Reaching a better understanding of the control of bimanual movements in older adults

Validating the measurement of upper limb sensorimotor behavior utilizing a tablet in neurologically intact controls and individuals with chronic stroke

BACKGROUND

Intact sensorimotor function of the upper extremity is essential for successfully performing activities of daily living. After a stroke, upper limb function is often compromised and requires rehabilitation. To develop appropriate rehabilitation interventions, sensitive and objective assessments are required. Current clinical measures often lack precision and technological devices (e.g. robotics) that are objective and sensitive to small changes in sensorimotor function are often unsuitable and impractical for performing home-based assessments. Here we developed a portable, tablet-based application capable of quantifying upper limb sensorimotor function after stroke. Our goal was to validate the developed application and accompanying data analysis against previously validated robotic measures of upper limb function in stroke.

METHODS

Twenty individuals with stroke, twenty age-matched older controls, and twenty younger controls completed an eight-target Visually Guided Reaching (VGR) task using a Kinarm Robotic Exoskeleton and a Samsung Galaxy Tablet. Participants completed eighty trials of the VGR task on each device, where each trial consisted of making a reaching movement to one of eight pseudorandomly appearing targets. We calculated several outcome parameters capturing various aspects of sensorimotor behavior (e.g., Reaction Time, Initial Direction Error, Max Speed, and Movement Time) from each reaching movement, and our analyses compared metric consistency between devices. We used the previously validated Kinarm Standard Analysis (KSA) and a custom in-house analysis to calculate each outcome parameter.

RESULTS

We observed strong correlations between the KSA and our custom analysis for all outcome parameters within each participant group, indicating our custom analysis accurately replicates the KSA. Minimal differences were observed for between-device comparisons (tablet vs. robot) in our outcome parameters. Additionally, we observed similar correlations for each device when comparing the Fugl-Meyer Assessment (FMA) scores of individuals with stroke to tablet-derived metrics, demonstrating that the tablet can capture clinically-based elements of upper limb impairment.

CONCLUSIONS

Tablet devices can accurately assess upper limb sensorimotor function in neurologically intact individuals and individuals with stroke. Our findings validate the use of tablets as a cost-effective and efficient assessment tool for upper-limb function after stroke.

Bimanual motor impairments in older adults: an updated systematic review and meta-analysis

This updated systematic review and meta-analysis further examined potential effects of aging on bimanual movements. Forty-seven qualified studies that compared bimanual motor performances between elderly and younger adults were included in this meta-analysis. Moderator variable analyses additionally determined whether altered bimanual motor performances in older adults were different based on the task types (i.e., symmetry vs. asymmetry vs. complex) or outcome measures (i.e., accuracy vs. variability vs. movement time). The random effects model meta-analysis on 80 comparisons from 47 included studies revealed significant negative overall effects indicating more bimanual movement impairments in the elderly adults than younger adults. Moderator variable analyses found that older adults showed more deficits in asymmetrical bimanual movement tasks than symmetrical and complex tasks, and the bimanual movement impairments in the elderly adults included less accurate, more variable, and greater movement execution time than younger adults. These findings suggest that rehabilitation programs for improving motor actions in older adults are necessary to focus on functional recovery of interlimb motor control including advanced motor performances as well coordination.

The effect of task symmetry on bimanual reach-to-grasp movements after cervical spinal cord injury

