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Coremans M, Carmeli E, De Bauw I, Essers B, Lemmens R, Verheyden G. Error Enhancement for Upper Limb Rehabilitation in the Chronic Phase after Stroke: A 5-Day Pre-Post Intervention Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:471. [PMID: 38257564 PMCID: PMC10820998 DOI: 10.3390/s24020471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1-Q3)) in (1) UL Fugl-Meyer assessment (1.0 (0.8-3.0), p < 0.001) and action research arm test (2.0 (0.8-2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0-0.3), p < 0.001) and quality of use (0.1 (0.1-0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (-0.45 (-0.81-0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training.
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Affiliation(s)
- Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel;
| | - Ineke De Bauw
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, 3000 Leuven, Belgium;
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
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Elnaggar RK, Alhowimel A, Alotaibi M, Abdrabo MS, Elfakharany MS. Exploring Temporospatial Gait Asymmetry, Dynamic Balance, and Locomotor Capacity After a 12-Week Split-Belt Treadmill Training in Adolescents with Unilateral Cerebral Palsy: A Randomized Clinical Study. Phys Occup Ther Pediatr 2023; 43:660-677. [PMID: 37038368 DOI: 10.1080/01942638.2023.2196334] [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: 05/20/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
AIM To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). METHODS Fifty-two adolescents with ULCP (age: 10-16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity [6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)] were assessed pre- and post-intervention. RESULTS The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p < .001, η2partial = 0.27), LoSdirectional [affected side direction (p = .033, η2partial = 0.09), forward direction (p = .004, η2partial = 0.16), and backward direction (p = .01, η2partial = 0.12)], and LoSoverall (p < .001, η2partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p < .001, η2partial = 0.38), TUDS (p = .032, η2partial = 0.09), 10mSRT (p = .021, η2partial = 0.10)] as compared to the control group. CONCLUSION The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Cairo University, Giza, Egypt
| | - Ahmed Alhowimel
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad Alotaibi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S Abdrabo
- Department of Basic Sciences, Cairo University, Giza, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
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Cho KH, Hong MR, Song WK. Upper-Limb Robot-Assisted Therapy Based on Visual Error Augmentation in Virtual Reality for Motor Recovery and Kinematics after Chronic Hemiparetic Stroke: A Feasibility Study. Healthcare (Basel) 2022; 10:healthcare10071186. [PMID: 35885713 PMCID: PMC9316043 DOI: 10.3390/healthcare10071186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to investigate the effect of upper-limb robot-assisted therapy based on visual error augmentation in virtual reality (UL-RAT-VEAVR) for motor recovery and kinematics after chronic hemiparetic stroke. This study applied a single-group pre- and post-intervention study design. A total of 27 stroke survivors (20 males and 7 females; mean age 54.51 years, mean onset duration 12.7 months) volunteered to participate in this study. UL-RAT-VEAVR was performed three times a week for four weeks, amounting to a total of twelve sessions, in which an end-effector-based robotic arm was used with a visual display environment in virtual reality. Each subject performed a total of 480 point-to-point movements toward 3 direction targets (medial, ipsilateral, and contralateral side) in the visual display environment system while holding the handle of the end-effector-based robotic arm. The visual error (distance to the targets on the monitor) in virtual reality was increased by 5% every week based on the subject’s maximum point-to-point reaching trajectory. Upper-limb motor recovery was measured in all subjects using the Fugl−Meyer Assessment (FMA) upper-limb subscale, the Box and Block Test (BBT), and the Action Research Arm Test (ARAT), before and after training. In addition, a kinematic assessment was also performed before and after training and consisted of time, speed, distance, and curvilinear ratio for point-to-point movement. There were significant improvements in both upper-limb motor function and kinematics after 4 weeks of UL-RAT-VEAVR (p < 0.05). Our results showed that the UL-RAT-VEAVR may have the potential to be used as one of the upper-limb rehabilitation strategies in chronic stroke survivors. Future studies should investigate the clinical effects of the error-augmentation paradigm using an RCT design.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong 27909, Korea;
