature related to a specific topic. On the one hand, the main countries, institutions, and authors researching this topic have been identified, as well as their evolution over time. On the other hand, the links between the authors, the countries, and the topics under research have been analyzed. The publications analysis was performed through the Web of Science database using the search terms "new technolog*," "neurorehabilitation," "physical therapy*," and "occupational therapy*." The selected interval of publication was from 1992 to December 2020. The results were analyzed using CitNetExplorer software. After a Web of Science search, a total of 454 publications and 135 citation networks were found, 1992 being the first year of publication. An exponential increase was detected from the year 2009. The largest number was detected in 2020. The main areas are rehabilitation and neurosciences and neurology. The most cited article was from Perry et al. in 2007, with a citation index of 460. The analysis of the top 20 most cited articles shows that most approach the use of robotic devices and brain-computer interface systems. In conclusion, the main theme was found to be the use of robotic devices to address neuromuscular rehabilitation goals and brain-computer interfaces and their applications in neurorehabilitation.
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Affiliation(s)
- Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Fundación DACER, Área de I+D+I, San Sebastián de los Reyes, 28702 Madrid, Spain
| | - Clara Martinez-Perez
- ISEC LISBOA—Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal; (C.M.-P.); (M.Á.S.-T.)
| | | | - Roberto Cano-de-la-Cuerda
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain;
| | | | - Miguel Ángel Sánchez-Tena
- ISEC LISBOA—Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal; (C.M.-P.); (M.Á.S.-T.)
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain
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28
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Listman JB, Tsay JS, Kim HE, Mackey WE, Heeger DJ. Long-Term Motor Learning in the "Wild" With High Volume Video Game Data. Front Hum Neurosci 2021; 15:777779. [PMID: 34987368 PMCID: PMC8720934 DOI: 10.3389/fnhum.2021.777779] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/25/2021] [Indexed: 01/12/2023] Open
Abstract
Motor learning occurs over long periods of practice during which motor acuity, the ability to execute actions more accurately, precisely, and in less time, improves. Laboratory-based studies of motor learning are typically limited to a small number of participants and a time frame of minutes to several hours per participant. There is a need to assess the generalizability of theories and findings from lab-based motor learning studies on larger samples and time scales. In addition, laboratory-based studies of motor learning use relatively simple motor tasks which participants are unlikely to be intrinsically motivated to learn, limiting the interpretation of their findings in more ecologically valid settings ("in the wild"). We studied the acquisition and longitudinal refinement of a complex sensorimotor skill embodied in a first-person shooter video game scenario, with a large sample size (N = 7174, 682,564 repeats of the 60 s game) over a period of months. Participants voluntarily practiced the gaming scenario for up to several hours per day up to 100 days. We found improvement in performance accuracy (quantified as hit rate) was modest over time but motor acuity (quantified as hits per second) improved considerably, with 40-60% retention from 1 day to the next. We observed steady improvements in motor acuity across multiple days of video game practice, unlike most motor learning tasks studied in the lab that hit a performance ceiling rather quickly. Learning rate was a non-linear function of baseline performance level, amount of daily practice, and to a lesser extent, number of days between practice sessions. In addition, we found that the benefit of additional practice on any given day was non-monotonic; the greatest improvements in motor acuity were evident with about an hour of practice and 90% of the learning benefit was achieved by practicing 30 min per day. Taken together, these results provide a proof-of-concept in studying motor skill acquisition outside the confines of the traditional laboratory, in the presence of unmeasured confounds, and provide new insights into how a complex motor skill is acquired in an ecologically valid setting and refined across much longer time scales than typically explored.
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Affiliation(s)
| | - Jonathan S. Tsay
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Hyosub E. Kim
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Wulf G, Lewthwaite R. Translating Thoughts Into Action: Optimizing Motor Performance and Learning Through Brief Motivational and Attentional Influences. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1177/09637214211046199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Skilled motor performance is essential in sports, the performing arts, various occupations, and many daily activities. Scientists and practitioners alike are therefore interested in understanding the conditions that influence the performance and learning of movement skills, and how they can be utilized to optimize training. In OPTIMAL theory, three motivational and attentional factors are key: enhanced expectancies for future performance, the performer’s autonomy, and an external focus of attention. We review recent evidence suggesting that each factor contributes independently to strengthen the coupling of goals to actions. This work has implications ranging from fostering more effective skill development in novice learners, to increasing the efficiency of athletes’ and musicians’ performance, and to facilitating the success of patients in regaining functional capabilities.