Injury to the cervical spinal cord results in deficits in bimanual control, reducing functional independence and quality of life. Despite this, little research has investigated the control strategies which underpin bimanual arm/hand movements following cervical spinal cord injury (cSCI). Using kinematics and surface electromyography this study explored how task symmetry affects bimanual control, in patients with an acute cSCI (< 6 m post injury), as they performed naturalistic bimanual reach-to-grasp actions (to objects at 50% and 70% of their maximal reach distance), and how this differs compared to uninjured age-matched controls. Twelve adults with a cSCI (mean age 69.25 years), with lesions at C3–C8, categorized by the American Spinal Injury Impairment Scale (AIS) at C or D and 12 uninjured age-matched controls (AMC) (mean age 69.29 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, less smooth and had longer deceleration phases than AMC (p < 0.05). Participants with a cSCI were less synchronous than AMC at peak velocity and just prior to object pick up (p < 0.05), but both groups ended the movement in a synchronous fashion. Peak muscle activity occurred just prior to object pick up for both groups. While there seems to be a greater reliance on the deceleration phase of the movement, we observed minimal disruption of the more impaired limb on the less impaired limb and no additional effects of task symmetry on bimanual control. Further research is needed to determine how to take advantage of this retained bimanual control in therapy.

A unified framework for coordinated multi-arm motion planning

Coordination is essential in the design of dynamic control strategies for multi-arm robotic systems. Given the complexity of the task and dexterity of the system, coordination constraints can emerge from different levels of planning and control. Primarily, one must consider task-space coordination, where the robots must coordinate with each other, with an object or with a target of interest. Coordination is also necessary in joint space, as the robots should avoid self-collisions at any time. We provide such joint-space coordination by introducing a centralized inverse kinematics (IK) solver under self-collision avoidance constraints, formulated as a quadratic program and solved in real-time. The space of free motion is modeled through a sparse non-linear kernel classification method in a data-driven learning approach. Moreover, we provide multi-arm task-space coordination for both synchronous or asynchronous behaviors. We define a synchronous behavior as that in which the robot arms must coordinate with each other and with a moving object such that they reach for it in synchrony. In contrast, an asynchronous behavior allows for each robot to perform independent point-to-point reaching motions. To transition smoothly from asynchronous to synchronous behaviors and vice versa, we introduce the notion of synchronization allocation. We show how this allocation can be controlled through an external variable, such as the location of the object to be manipulated. Both behaviors and their synchronization allocation are encoded in a single dynamical system. We validate our framework on a dual-arm robotic system and demonstrate that the robots can re-synchronize and adapt the motion of each arm while avoiding self-collision within milliseconds. The speed of control is exploited to intercept fast moving objects whose motion cannot be predicted accurately.

Age-related differences in bimanual movements: A systematic review and meta-analysis

BACKGROUND

With increasing age motor functions decline. The additional challenges of executing bimanual movements further hinder motor functions in older adults. The current systematic review and meta-analysis determined the effects of healthy aging on performance in bimanual movements as compared to younger adults.

METHODS

Our comprehensive search identified 27 studies that reported bimanual movement performance measures. Each study included a between groups comparison of older (mean age=68.79years) and younger adults (mean age=23.14years). The 27 qualified studies generated 40 total outcome measure comparisons: (a) accuracy: 18, (b) variability: 14, and (c) movement time: eight.

RESULTS

Our meta-analysis conducted on a random effects model identified a relatively large negative standardized mean difference effect (ES=-0.93). This indicates that older adults exhibited more impaired bimanual movement performance in comparison to younger adults in our group of studies. Specifically, a moderator variable analysis revealed large negative effects in both accuracy (ES=-0.94) and variability (ES=-1.00), as well as a moderate negative effect (ES=-0.71) for movement time. These findings indicate that older adults displayed reduced accuracy, greater variability, and longer execution time when executing bimanual movements.

CONCLUSION

These meta-analytic findings revealed that aging impairs bimanual movement performance.