| | - Mi-Ran Hong
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, 58 Samgaksan-ro, Gangbuk-gu, Seoul 01022, Korea;
| | - Won-Kyung Song
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, 58 Samgaksan-ro, Gangbuk-gu, Seoul 01022, Korea;
- Correspondence: ; Tel.: +82-2-901-1901; Fax: +82-2-901-1910
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Dalla Gasperina S, Roveda L, Pedrocchi A, Braghin F, Gandolla M. Review on Patient-Cooperative Control Strategies for Upper-Limb Rehabilitation Exoskeletons. Front Robot AI 2021; 8:745018. [PMID: 34950707 PMCID: PMC8688994 DOI: 10.3389/frobt.2021.745018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
Technology-supported rehabilitation therapy for neurological patients has gained increasing interest since the last decades. The literature agrees that the goal of robots should be to induce motor plasticity in subjects undergoing rehabilitation treatment by providing the patients with repetitive, intensive, and task-oriented treatment. As a key element, robot controllers should adapt to patients’ status and recovery stage. Thus, the design of effective training modalities and their hardware implementation play a crucial role in robot-assisted rehabilitation and strongly influence the treatment outcome. The objective of this paper is to provide a multi-disciplinary vision of patient-cooperative control strategies for upper-limb rehabilitation exoskeletons to help researchers bridge the gap between human motor control aspects, desired rehabilitation training modalities, and their hardware implementations. To this aim, we propose a three-level classification based on 1) “high-level” training modalities, 2) “low-level” control strategies, and 3) “hardware-level” implementation. Then, we provide examples of literature upper-limb exoskeletons to show how the three levels of implementation have been combined to obtain a given high-level behavior, which is specifically designed to promote motor relearning during the rehabilitation treatment. Finally, we emphasize the need for the development of compliant control strategies, based on the collaboration between the exoskeleton and the wearer, we report the key findings to promote the desired physical human-robot interaction for neurorehabilitation, and we provide insights and suggestions for future works.
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Affiliation(s)
- Stefano Dalla Gasperina
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Loris Roveda
- Istituto Dalle Molle di studi sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Francesco Braghin
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy.,Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
| | - Marta Gandolla
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy.,Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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5
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Short MR, Hernandez-Pavon JC, Jones A, Pons JL. EEG hyperscanning in motor rehabilitation: a position paper. J Neuroeng Rehabil 2021; 18:98. [PMID: 34112208 PMCID: PMC8194127 DOI: 10.1186/s12984-021-00892-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Studying the human brain during interpersonal interaction allows us to answer many questions related to motor control and cognition. For instance, what happens in the brain when two people walking side by side begin to change their gait and match cadences? Adapted from the neuroimaging techniques used in single-brain measurements, hyperscanning (HS) is a technique used to measure brain activity from two or more individuals simultaneously. Thus far, HS has primarily focused on healthy participants during social interactions in order to characterize inter-brain dynamics. Here, we advocate for expanding the use of this electroencephalography hyperscanning (EEG-HS) technique to rehabilitation paradigms in individuals with neurological diagnoses, namely stroke, spinal cord injury (SCI), Parkinson's disease (PD), and traumatic brain injury (TBI). We claim that EEG-HS in patient populations with impaired motor function is particularly relevant and could provide additional insight on neural dynamics, optimizing rehabilitation strategies for each individual patient. In addition, we discuss future technologies related to EEG-HS that could be developed for use in the clinic as well as technical limitations to be considered in these proposed settings.