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Affiliation(s)
- Gabriele Wulf
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas
| | - Rebecca Lewthwaite
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Division of Biokinesiology and Physical Therapy, University of Southern California
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30
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Leech KA, Roemmich RT, Gordon J, Reisman DS, Cherry-Allen KM. Updates in Motor Learning: Implications for Physical Therapist Practice and Education. Phys Ther 2021; 102:6409654. [PMID: 34718787 PMCID: PMC8793168 DOI: 10.1093/ptj/pzab250] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
Over the past 3 decades, the volume of human motor learning research has grown enormously. As such, the understanding of motor learning (ie, sustained change in motor behavior) has evolved. It has been learned that there are multiple mechanisms through which motor learning occurs, each with distinctive features. These mechanisms include use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning. It is now understood that these different motor learning mechanisms contribute in parallel or in isolation to drive desired changes in movement, and each mechanism is thought to be governed by distinct neural substrates. This expanded understanding of motor learning mechanisms has important implications for physical therapy. It has the potential to facilitate the development of new, more precise treatment approaches that physical therapists can leverage to improve human movement. This Perspective describes scientific advancements related to human motor learning mechanisms and discusses the practical implications of this work for physical therapist practice and education.
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Affiliation(s)
- Kristan A Leech
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
- Address all correspondence to Dr Leech at:
| | - Ryan T Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - James Gordon
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Darcy S Reisman
- Physical Therapy Department, University of Delaware, Newark, Delaware, USA
| | - Kendra M Cherry-Allen
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
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McLaren R, Smith PF, Lord S, Kaur PK, Zheng Y, Taylor D. Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e32085. [PMID: 34609323 PMCID: PMC8527374 DOI: 10.2196/32085] [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: 07/26/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID) DERR1-10.2196/32085
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Affiliation(s)
- Ruth McLaren
- Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Sue Lord
- Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Preet Kamal Kaur
- Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Yiwen Zheng
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial. Acta Neurol Belg 2021; 121:1157-1164. [PMID: 33586087 DOI: 10.1007/s13760-021-01624-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an individual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in individuals with chronic oropharyngeal dysphagia after stroke.
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Mawase F, Cherry-Allen K, Xu J, Anaya M, Uehara S, Celnik P. Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke. Neurorehabil Neural Repair 2021; 34:733-745. [PMID: 32845230 PMCID: PMC7457456 DOI: 10.1177/1545968320939563] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.
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Affiliation(s)
- Firas Mawase
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kendra Cherry-Allen
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jing Xu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Manuel Anaya
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shintaro Uehara
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Fujita Health University, Toyoake, Aichi, Japan
| | - Pablo Celnik
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Readinger J, Eastlack M, Von Nieda K, Kantak S, Sawyer K. Feasibility and longitudinal effects of repeated participation in an annual, brief and intense exercise program in individuals with Parkinson's disease: A case report. Physiother Theory Pract 2021; 38:3194-3205. [PMID: 34313192 DOI: 10.1080/09593985.2021.1952667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional decline is expected over time in persons with Parkinson's disease (PD). Intense exercise (RPE ≥ 5-7/10), incorporating motor learning principles, may be beneficial. Purpose:The purpose of this case report is to describe the feasibility and longitudinal effects after individuals with PD participated in multiple, 3.5-day, intensive exercise programs called Movement Camp (Camp). METHODS Developed based on the principles of skill, capacity, and motivation, the Camp was offered four times (spring 2014-spring 2017) over the course of three years. Camp consisted of 3.5 days, with approximately 5.5 hours of exercise per day. The four participants on whom we are reporting were selected because they participated in three or more Camps, thus providing longitudinal data. Participants rotated through high-intensity, one-hour exercise stations targeting balance, endurance, gait, upper extremity function and three 30-minute group training sessions. Balance (Mini-BESTest), endurance (six-minute walk test), gait speed, and function (five times sit-to-stand) were examined. RESULTS Testing was completed prior to, post, and six weeks post intervention. Over three years, participants maintained or improved performance on most measures. CONCLUSION The outcomes of this case report suggest that brief, intensive exercise based on motor learning principles is feasible and may maintain or improve function in persons with PD over three years.
