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Wu M, Kim J, Gaebler-Spira D. Improving trunk posture control in children with CP through a cable-driven robotic hippotherapy: A randomized controlled feasibility study. Gait Posture 2024; 113:209-214. [PMID: 38943825 PMCID: PMC11381160 DOI: 10.1016/j.gaitpost.2024.06.020] [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: 10/22/2023] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Many children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. RESEARCH QUESTION The goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. METHOD Ten children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. RESULTS The change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. -1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). SIGNIFICANCE Results from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP.
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Affiliation(s)
- Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
| | - Janis Kim
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Deborah Gaebler-Spira
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Lee SY, Seo J, Seo CH, Cho YS, Joo SY. Gait Performance and Brain Activity Are Improved by Gait Automatization during Robot-Assisted Gait Training in Patients with Burns: A Prospective, Randomized, Single-Blinded Study. J Clin Med 2024; 13:4838. [PMID: 39200980 PMCID: PMC11355861 DOI: 10.3390/jcm13164838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Patients with lower extremity burn injuries have decreased gait function. Gait dysfunctions are compensated by activation of executive areas such as the prefrontal cortex (PFC). Although robot-assisted gait training (RAGT) can improve gait function, the training mechanisms of RAGT are unknown. We aimed to determine the clinical effects of RAGT in patients with burns and investigate their underlying mechanisms. Methods: This single-blind, randomized controlled trial involved 54 patients with lower extremity burns. The RAGT group underwent RAGT using SUBAR® and conventional training. The control (CON) group underwent only conventional training. The primary outcome was cortical activity measured using a functional near-infrared spectroscopy device before and after 8 weeks of training to confirm the compensatory effect of gait dysfunction. The secondary outcomes were the functional ambulation category (FAC) to evaluate gait performance, 6-min walking test (6 MWT) distance to measure gait speed, isometric force and range of motion (ROM) of lower extremities to evaluate physical function, and the visual analog scale (VAS) score to evaluate subjective pain during gait. Results: PFC activation during the gait phase in the RAGT group decreased significantly compared with that of the CON. The VAS score decreased and FAC score improved after 8 weeks of training in both groups. The 6 MWT scores, isometric strengths (the left knee flexor and bilateral ankle plantar flexors), and the ROMs (the extensions of bilateral hip and bilateral knee) of the RAGT group were significantly improved compared with those of the CON. RAGT improved gait speed, lower extremity ROMs, and lower extremity muscles strengths in patients with burns. Conclusions: The improvement in gait speed and cerebral blood flow evaluation results suggests that the automatization of gait is related to the treatment mechanism during RAGT.
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Affiliation(s)
- Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon 14584, Republic of Korea;
| | - Jisu Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 01000, Republic of Korea; (J.S.); (C.H.S.); (Y.S.C.)
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 01000, Republic of Korea; (J.S.); (C.H.S.); (Y.S.C.)
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 01000, Republic of Korea; (J.S.); (C.H.S.); (Y.S.C.)
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 01000, Republic of Korea; (J.S.); (C.H.S.); (Y.S.C.)