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Affiliation(s)
- Matthew R Short
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Julio C Hernandez-Pavon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Jones
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA
| | - Jose L Pons
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA. .,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Manjunatha H, Pareek S, Jujjavarapu SS, Ghobadi M, Kesavadas T, Esfahani ET. Upper Limb Home-Based Robotic Rehabilitation During COVID-19 Outbreak. Front Robot AI 2021; 8:612834. [PMID: 34109220 PMCID: PMC8181124 DOI: 10.3389/frobt.2021.612834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/03/2021] [Indexed: 12/23/2022] Open
Abstract
The coronavirus disease (COVID-19) outbreak requires rapid reshaping of rehabilitation services to include patients recovering from severe COVID-19 with post-intensive care syndromes, which results in physical deconditioning and cognitive impairments, patients with comorbid conditions, and other patients requiring physical therapy during the outbreak with no or limited access to hospital and rehabilitation centers. Considering the access barriers to quality rehabilitation settings and services imposed by social distancing and stay-at-home orders, these patients can be benefited from providing access to affordable and good quality care through home-based rehabilitation. The success of such treatment will depend highly on the intensity of the therapy and effort invested by the patient. Monitoring patients' compliance and designing a home-based rehabilitation that can mentally engage them are the critical elements in home-based therapy's success. Hence, we study the state-of-the-art telerehabilitation frameworks and robotic devices, and comment about a hybrid model that can use existing telerehabilitation framework and home-based robotic devices for treatment and simultaneously assess patient's progress remotely. Second, we comment on the patients' social support and engagement, which is critical for the success of telerehabilitation service. As the therapists are not physically present to guide the patients, we also discuss the adaptability requirement of home-based telerehabilitation. Finally, we suggest that the reformed rehabilitation services should consider both home-based solutions for enhancing the activities of daily living and an on-demand ambulatory rehabilitation unit for extensive training where we can monitor both cognitive and motor performance of the patients remotely.
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Affiliation(s)
- Hemanth Manjunatha
- Human in the Loop Systems Laboratory, Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, United States
| | - Shrey Pareek
- Health Care Engineering Systems Center, University of Illinois Urbana-Champaign, Champaign, IL, United States
| | - Sri Sadhan Jujjavarapu
- Human in the Loop Systems Laboratory, Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, United States
| | - Mostafa Ghobadi
- Human in the Loop Systems Laboratory, Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, United States
| | - Thenkurussi Kesavadas
- Health Care Engineering Systems Center, University of Illinois Urbana-Champaign, Champaign, IL, United States
| | - Ehsan T Esfahani
- Human in the Loop Systems Laboratory, Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, United States
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Keshner EA, Lamontagne A. The Untapped Potential of Virtual Reality in Rehabilitation of Balance and Gait in Neurological Disorders. FRONTIERS IN VIRTUAL REALITY 2021; 2:641650. [PMID: 33860281 PMCID: PMC8046008 DOI: 10.3389/frvir.2021.641650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Dynamic systems theory transformed our understanding of motor control by recognizing the continual interaction between the organism and the environment. Movement could no longer be visualized simply as a response to a pattern of stimuli or as a demonstration of prior intent; movement is context dependent and is continuously reshaped by the ongoing dynamics of the world around us. Virtual reality is one methodological variable that allows us to control and manipulate that environmental context. A large body of literature exists to support the impact of visual flow, visual conditions, and visual perception on the planning and execution of movement. In rehabilitative practice, however, this technology has been employed mostly as a tool for motivation and enjoyment of physical exercise. The opportunity to modulate motor behavior through the parameters of the virtual world is often ignored in practice. In this article we present the results of experiments from our laboratories and from others demonstrating that presenting particular characteristics of the virtual world through different sensory modalities will modify balance and locomotor behavior. We will discuss how movement in the virtual world opens a window into the motor planning processes and informs us about the relative weighting of visual and somatosensory signals. Finally, we discuss how these findings should influence future treatment design.