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Affiliation(s)
- Janet Readinger
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Marty Eastlack
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Kristin Von Nieda
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Shailesh Kantak
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Karen Sawyer
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
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Conner BC, Schwartz MH, Lerner ZF. Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy. J Biomech 2021; 126:110601. [PMID: 34332214 DOI: 10.1016/j.jbiomech.2021.110601] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/12/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this study was to determine the neuromuscular and biomechanical response to four weeks of exoskeleton ankle resistance therapy (exo-therapy) in children with CP. Five children with CP (12 - 17 years, GMFCS I - II, two diplegic and three hemiplegic, four males and one female) were recruited for ten 20-minute sessions of exo-therapy. Surface electromyography, three-dimensional kinematics, and metabolic data were collected at baseline and after training was complete. After completion of training and with no device on, participants walked with decreased co-contraction between the plantar flexors and dorsiflexors (-29 ± 11%, p = 0.02), a more typical plantar flexor activation profile (33 ± 13% stronger correlation to a typical soleus activation profile, p = 0.01), and increased neural control complexity (7 ± 3%, p < 0.01 measured via muscle synergy analysis). These improvements in neuromuscular control led to a more mechanically efficient gait pattern (58 ± 34%, p < 0.05) with a reduced metabolic cost of transport (-29 ± 15%, p = 0.02). The findings from this study suggest that ankle exoskeleton resistance therapy shows promise for rapidly improving neuromuscular control for children with CP, and may serve as a meaningful rehabilitative complement to common surgical procedures.
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Affiliation(s)
- Benjamin C Conner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Michael H Schwartz
- James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zachary F Lerner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA; Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA.
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Customizing Robot-Assisted Passive Neurorehabilitation Exercise Based on Teaching Training Mechanism. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9972560. [PMID: 34195289 PMCID: PMC8184331 DOI: 10.1155/2021/9972560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
Passive movement is an important mean of rehabilitation for stroke survivors in the early stage or with greater paralysis. The upper extremity robot is required to assist therapists with passive movement during clinical rehabilitation, while customizing is one of the crucial issues for robot-assisted upper extremity training, which fits the patient-centeredness. Robot-assisted teaching training could address the need well. However, the existing control strategies of teaching training are usually commanded by position merely, having trouble to achieve the efficacy of treatment by therapists. And deficiency of flexibility and compliance comes to the training trajectory. This research presents a novel motion control strategy for customized robot-assisted passive neurorehabilitation. The teaching training mechanism is developed to coordinate the movement of the shoulder and elbow, ensuring the training trajectory correspondence with human kinematics. Furthermore, the motion trajectory is adjusted by arm strength to realize dexterity and flexibility. Meanwhile, the torque sensor employed in the human-robot interactive system identifies movement intention of human. The goal-directed games and feedbacks promote the motor positivity of stroke survivors. In addition, functional experiments and clinical experiments are investigated with a healthy adult and five recruited stroke survivors, respectively. The experimental results present that the suggested control strategy not only serves with safety training but also presents rehabilitation efficacy.
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Tsay JS, Winstein CJ. Five Features to Look for in Early-Phase Clinical Intervention Studies. Neurorehabil Neural Repair 2021; 35:3-9. [PMID: 33243083 PMCID: PMC9873309 DOI: 10.1177/1545968320975439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery and demote compensation. However, many clinicians struggle to find interventions centered on these principles in our nascent, rapidly growing body of literature. Not to mention the immense pressure from regulatory bodies and organizational balance sheets that further discourage time-intensive recovery-promoting interventions, incentivizing clinicians to prioritize practical constraints over sound clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. To narrow the gap between the busy clinician and the cutting-edge motor recovery literature, we distilled 5 features found in early-phase clinical intervention studies-ones that value the more enduring biological recovery processes over the more immediate compensatory remedies. Filtering emerging literature through this lens and routinely integrating promising research into daily practice can break down practical barriers for effective clinical translation and ultimately promote durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded and caring clinicians, students, activists, and research trainees, who are poised to not only advance rehabilitation science, but also erect evidence-based policy changes to accelerate recovery-based stroke care.