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Rejc E, Bowersock C, Pisolkar T, Omofuma I, Luna T, Khan M, Santamaria V, Ugiliweneza B, Angeli CA, Forrest GF, Stein J, Agrawal S, Harkema SJ. Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study. Neurotrauma Rep 2024; 5:277-292. [PMID: 38515546 PMCID: PMC10956531 DOI: 10.1089/neur.2024.0013] [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] [Indexed: 03/23/2024] Open
Abstract
Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (n = 5) or high-thoracic (n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Medicine, University of Udine, Udine, Italy
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Isirame Omofuma
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Moiz Khan
- Department of Radiology at BWH, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Santamaria
- Department of Physical Therapy, New York Medical College, Valhalla, New York, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Hinnekens E, Berret B, Morard E, Do MC, Barbu-Roth M, Teulier C. Optimization of modularity during development to simplify walking control across multiple steps. Front Neural Circuits 2024; 17:1340298. [PMID: 38343616 PMCID: PMC10853381 DOI: 10.3389/fncir.2023.1340298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
Introduction Walking in adults relies on a small number of modules, reducing the number of degrees of freedom that needs to be regulated by the central nervous system (CNS). While walking in toddlers seems to also involve a small number of modules when considering averaged or single-step data, toddlers produce a high amount of variability across strides, and the extent to which this variability interacts with modularity remains unclear. Methods Electromyographic activity from 10 bilateral lower limb muscles was recorded in both adults (n = 12) and toddlers (n = 12) over 8 gait cycles. Toddlers were recorded while walking independently and while being supported by an adult. This condition was implemented to assess if motor variability persisted with reduced balance constraints, suggesting a potential central origin rather than reliance on peripheral regulations. We used non-negative matrix factorization to model the underlying modular command with the Space-by-Time Decomposition method, with or without averaging data, and compared the modular organization of toddlers and adults during multiple walking strides. Results Toddlers were more variable in both conditions (i.e. independent walking and supported by an adult) and required significantly more modules to account for their greater stride-by-stride variability. Activations of these modules varied more across strides and were less parsimonious compared to adults, even with diminished balance constraints. Discussion The findings suggest that modular control of locomotion evolves between toddlerhood and adulthood as the organism develops and practices. Adults seem to be able to generate several strides of walking with less modules than toddlers. The persistence of variability in toddlers when balance constraints were lowered suggests a link with the ability to explore rather than with corrective mechanisms. In conclusion, the capacity of new walkers to flexibly activate their motor command suggests a broader range of possible actions, though distinguishing between modular and non-modular inputs remains challenging.
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Affiliation(s)
- Elodie Hinnekens
- Université Paris-Saclay, CIAMS, Orsay, France
- Université Paris-Saclay, CIAMS, Orléans, France
| | - Bastien Berret
- Université Paris-Saclay, CIAMS, Orsay, France
- Université Paris-Saclay, CIAMS, Orléans, France
| | - Estelle Morard
- Université Paris-Saclay, CIAMS, Orsay, France
- Université Paris-Saclay, CIAMS, Orléans, France
| | - Manh-Cuong Do
- Université Paris-Saclay, CIAMS, Orsay, France
- Université Paris-Saclay, CIAMS, Orléans, France
| | - Marianne Barbu-Roth
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, Paris, France
| | - Caroline Teulier
- Université Paris-Saclay, CIAMS, Orsay, France
- Université Paris-Saclay, CIAMS, Orléans, France
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Edgerton VR, Gad P. Spinal automaticity of movement control and its role in recovering function after spinal injury. Expert Rev Neurother 2022; 22:655-667. [PMID: 36043398 DOI: 10.1080/14737175.2022.2115359] [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: 11/04/2022]
Abstract
INTRODUCTION The significance of the spinal circuitry in controlling postural and locomotor functions largely re-emerged in the mid-1970s under the leadership of Sten Grillner, demonstrating key phenomena of "central pattern generation" and "fictive locomotion" with an evolutionary perspective. These concepts raised the question of how much function can be recovered after paralysis, given the intrinsic automaticity of spinal networks in injured and uninjured states in adults. AREAS COVERED This review explores biological mechanisms governing spinal control of movements such as posture and locomotion. We focus on concepts that have evolved from experiments performed over the past decade. Rather than a comprehensive review of the vast literature on the neural control of posture and locomotion, we focus on the various mechanisms underlying functional automaticity, and their clinical relevance. EXPERT OPINION We propose that multiple combinations of sensory mechanoreceptors linked to proprioception generate an infinite number of different sensory ensembles, having species-specific meaning and extensive influence in controlling posture and locomotion. These sensory ensembles are translated as a probabilistic phenomenon into highly specific but indeterminate actions. Therefore, we opine that spinal translation of these ensembles in real-time plays a central role in the automaticity of motor control in individuals with and without severe neuromotor dysfunction.