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Affiliation(s)
- Emily A. Keshner
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
- Correspondence: Emily A. Keshner,
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Virtual Reality and Mobility Laboratory, CISSS Laval—Jewish Rehabilitation Hospital Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, QC, Canada
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Abdel Majeed Y, Awadalla S, Patton JL. Effects of robot viscous forces on arm movements in chronic stroke survivors: a randomized crossover study. J Neuroeng Rehabil 2020; 17:156. [PMID: 33234156 PMCID: PMC7685605 DOI: 10.1186/s12984-020-00782-3] [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] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background Our previous work showed that speed is linked to the ability to recover in chronic stroke survivors. Participants moving faster on the first day of a 3-week study had greater improvements on the Wolf Motor Function Test. Methods We examined the effects of three candidate speed-modifying fields in a crossover design: negative viscosity, positive viscosity, and a “breakthrough” force that vanishes after speed exceeds an individualized threshold. Results Negative viscosity resulted in a significant speed increase when it was on. No lasting after effects on movement speed were observed from any of these treatments, however, training with negative viscosity led to significant improvements in movement accuracy and smoothness. Conclusions Our results suggest that negative viscosity could be used as a treatment to augment the training process while still allowing participants to make their own volitional motions in practice. Trial registration This study was approved by the Institutional Review Boards at Northwestern University (STU00206579) and the University of Illinois at Chicago (2018-1251).
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Affiliation(s)
- Yazan Abdel Majeed
- Richard and Loan Hill Bioengineering Department, University of Illinois at Chicago, Morgan St, 60607, Chicago, USA.,Shirley Ryan AbilityLab, Erie St, 60611, Chicago, USA
| | - Saria Awadalla
- School of Public Health, University of Illinois at Chicago, Taylor St, 60612, Chicago, USA
| | - James L Patton
- Richard and Loan Hill Bioengineering Department, University of Illinois at Chicago, Morgan St, 60607, Chicago, USA. .,Shirley Ryan AbilityLab, Erie St, 60611, Chicago, USA.
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Fasola J, Kannape OA, Bouri M, Bleuler H, Blanke O. Error Augmentation Improves Visuomotor Adaptation during a Full-Body Balance Task. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1529-1533. [PMID: 31946185 DOI: 10.1109/embc.2019.8857523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Visual amplification of kinematic errors has successfully been applied to improve performance for upper limb movements. In this study, we investigated whether visual error augmentation can promote faster adaptation during a full-body balance task. Healthy volunteers controlled a cursor by shifting their weight on the THERA-Trainer coro platform. Two experimental groups and one control group were asked to reach visual targets. For the two experimental groups, the cursor's deviation from the ideal straight line trajectory was augmented by a gain of 1.5 and 2, respectively, while the control group did not experience visual error amplification (gain of 1). Error augmentation with a gain of 1.5 enhanced the speed and the amount of motor adaptation, while the highest gain might have decreased the stability of adaptation. As visual feedback is commonly used in balance training, our preliminary data suggest that integrating visual error augmentation in postural exercises may facilitate balance control.
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Hwang IS, Hu CL, Yang ZR, Lin YT, Chen YC. Improving Precision Force Control With Low-Frequency Error Amplification Feedback: Behavioral and Neurophysiological Mechanisms. Front Physiol 2019; 10:131. [PMID: 30842742 PMCID: PMC6391708 DOI: 10.3389/fphys.2019.00131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 02/01/2019] [Indexed: 11/13/2022] Open
Abstract
Although error amplification (EA) feedback has been shown to improve performance on visuomotor tasks, the challenge of EA is that it concurrently magnifies task-irrelevant information that may impair visuomotor control. The purpose of this study was to improve the force control in a static task by preclusion of high-oscillatory components in EA feedback that cannot be timely used for error correction by the visuomotor system. Along with motor unit behaviors and corticomuscular coherence, force fluctuations (Fc) were modeled with non-linear SDA to contrast the reliance of the feedback process and underlying neurophysiological mechanisms by using real feedback, EA, and low-frequency error amplification (LF-EA). During the static force task in the experiment, the EA feedback virtually potentiated the size of visual error, whereas the LF-EA did not channel high-frequency errors above 0.8 Hz into the amplification process. The results showed that task accuracy was greater with the LF-EA than with the real and EA feedback modes, and that LF-EA led to smaller and more complex Fc. LF-EA generally led to smaller SDA variables of Fc (critical time points, critical point of Fc, the short-term effective diffusion coefficient, and short-term exponent scaling) than did real feedback and EA. The use of LF-EA feedback increased the irregularity of the ISIs of MUs but decreased the RMS of the mean discharge rate, estimated with pooled MU spike trains. Beta-range EEG–EMG coherence spectra (13–35 Hz) in the LF-EA condition were the greatest among the three feedback conditions. In summary, amplification of low-frequency errors improves force control by shifting the relative significances of the feedforward and feedback processes. The functional benefit arises from the increase in the common descending drive to promote a stable state of MU discharges.