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Conner BC, Remec NM, Orum EK, Frank EM, Lerner ZF. Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:282-289. [PMID: 33251524 PMCID: PMC7694567 DOI: 10.1109/ojemb.2020.3035316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Goal To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). Methods Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. Results Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). Conclusions The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 - 6 times greater than what has been reported previously.
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Affiliation(s)
- Benjamin C Conner
- B. C. Conner is with the University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. N. M. Remec is with Phoenix Children's Hospital, Phoenix, AZ, USA. E. K. Orum and E. M. Frank are with the College of Health Solutions, Arizona State University, Tempe, AZ, USA. Z. F. Lerner is with the Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, USA and also the Department of Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Nushka M Remec
- B. C. Conner is with the University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. N. M. Remec is with Phoenix Children's Hospital, Phoenix, AZ, USA. E. K. Orum and E. M. Frank are with the College of Health Solutions, Arizona State University, Tempe, AZ, USA. Z. F. Lerner is with the Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, USA and also the Department of Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Elizabeth K Orum
- B. C. Conner is with the University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. N. M. Remec is with Phoenix Children's Hospital, Phoenix, AZ, USA. E. K. Orum and E. M. Frank are with the College of Health Solutions, Arizona State University, Tempe, AZ, USA. Z. F. Lerner is with the Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, USA and also the Department of Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Emily M Frank
- B. C. Conner is with the University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. N. M. Remec is with Phoenix Children's Hospital, Phoenix, AZ, USA. E. K. Orum and E. M. Frank are with the College of Health Solutions, Arizona State University, Tempe, AZ, USA. Z. F. Lerner is with the Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, USA and also the Department of Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Zachary F Lerner
- B. C. Conner is with the University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. N. M. Remec is with Phoenix Children's Hospital, Phoenix, AZ, USA. E. K. Orum and E. M. Frank are with the College of Health Solutions, Arizona State University, Tempe, AZ, USA. Z. F. Lerner is with the Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, USA and also the Department of Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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Wang C, Winstein C, D'Argenio DZ, Schweighofer N. The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:881-890. [PMID: 32830617 DOI: 10.1177/1545968320948609] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In motor skill learning, larger doses of practice lead to greater efficacy of practice, lower efficiency of practice, and better long-term retention. Whether such learning principles apply to motor practice after stroke is unclear. Here, we developed novel mixed-effects models of the change in the perceived quality of arm movements during and following task practice. The models were fitted to data from a recent randomized controlled trial of the effect of dose of task practice in chronic stroke. Analysis of the models' learning and retention rates demonstrated an increase in efficacy of practice with greater doses, a decrease in efficiency of practice with both additional dosages and additional bouts of training, and fast initial decay following practice. Two additional effects modulated retention: a positive "self-practice" effect, and a negative effect of dose. Our results further suggest that for patients with sufficient arm use post-practice, self-practice will further improve use.
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Affiliation(s)
- Chunji Wang
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Carolee Winstein
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - David Z D'Argenio
- Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Nicolas Schweighofer
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Moliterno AH, Bezerra FV, Pires LA, Roncolato SS, da Silva TD, Massetti T, Fernani DCGL, Magalhães FH, de Mello Monteiro CB, Dantas MTAP. Effect of Contextual Interference in the Practicing of a Computer Task in Individuals Poststroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2937285. [PMID: 32775414 PMCID: PMC7396124 DOI: 10.1155/2020/2937285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sensory and motor alterations resulting from stroke often impair the performance and learning of motor skills. The present study is aimed at investigating whether and how poststroke individuals and age- and sex-matched healthy controls benefit from a contextual interference effect on the practice of a maze task (i.e., constant vs. random practice) performed on the computer. METHODS Participants included 21 poststroke individuals and 21 healthy controls, matched by sex and age (30 to 80 years). Both groups were divided according to the type of the practice (constant or random) presented in the acquisition phase of the learning protocol. For comparison between the groups, types of practice, and blocks of attempts, the analysis of variance with Tukey's post hoc test (p < 0.05) was used. RESULTS Poststroke individuals presented longer movement times as compared with the control group. In addition, only poststroke individuals who performed the task with random practice showed improved performance at the transfer phase. Moreover, randomized practice enabled poststroke individuals to perform the transfer task similarly to individuals without any neurological impairment. CONCLUSION The present findings indicated a significant effect of contextual interference of practice in poststroke individuals, suggesting that applying randomized training must be considered when designing rehabilitation protocols for this population.