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Affiliation(s)
- V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA 90095 USA.,Department of Neurosurgery, University of California, Los Angeles, CA 90095 USA.,Brain Research Institute, University of California, Los Angeles, CA 90095 USA.,Institut Guttmann. Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, 08916 Badalona, Spain
| | - Parag Gad
- Department of Neurobiology, University of California, Los Angeles, CA 90095 USA
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Ghanati HA, Letafatkar A, Shojaedin S, Hadadnezhad M, Schöllhorn WI. Comparing the Effects of Differential Learning, Self-Controlled Feedback, and External Focus of Attention Training on Biomechanical Risk Factors of Anterior Cruciate Ligament (ACL) in Athletes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610052. [PMID: 36011685 PMCID: PMC9408147 DOI: 10.3390/ijerph191610052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 05/13/2023]
Abstract
The current study aimed to compare the possible effects of differential learning strategy, self-controlled feedback, and external focus of attention on kinetic and kinematic risk factors of anterior cruciate ligament (ACL) injury in athletes. Forty-eight male athletes from three sports of handball, volleyball and basketball were selected for this study and were randomly divided into four groups: differential learning (n = 12), self-control feedback (n = 12), external focus (n = 12), and control (n = 12) group. All groups followed the intervention for eight weeks with three sessions per week. Data were analyzed by means of 4 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. A significant group × time interaction and the main effect of time was found for most kinetic and kinematic variables. The main effect of the group was significant only at the knee abduction angle. Differential learning and external focus of attention methods positively reduced the kinetic and kinematic variables that are considered risk factors for ACL injury. However, the effect sizes (Cohen's d) for the changes in most of the variables were larger for the differential learning group. Tailoring the boundary conditions that are based on the manipulations created in the exercise through variability and variety of movements associated with differential learning methods rather than repeating movements could reduce the risk of ACL injury.
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Affiliation(s)
- Hadi Abbaszadeh Ghanati
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Sadredin Shojaedin
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Malihe Hadadnezhad
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Wolfgang I. Schöllhorn
- Department for Training and Movement Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
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Agarwal R, Hussain A, Skm V, Campolo D. Haptic feedback system for postural adaptation during robotic rehabilitation of upper limb. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176132 DOI: 10.1109/icorr55369.2022.9896531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although trunk compensation during stroke rehabilitation is widely studied, the proposed solutions primarily include a trunk constraint, which has several disadvantages. In this study, we have proposed a haptic feedback-based system for postural training during upper-limb motor rehabilitation. We have tested the proposed system on six healthy people in this preliminary study. Participants performed a simple 1-dimensional reaching task while their posture was being monitored. They received haptic feedback based on their trunk posture. Preliminary results revealed a significant decline in postural error (p<0.05) after the haptic-based training. The reduction in error was maintained even after haptic feedback was turned off. This study shows that haptic feedback could be a viable alternative to the traditional constraint-based methods for postural adaptation. Additional studies need to be conducted to further evaluate the influence of using such feedback strategies.
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Stochastic spinal neuromodulation tunes the intrinsic logic of spinal neural networks. Exp Neurol 2022; 355:114138. [DOI: 10.1016/j.expneurol.2022.114138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
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Baylo-Marín O, Flores Á, García-Alías G. Long-term rehabilitation reduces task error variability in cervical spinal cord contused rats. Exp Neurol 2021; 348:113928. [PMID: 34813841 DOI: 10.1016/j.expneurol.2021.113928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/27/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
To promote skilled forelimb function following a spinal cord injury, we have evaluated whether long-term voluntary sensorimotor rehabilitation can promote substantial reaching and grasping recovery. Long-Evans rats were trained to reach single pellets and then received a moderate 100 kdyn contusion to the C5 lateral funiculi. During the first eight months post-injury, a group of animals was enrolled in daily skilled reaching rehabilitation consisting of grabbing and manipulating seeds from the bottom of a grid. Single-pellet reaching and grasping recovery was tested biweekly throughout the functional follow-up and the recovery was compared to a second group of contused but non-rehabilitated animals. Following the injury, reaching and grasping success dropped to zero in both groups and remained absent for three months post-injury, followed by a slight recovery that remained constant until the end of the follow-up. No differences in reaching success were found between groups. Nevertheless, the type of gesture errors in the failed attempts were categorized and scored. The errors ranged from the animal's inability to lift the paw and initiate the movement to the final stage of the attempt, in which the pellet falls during grasping and retraction of the paw towards the mouth. Both groups of animals exhibited similar types of errors but the animals with rehabilitation showed less error variability and those that occurred at the latest stages of the attempt predominated compared to those performed by the non-trained animals. Histological examination of the injury showed that injury severity was similar between groups and that the damage was circumscribed to the site of impact, affecting mainly the dorsal and medial region of the lateral funiculi, with preservation of the dorsal component of the corticospinal tract and the interneurons and motoneurons of the spinal segments beyond the site of injury. The results indicate that activity-dependent plasticity driven by voluntary rehabilitation decreases task error variability and drives the recovery of the movement gestures. However, the plasticity achieved is insufficient to attain full functional recovery to successfully reach, grasp and release the pellets in the mouth, indicating the necessity for additional interventional therapies to promote repair.