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Affiliation(s)
- Ing-Shiou Hwang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ling Hu
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zong-Ru Yang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Ting Lin
- Physical Education Office, Asian University, Taichung, Taiwan
| | - Yi-Ching Chen
- Department of Physical Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan.,Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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11
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Milot MH, Marchal-Crespo L, Beaulieu LD, Reinkensmeyer DJ, Cramer SC. Neural circuits activated by error amplification and haptic guidance training techniques during performance of a timing-based motor task by healthy individuals. Exp Brain Res 2018; 236:3085-3099. [PMID: 30132040 PMCID: PMC6223879 DOI: 10.1007/s00221-018-5365-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/17/2018] [Indexed: 01/07/2023]
Abstract
To promote motor learning, robotic devices have been used to improve subjects' performance by guiding desired movements (haptic guidance-HG) or by artificially increasing movement errors to foster a more rapid learning (error amplification-EA). To better understand the neurophysiological basis of motor learning, a few studies have evaluated brain regions activated during EA/HG, but none has compared both approaches. The goal of this study was to investigate using fMRI which brain networks were activated during a single training session of HG/EA in healthy adults learning to play a computerized pinball-like timing task. Subjects had to trigger a robotic device by flexing their wrist at the correct timing to activate a virtual flipper and hit a falling ball towards randomly positioned targets. During training with HG/EA, subjects' timing errors were decreased/increased, respectively, by the robotic device to delay or accelerate their wrist movement. The results showed that at the beginning of the training period with HG/EA, an error-detection network, including cerebellum and angular gyrus, was activated, consistent with subjects recognizing discrepancies between their intended actions and the actual movement timing. At the end of the training period, an error-detection network was still present for EA, while a memory consolidation/automatization network (caudate head and parahippocampal gyrus) was activated for HG. The results indicate that training movement with various kinds of robotic input relies on different brain networks. Better understanding the neurophysiological underpinnings of brain processes during HG/EA could prove useful for optimizing rehabilitative movement training for people with different patterns of brain damage.