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Affiliation(s)
- Alice Haniuda Moliterno
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | - Fernanda Vieira Bezerra
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | | | | | - Talita Dias da Silva
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Thais Massetti
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Fernando Henrique Magalhães
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Maria Tereza Artero Prado Dantas
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
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Bunketorp Käll L, Fridén J, Björnsdotter M. Regional estimates of cortical thickness in brain areas involved in control of surgically restored limb movement in patients with tetraplegia. J Spinal Cord Med 2020; 43:462-469. [PMID: 30352011 PMCID: PMC7480520 DOI: 10.1080/10790268.2018.1535639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Context/Objective: Spinal cord injury (SCI) causes atrophy of brain regions linked to motor function. We aimed to estimate cortical thickness in brain regions that control surgically restored limb movement in individuals with tetraplegia. Design: Cross-sectional study. Setting: Sahlgrenska University hospital, Gothenburg, Sweden. Participants: Six individuals with tetraplegia who had undergone surgical restoration of grip function by surgical transfer of one elbow flexor (brachioradialis), to the paralyzed thumb flexor (flexor pollicis longus). All subjects were males, with a SCI at the C6 or C7 level, and a mean age of 40 years (range = 31-48). The average number of years elapsed since the SCI was 13 (range = 6-26). Outcome measures: We used structural magnetic resonance imaging (MRI) to estimate the thickness of selected motor cortices and compared these measurements to those of six matched control subjects. The pinch grip control area was defined in a previous functional MRI study. Results: Compared to controls, the cortical thickness in the functionally defined pinch grip control area was not significantly reduced (P = 0.591), and thickness showed a non-significant but positive correlation with years since surgery in the individuals with tetraplegia. In contrast, the anatomically defined primary motor cortex as a whole exhibited substantial atrophy (P = 0.013), with a weak negative correlation with years since surgery. Conclusion: Individuals with tetraplegia do not seem to have reduced cortical thickness in brain regions involved in control of surgically restored limb movement. However, the studied sample is very small and further studies with larger samples are required to establish these findings.
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Affiliation(s)
- Lina Bunketorp Käll
- Centre for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,MedTech West, Röda stråket 10B, Sahlgrenska University Hospital, Gothenburg, Sweden,Correspondence to: Lina Bunketorp Käll, Centre for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital/Mölndal, House U1, 6th floor, 431 80Mölndal, Sweden.
| | - Jan Fridén
- Centre for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden,Department of Tetraplegia Hand Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Malin Björnsdotter
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
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43
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Buxbaum LJ, Varghese R, Stoll H, Winstein CJ. Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation. Neurorehabil Neural Repair 2020; 34:512-522. [PMID: 32476616 DOI: 10.1177/1545968320913554] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU. Objective. We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke. Methods. Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores. Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU (P < .05). Attention/arousal predicted NU above and beyond UEFM (P < .05). Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.
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Affiliation(s)
- Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Thomas Jefferson University, Philadelphia, PA, USA
| | - Rini Varghese
- University of Southern California, Los Angeles, CA, USA
| | - Harrison Stoll
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
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Eliassen M, Lahelle A. Enhancing functional improvement in reablement – a qualitative study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1761449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Center for Care Sciences, North, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Andreas Lahelle
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, National Neuromuscular Center, University Hospital of North Norway, Tromsø, Norway
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45
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Conner BC, Luque J, Lerner ZF. Adaptive Ankle Resistance from a Wearable Robotic Device to Improve Muscle Recruitment in Cerebral Palsy. Ann Biomed Eng 2020; 48:1309-1321. [PMID: 31950309 PMCID: PMC7096247 DOI: 10.1007/s10439-020-02454-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Individuals with cerebral palsy can have weak and poorly coordinated ankle plantar flexor muscles that contribute to inefficient walking patterns. Previous studies attempting to improve plantar flexor function have had inconsistent effects on mobility, likely due to a lack of task-specificity. The goal of this study was to develop, validate, and test the feasibility and neuromuscular response of a novel wearable adaptive resistance platform to increase activity of the plantar flexors during the propulsive phase of gait. We recruited eight individuals with spastic cerebral palsy to walk with adaptive plantar flexor resistance provided from an untethered exoskeleton. The resistance system and protocol was safe and feasible for all of our participants. Controller validation demonstrated our ability to provide resistance that proportionally- and instantaneously-adapted to the biological ankle moment (R = 0.92 ± 0.04). Following acclimation to resistance (0.16 ± 0.02 Nm/kg), more-affected limbs exhibited a 45 ± 35% increase in plantar flexor activity (p = 0.02), a 26 ± 24% decrease in dorsiflexor activity (p < 0.05), and a 46 ± 25% decrease in co-contraction (tibialis anterior and soleus) (p = 0.02) during the stance phase. This adaptive resistance system warrants further investigation for use in a longitudinal intervention study.