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Affiliation(s)
- Olaia Baylo-Marín
- Department of Cell Biology, Physiology and Immunology & Institute of Neuroscience, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - África Flores
- Department of Cell Biology, Physiology and Immunology & Institute of Neuroscience, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Guillermo García-Alías
- Department of Cell Biology, Physiology and Immunology & Institute of Neuroscience, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Institut Guttmann de Neurorehabilitació, Badalona, Spain.
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Gendy A, Demasi M, Patton J. Human-Human connected dyads learning a visuomotor rotation in a movement tracking task . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6613-6618. [PMID: 34892624 DOI: 10.1109/embc46164.2021.9631092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dyads are couples of collaborative humans that perform a task together while mechanically connected by a robot. As shown in different studies [1] [2], haptic interaction can be beneficial for motor performance so that the dyad outperforms the subject executing the task alone. These achievements are hypothesized to be the result of the haptic communication engaged between the subjects that triggers internal forward models. In this way the dyad's components can attain additional information about the task, hence improving their performance. Here we show a novel dual robotic system, called Pantograph, used in a pilot study to understand the influence that the nature of the partner has on the learning process. The main hypothesis that we claim is that a Novice-Novice type of interaction is more beneficial, in terms of speed of learning, with respect to an Expert-Novice type of interaction. The results show time constants equal to 5.53 ± 2.79 and 8.45 ± 3.78 for the Novice-Novice and Expert-Novice group, respectively. However, the p-value obtained was p = 7.54%. Hence, we can not generalize our results, but this research study shows how haptic communication between interacting humans allows for motor learning and how the nature of the subjects could be an important factor of the learning process.
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Swann-Thomsen HE, Viall DD, Brumley MR. Acute intrathecal administration of quipazine elicits air-stepping behavior. Behav Pharmacol 2021; 32:259-264. [PMID: 33595953 PMCID: PMC8119288 DOI: 10.1097/fbp.0000000000000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Serotonin plays a pivotal role in the initiation and modulation of locomotor behavior in the intact animal, as well as following spinal cord injury. Quipazine, a serotonin 2 receptor agonist, has been used successfully to initiate and restore motor behavior in rodents. Although evidence suggests that the effects of quipazine are spinally mediated, it is unclear whether intrathecal (IT) quipazine administration alone is enough to activate locomotor-like activity or whether additional stimulation is needed. Thus, the current study examined the effects of IT administration of quipazine in postnatal day 1 rats in two separate experiments. In experiment 1, quipazine (0.1, 0.3, or 1.0 mg/kg) was dissolved in saline and administered via IT injection to the thoracolumbar cord. There was no significant effect of drug on hindlimb alternating stepping. In experiment 2, quipazine (0.3 or 1.0 mg/kg) was dissolved in a polysorbate 80-saline solution (Tween 80) and administered via IT injection. Polysorbate 80 was used to disrupt the blood-brain barrier to facilitate absorption of quipazine. The injection was followed by tail pinch 5 minutes post-injection. A significant increase in the percentage of hindlimb alternating steps was found in subjects treated with 0.3 mg/kg quipazine, suggesting that IT quipazine when combined with sensory stimulation to the spinal cord, facilitates locomotor-like behavior. These findings indicate that dissolving the drug in polysorbate 80 rather than saline may heighten the effects of IT quipazine. Collectively, this study provides clarification on the role of quipazine in evoking spinally-mediated locomotor behavior.