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Affiliation(s)
- Marie-Hélène Milot
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Pavillon Gérald-Lasalle, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Laura Marchal-Crespo
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems IRIS, ETH Zurich, TAN E3 Tannenstrasse 1, 8092, Zurich, Switzerland.,Gerontechnology and Rehabilitation Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Louis-David Beaulieu
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Pavillon Gérald-Lasalle, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - David J Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California, 4200 Engineering Gateway, Irvine, CA, 92697, USA.,Department of Biomedical Engineering, University of California, 3120 Natural Sciences II, Irvine, CA, 92697, USA
| | - Steven C Cramer
- Department of Mechanical and Aerospace Engineering, University of California, 4200 Engineering Gateway, Irvine, CA, 92697, USA.,Department of Biomedical Engineering, University of California, 3120 Natural Sciences II, Irvine, CA, 92697, USA.,Department of Anatomy and Neurobiology, University of California, 364 Med Surge II, Irvine, CA, 92697, USA.,Department of Neurology, University of California, 200 S. Manchester AVE, Orange, CA, 92868, USA
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Liu LY, Li Y, Lamontagne A. The effects of error-augmentation versus error-reduction paradigms in robotic therapy to enhance upper extremity performance and recovery post-stroke: a systematic review. J Neuroeng Rehabil 2018; 15:65. [PMID: 29973250 PMCID: PMC6033222 DOI: 10.1186/s12984-018-0408-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
Despite upper extremity function playing a crucial role in maintaining one's independence in activities of daily living, upper extremity impairments remain one of the most prevalent post-stroke deficits. To enhance the upper extremity motor recovery and performance among stroke survivors, two training paradigms in the fields of robotics therapy involving modifying haptic feedback were proposed: the error-augmentation (EA) and error-reduction (ER) paradigms. There is a lack of consensus, however, as to which of the two paradigms yields superior training effects. This systematic review aimed to determine (i) whether EA is more effective than conventional repetitive practice; (ii) whether ER is more effective than conventional repetitive practice and; (iii) whether EA is more effective than ER in improving post-stroke upper extremity motor recovery and performance. The study search and selection process as well as the ratings of methodological quality of the articles were conducted by two authors separately, and the results were then compared and discussed among the two reviewers. Findings were analyzed and synthesized using the level of evidence. By August 1st 2017, 269 articles were found after searching 6 databases, and 13 were selected based on criteria such as sample size, type of participants recruited, type of interventions used, etc. Results suggest, with a moderate level of evidence, that EA is overall more effective than conventional repetitive practice (motor recovery and performance) and ER (motor performance only), while ER appears to be no more effective than conventional repetitive practice. However, intervention effects as measured using clinical outcomes were under most instance not 'clinically meaningful' and effect sizes were modest. While stronger evidence is required to further support the efficacy of error modification therapies, the influence of factors related to the delivery of the intervention (such as intensity, duration) and personal factors (such as stroke severity and time of stroke onset) deserves further investigations as well.
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Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada. .,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada.
| | - Youlin Li
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada
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Improvement in Hand Trajectory of Reaching Movements by Error-Augmentation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 29564773 DOI: 10.1007/5584_2018_151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The purpose of this study was to investigate whether adaptive responses to error-augmentation force fields, would decrease the trajectory errors in hand-reaching movements in multiple directions in healthy individuals. The study was conducted, as a randomized controlled trial, in 41 healthy subjects. The study group trained on a 3D robotic system, applying error-augmenting forces on the hand during the execution of tasks. The control group carried out the same protocol in null-field conditions. A mixed-model ANOVA was implemented to investigate the interaction between groups and time, and changes in outcome measures within groups. The findings were that there was a significant interaction effect for group × time in terms of the magnitude of movement errors across game-sets. The trajectory error of the study group significantly decreased from 0.035 ± 0.013 m at baseline to 0.029 ± 0.011 m at a follow-up, which amounted to a 14.8% improvement. The degree of movement errors were not significantly changed within a game-set. We conclude that practicing hand-reaching movement in multiple random directions, using the error-augmentation technique, decreases the deviation of the hand trajectory from a straight line. However, this type of training prevents the generalizability of adaptation between consecutive reaching movements. Further studies should investigate the feasibility of this training method for rehabilitation of post-stroke individuals.