Bimanual reach to grasp movements after cervical spinal cord injury

Injury to the cervical spinal cord results in bilateral deficits in arm/hand function reducing functional independence and quality of life. To date little research has been undertaken to investigate control strategies of arm/hand movements following cervical spinal cord injury (cSCI). This study aimed to investigate unimanual and bimanual coordination in patients with acute cSCI using 3D kinematic analysis as they performed naturalistic reach to grasp actions with one hand, or with both hands together (symmetrical task), and compare this to the movement patterns of uninjured younger and older adults. Eighteen adults with a cSCI (mean 61.61 years) with lesions at C4-C8, with an American Spinal Injury Association (ASIA) grade B to D and 16 uninjured younger adults (mean 23.68 years) and sixteen uninjured older adults (mean 70.92 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, and had longer deceleration phases than uninjured participants. These differences were exacerbated during bimanual reach-to-grasp tasks. Maximal grasp aperture was no different between groups, but reached earlier by people with cSCI. Participants with a cSCI were less synchronous than younger and older adults but all groups used the deceleration phase for error correction to end the movement in a synchronous fashion. Overall, this study suggests that after cSCI a level of bimanual coordination is retained. While there seems to be a greater reliance on feedback to produce both the reach to grasp, we observed minimal disruption of the more impaired limb on the less impaired limb. This suggests that bimanual movements should be integrated into therapy.

Eye and hand movement strategies in older adults during a complex reaching task

The kinematics of upper limb movements and the coordination of eye and hand movements are affected by ageing. These age differences are exacerbated when task difficulty is increased, but the exact nature of these differences remains to be established. We examined the performance of 12 older adults (mean age = 74) and 11 younger adults (mean age = 20) on a multi-phase prehension task. Participants had to reach for a target ball with their preferred hand, pick it up and place it in a tray, then reach for a second target ball and place that in the same tray. On half the trials (stabilising condition), participants were required to hold the tray just above the surface of the table with their non-preferred hand and keep it as still as possible. Hand and eye movements were recorded. Older adults took longer to complete their movements and reached lower peak velocities than the younger adults. Group differences were most apparent in the stabilising condition, suggesting that the added complexity had a greater effect on the performance of the older adults than the young. During pickup, older adults preferred to make an eye movement to the next target as soon as possible, but spent longer fixating the current target during placement, when accuracy requirements were higher. These latter observations suggest that older adults employed a task-dependent eye movement strategy, looking quickly to the next target to allow more time for planning and execution when possible, but fixating on their hand and successful placement of the ball when necessary.

Age-related changes in distance from center of mass to center of pressure during one-leg standing

The purpose of this study was to clarify the age-related effects of distances from the center of pressure (COP) to the center of mass (COM) (COP-COM distances) during one-leg standing (OLS) task. Healthy old and young adults (n = 11 each) participated in this study. The authors divided the task into 3 phases (accelerated, decelerated, and steady) based on the relationship between COM and COP. COP-COM distances in the older group were significantly reduced during the accelerated phase, then significantly increased during the decelerated and steady phases. Furthermore, distances during these phases correlated inversely with OLS time. The authors conclude that OLS time is shortened by the larger braking response to COM shifts just after leg-lifting, and the production of larger inertial forces to maintain COM position during the OLS in older individuals.

The effects of ageing and visual field loss on pointing to visual targets

Purpose

To investigate the effect of ageing on visuomotor function and subsequently evaluate the effect of visual field loss on such function in older adults.

Methods

Two experiments were performed: 1) to determine the effect of ageing on visual localisation and subsequent pointing precision, and 2) to determine the effect of visual field loss on these outcome measures. For Experiment 1, we measured visual localisation and pointing precision radially at visual eccentricities of 5, 10 and 15° in 25 older (60–72 years) and 25 younger (20–31 years) adults. In the pointing task, participants were asked to point to a target on a touchscreen at a natural pace that prioritised accuracy of the touch. In Experiment 2, a subset of these tasks were performed at 15° eccentricity under both monocular and binocular conditions, by 8 glaucoma (55–76 years) and 10 approximately age-matched controls (61–72 years).

Results

Visual localisation and pointing precision was unaffected by ageing (p>0.05) and visual field loss (p>0.05), although movement time was increased in glaucoma (p = 0.01).

Conclusion

Visual localisation and pointing precision to high contrast stimuli within the central 15° of vision are unaffected by ageing. Even in the presence of significant visual field loss, older adults with glaucoma are able perform such tasks with reasonable precision provided the target can be perceived and movement time is not restricted.