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Abstract
Even for a stereotyped task, sensorimotor behavior is generally variable due to noise, redundancy, adaptability, learning or plasticity. The sources and significance of different kinds of behavioral variability have attracted considerable attention in recent years. However, the idea that part of this variability depends on unique individual strategies has been explored to a lesser extent. In particular, the notion of style recurs infrequently in the literature on sensorimotor behavior. In general use, style refers to a distinctive manner or custom of behaving oneself or of doing something, especially one that is typical of a person, group of people, place, context, or period. The application of the term to the domain of perceptual and motor phenomenology opens new perspectives on the nature of behavioral variability, perspectives that are complementary to those typically considered in the studies of sensorimotor variability. In particular, the concept of style may help toward the development of personalised physiology and medicine by providing markers of individual behaviour and response to different stimuli or treatments. Here, we cover some potential applications of the concept of perceptual-motor style to different areas of neuroscience, both in the healthy and the diseased. We prefer to be as general as possible in the types of applications we consider, even at the expense of running the risk of encompassing loosely related studies, given the relative novelty of the introduction of the term perceptual-motor style in neurosciences.
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Affiliation(s)
- Pierre-Paul Vidal
- CNRS, SSA, ENS Paris Saclay, Université de Paris, Centre Borelli, 75005 Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Francesco Lacquaniti
- Department of Systems Medicine, Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory of Neuromotor Physiology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
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Koh MH, Yen SC, Leung LY, Gans S, Sullivan K, Adibnia Y, Pavel M, Hasson CJ. Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment. J Neuroeng Rehabil 2021; 18:66. [PMID: 33882949 PMCID: PMC8059234 DOI: 10.1186/s12984-021-00856-w] [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: 11/16/2020] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach for locomotor training that allows patients to receive remote physical assistance from trainers. Methods In the approach, a trainer holds a small robotic manipulandum that shadows the motion of a large robotic arm magnetically attached to a locomoting patient's leg. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. An initial evaluation of the telerobotic system’s transparency (ability to follow the leg during unassisted locomotion) was performed with two unimpaired participants. Transparency was quantified by the magnitude of unwanted robot interaction forces. In a small six-session feasibility study, six individuals who had prior strokes telerobotically interacted with two trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg’s swing length. Results During unassisted walking, unwanted robot interaction forces averaged 3−4 N (swing–stance) for unimpaired individuals and 2−3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R2 = .99; p < 0.001) and increased with patient height during swing (R2 = .71; p = 0.073). During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1−6 (p = 0.058). Conclusions The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials are needed before conclusions regarding efficacy can be made.
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Affiliation(s)
- Min Hyong Koh
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA
| | - Sheng-Che Yen
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA
| | - Lester Y Leung
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Sarah Gans
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Keri Sullivan
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Yasaman Adibnia
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, USA
| | - Misha Pavel
- Khoury College of Computer Sciences, Northeastern University, Boston, USA
| | - Christopher J Hasson
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301 Robinson Hall, Boston, MA, 02115-5005, USA. .,Departments of Bioengineering and Biology, Northeastern University, Boston, USA.