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Affiliation(s)
- Benjamin C Conner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Jason Luque
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR, Bldg 69, Flagstaff, AZ, 86011, USA
| | - Zachary F Lerner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA.
- Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR, Bldg 69, Flagstaff, AZ, 86011, USA.
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Blanton S, Clark PC, Cotsonis G, Dunbar SB. Factors associated with depressive symptoms of carepartners of stroke survivors after discharge from rehabilitation therapy. Top Stroke Rehabil 2020; 27:590-600. [PMID: 32160824 DOI: 10.1080/10749357.2020.1738678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The long-term consequences of stroke affect both the carepartner (CP) and stroke survivor (SS). Understanding the effects of informal caregiving that may influence the ability of the family to carry over therapeutic activities in the home environment is critical for family-centered care.Objective: This study examined the relationship of CP and SS factors associated with CP depressive symptoms to gain insights into CP needs that may occur after formal rehabilitation therapy has ended for SS with upper extremity deficits.Methods: This correlational study used baseline data of 32 dyads of family CP and SS with upper extremity impairment who had completed rehabilitation therapy and were enrolled in a pilot study of a web-based CP-integrated rehabilitation program. Data using standard questionnaires for CP factors and SS memory and behavior problems and an objective assessment of SS upper extremity function were obtained. Data analysis included descriptive statistics and Pearson product moment correlations.Results: CPs were female (62.5%), White (61.29%), and spouses (68.75%). CPs reported mild-moderate depressive symptoms (M = 9.5 ± 8.3), and a majority had some degree of family conflict. Higher CP depressive symptoms were related to worse life changes (r = -0.41, p =.02), greater fatigue (r = 0.50, p =.004), less effective family functioning (r = 0.46, p =.01), less autonomy support to SS (r = -0.42, p =.02), and more SS memory and behavior problems (r = 0.45, p =.01). Only CP fatigue was related to SS upper extremity function.Conclusions: Negative impacts of caregiving were found in this group of relatively high physically functioning SS which may hinder CP from providing optimal support for SS. Addressing CP needs including education regarding depression, fatigue, SS memory, and behavior problems, and family functioning while SS is receiving rehabilitation therapy may be important considerations to help facilitate the CP to support the SS in carrying over therapeutic activities in the home environment.
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Affiliation(s)
- Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Carpinella I, Lencioni T, Bowman T, Bertoni R, Turolla A, Ferrarin M, Jonsdottir J. Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial. J Neuroeng Rehabil 2020; 17:10. [PMID: 32000790 PMCID: PMC6990497 DOI: 10.1186/s12984-020-0646-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. METHODS Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). RESULTS R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019). CONCLUSIONS Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. TRIAL REGISTRATION www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.
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Affiliation(s)
- Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy.
| | - Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Rita Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Andrea Turolla
- Movement Neuroscience Research Group, IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venezia, Lido, Italy
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
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48
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Maier M, Ballester BR, Verschure PFMJ. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci 2019; 13:74. [PMID: 31920570 PMCID: PMC6928101 DOI: 10.3389/fnsys.2019.00074] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023] Open
Abstract
What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.
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Affiliation(s)
- Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institucio Catalana de Recerca I Estudis Avançats, Barcelona, Spain
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Kafri M, Atun-Einy O. From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice. Phys Ther 2019; 99:1628-1643. [PMID: 31407003 DOI: 10.1093/ptj/pzz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS Papers published before the year 2000 were excluded. CONCLUSION The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
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Effect of arm cycling and task-oriented exercises on fatigue and upper limb performance in multiple sclerosis: a randomized crossover study. Int J Rehabil Res 2019; 42:300-308. [DOI: 10.1097/mrr.0000000000000362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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