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Chen YC, Lin YT, Chang GC, Hwang IS. Perceptual influences of error size on voluntary force control during a compound sinusoidal force task. Hum Mov Sci 2017; 56:46-53. [PMID: 29101823 DOI: 10.1016/j.humov.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 09/25/2017] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
Visual feedback that provides error information is critical to task quality and motor adjustments. This study investigated how the size of perceived errors via visual feedback affected rate control and force gradation strategy of a designate force task. Fourteen young adults coupled force exertions to a compound sinusoidal signal (0.2 Hz and 0.5 Hz) that fluctuated around a mean level of 30% of maximal voluntary contraction, when the size of execution errors were differently scaled with the error amplification factors. In the low (LAF) and high (HAF) amplification factor conditions, the execution errors in the visual display half and double of the real errors, respectively. The visualized error was the real errors in the medium amplification factor (MAF) condition. In addition to a phase-lead of force output, the LAF condition that virtually reduced the size of error feedback associated with a poorer task accuracy than the MAF and HAF conditions. Virtual increase in error size of visual feedback selectively suppressed the fast target force at 0.5 Hz. In addition, complexity and high-frequency components (>0.75 Hz) of force outputs multiplied progressively with increasing error size. Error-enhancing feedback suppressed fast target force, accentuating the use of error information to tune force output, whereas error-reducing feedback enhanced fast target force in favor of predictive force control.
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Affiliation(s)
- Yi-Ching Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung City 40201, Taiwan; Physical Therapy Room, Chung Shan Medical University Hospital, Taichung City 40201, Taiwan
| | - Yen-Ting Lin
- Physical Education Office, Asian University, Taichung City 41354, Taiwan
| | - Gwo-Ching Chang
- Department of Information Engineering, I-Shou University, Kaohsiung City 84001, Taiwan
| | - Ing-Shiou Hwang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan.
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Chen YC, Lin YT, Chang GC, Hwang IS. Paradigm Shifts in Voluntary Force Control and Motor Unit Behaviors with the Manipulated Size of Visual Error Perception. Front Physiol 2017; 8:140. [PMID: 28348530 PMCID: PMC5346555 DOI: 10.3389/fphys.2017.00140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/23/2017] [Indexed: 12/13/2022] Open
Abstract
The detection of error information is an essential prerequisite of a feedback-based movement. This study investigated the differential behavior and neurophysiological mechanisms of a cyclic force-tracking task using error-reducing and error-enhancing feedback. The discharge patterns of a relatively large number of motor units (MUs) were assessed with custom-designed multi-channel surface electromyography following mathematical decomposition of the experimentally-measured signals. Force characteristics, force-discharge relation, and phase-locking cortical activities in the contralateral motor cortex to individual MUs were contrasted among the low (LSF), normal (NSF), and high scaling factor (HSF) conditions, in which the sizes of online execution errors were displayed with various amplification ratios. Along with a spectral shift of the force output toward a lower band, force output with a more phase-lead became less irregular, and tracking accuracy was worse in the LSF condition than in the HSF condition. The coherent discharge of high phasic (HP) MUs with the target signal was greater, and inter-spike intervals were larger, in the LSF condition than in the HSF condition. Force-tracking in the LSF condition manifested with stronger phase-locked EEG activity in the contralateral motor cortex to discharge of the (HP) MUs (LSF > NSF, HSF). The coherent discharge of the (HP) MUs during the cyclic force-tracking predominated the force-discharge relation, which increased inversely to the error scaling factor. In conclusion, the size of visualized error gates motor unit discharge, force-discharge relation, and the relative influences of the feedback and feedforward processes on force control. A smaller visualized error size favors voluntary force control using a feedforward process, in relation to a selective central modulation that enhance the coherent discharge of (HP) MUs.
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Affiliation(s)
- Yi-Ching Chen
- School of Physical Therapy, Chung Shan Medical UniversityTaichung, Taiwan; Physical Therapy Room, Chung Shan Medical University HospitalTaichung, Taiwan
| | - Yen-Ting Lin
- Physical Education Room, Asian University Taichung, Taiwan
| | - Gwo-Ching Chang
- Department of Information Engineering, I-Shou University Kaohsiung, Taiwan
| | - Ing-Shiou Hwang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung UniversityTainan, Taiwan; Department of Physical Therapy, College of Medicine, National Cheng Kung UniversityTainan, Taiwan
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