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14
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Park SH, Hsu CJ, Lin JT, Dee W, Roth EJ, Rymer WZ, Wu M. Increased motor variability facilitates motor learning in weight shift toward the paretic side during walking in individuals post-stroke. Eur J Neurosci 2021; 53:3490-3506. [PMID: 33783888 DOI: 10.1111/ejn.15212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to determine whether applying "varied" versus constant pelvis assistance force mediolaterally toward the paretic side of stroke survivors during walking would result in short-term improvement in weight shift toward the paretic side. Twelve individuals post-stroke (60.4 ± 6.2 years; gait speed: 0.53 ± 0.19 m/s) were tested under two conditions (varied vs. constant). Each condition was conducted in a single separate session, which consisted of (a) treadmill walking with no assistance force for 1 min (baseline), pelvis assistance toward the paretic side for 9 min (adaptation), and then no force for additional 1 min (post-adaptation), and (b) overground walking. In the "varied" condition, the magnitude of force was randomly changed across steps between 30% and 100% of the predetermined amount. In the abrupt condition, the magnitude of force was kept constant at 100% of the predetermined amount. Participants exhibited greater improvements in weight shift toward the paretic side (p < 0.01) and in muscle activity of plantar flexors and hip adductors of the paretic leg (p = 0.02) from baseline to late post-adaptation period for the varied condition than for the constant condition. Motor variability of the peak pelvis displacement at baseline was correlated with improvement in weight shift toward the paretic side after training for the varied (R2 = 0.64, p = 0.01) and the constant condition (R2 = 0.39, p = 0.03). These findings suggest that increased motor variability, induced by applying the varied pelvis assistance, may facilitate motor learning in weight shift and gait symmetry during walking in individuals post-stroke.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
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15
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Bertucco M, Nardello F, Magris R, Cesari P, Latash ML. Postural Adjustments during Interactions with an Active Partner. Neuroscience 2021; 463:14-29. [PMID: 33774125 DOI: 10.1016/j.neuroscience.2021.03.020] [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: 01/05/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
Ensuring stability of the human vertical posture is a complex task requiring both anticipatory and compensatory postural strategies when a standing person performs fast actions and interacts with the environment, which can include other persons. How people adjust their preparatory and compensatory postural adjustments in situations when they interact with an active partner is still poorly understood. In this study we investigated the postural adjustments while two healthy persons played a traditional childhood game. While standing facing each other, they were asked to push with their hands against the hands of the opponent only, and to make the opponent to take a step. We explored strategies when pushing the opponent's hands generated perturbations to the posture of both players and when one of the players withdrew the arms to neutralize the opponent's pushing action. Electromyograms were recorded from the leg and trunk muscles and used to quantify early (EPAs), anticipatory (APAs) and compensatory (CPAs) postural adjustments, as well as the co-activation and reciprocal changes in the activity of agonist-antagonist pairs. Results showed higher indices of muscle co-activation during EPAs during the game compared to the control conditions. We found that postural preparation strategies defined whether a participant kept or lost balance during the game. Our results highlight the importance of muscle co-activation, the role of anticipation, and the difference in strategies while interacting with an active partner as compared to interactions with passive objects.
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Affiliation(s)
- Matteo Bertucco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Francesca Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Cesari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
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16
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Pham BN, Luo J, Anand H, Kola O, Salcedo P, Nguyen C, Gaunt S, Zhong H, Garfinkel A, Tillakaratne N, Edgerton VR. Redundancy and multifunctionality among spinal locomotor networks. J Neurophysiol 2020; 124:1469-1479. [PMID: 32966757 PMCID: PMC8356786 DOI: 10.1152/jn.00338.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 02/08/2023] Open
Abstract
c-Fos is used to identify system-wide neural activation with cellular resolution in vivo. However, c-Fos can only capture neural activation of one event. Targeted recombination in active populations (TRAP) allows the capture of two different c-Fos activation patterns in the same animal. So far, TRAP has only been used to examine brain circuits. This study uses TRAP to investigate spinal circuit activation during resting and stepping, giving novel insights of network activation during these events. The level of colabeled (c-Fos+ and TRAP+) neurons observed after performing two bouts of stepping suggests that there is a probabilistic-like phenomenon that can recruit many combinations of neural populations (synapses) when repetitively generating many step cycles. Between two 30-min bouts of stepping, each consisting of thousands of steps, only ∼20% of the neurons activated from the first bout of stepping were also activated by the second bout. We also show colabeling of interneurons that have been active during stepping and resting. The use of the FosTRAP methodology in the spinal cord provides a new tool to compare the engagement of different populations of spinal interneurons in vivo under different motor tasks or under different conditions.NEW & NOTEWORTHY The results are consistent with there being an extensive amount of redundancy among spinal locomotor circuits. Using the newly developed FosTRAP mouse model, only ∼20% of neurons that were active (labeled by Fos-linked tdTomato expression) during a first bout of 30-min stepping were also labeled for c-Fos during a second bout of stepping. This finding suggests variability of neural networks that enables selection of many combinations of neurons (synapses) when generating each step cycle.
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Affiliation(s)
- Bau N. Pham
- Department of Bioengineering, University of California, Los Angeles, California
| | - Jiangyuan Luo
- Department of Neuroscience, University of California, Los Angeles, California
| | - Harnadar Anand
- Institute for Society and Genetics, University of California, Los Angeles, California
| | - Olivia Kola
- Department of Neuroscience, University of California, Los Angeles, California
| | - Pia Salcedo
- Department of Psychobiology, University of California, Los Angeles, California
| | - Connie Nguyen
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, California
| | - Sarah Gaunt
- Department of Molecular Cellular and Developmental Biology, University of California, Los Angeles, California
| | - Hui Zhong
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
| | - Alan Garfinkel
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
| | - Niranjala Tillakaratne
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Brain Research Institute, University of California, Los Angeles, California
| | - V. Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Brain Research Institute, University of California, Los Angeles, California
- Department of Neurobiology, University of California, Los Angeles, California
- Department of Neurosurgery, University of California, Los Angeles, California
- Institut Guttmann, Hospital de Neurorehabilitació, Universitat Autònoma de Barcelona, Badalona, Spain
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, Australia
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17
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Joo SY, Lee SY, Cho YS, Lee KJ, Kim SH, Seo CH. Effectiveness of robot-assisted gait training on patients with burns: a preliminary study. Comput Methods Biomech Biomed Engin 2020; 23:888-893. [DOI: 10.1080/10255842.2020.1769080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Kuem Ju Lee
- Department of Rehabilitation & Assistive Technology, Korea National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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18
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Lokesh R, Ranganathan R. Haptic Assistance That Restricts the Use of Redundant Solutions is Detrimental to Motor Learning. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1373-1380. [PMID: 32340954 DOI: 10.1109/tnsre.2020.2990129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Understanding the use of haptic assistance to facilitate motor learning is a critical issue, especially in the context of tasks requiring control of motor variability. However, the question of how haptic assistance should be designed in tasks with redundancy, where multiple solutions are available, is currently unknown. Here we examined the effect of haptic assistance that either allowed or restricted the use of redundant solutions on the learning of a bimanual steering task. 60 college-aged participants practiced steering a single cursor placed in between their hands along a smooth W-shaped track of a certain width as quickly as possible. Haptic assistance was either applied at (i) the 'task' level using a force channel that only constrained the cursor to the track, allowing for the use of different hand trajectories, or (ii) the 'individual effector' level using a force channel that constrained each hand to a specific trajectory. In addition, we also examined the effect of simply 'fading' assistance in a linear fashion- i.e., decreasing force gains with practice to reduce dependence on haptic assistance. Results showed all groups improved with practice - however, groups with haptic assistance at the individual effector level performed worse than those at the task level. Besides, we did not find sufficient evidence for the benefits of linearly fading assistance in our task. Overall, the results suggest that haptic assistance is not effective for motor learning when it restricts the use of redundant solutions.
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19
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Proprioception: Bottom-up directive for motor recovery after spinal cord injury. Neurosci Res 2019; 154:1-8. [PMID: 31336141 DOI: 10.1016/j.neures.2019.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/03/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022]
Abstract
Proprioceptive feedback provides movement-matched sensory information essential for motor control and recovery after spinal cord injury. While it is understood that the fundamental contribution of proprioceptive feedback circuits in locomotor recovery is to activate the local spinal cord interneurons and motor neurons in a context-dependent manner, the precise mechanisms by which proprioception enables motor recovery after a spinal cord injury remain elusive. Furthermore, how proprioception contributes to motor learning mechanisms intrinsic to spinal cord networks and gives rise to motor recovery is currently unknown. This review discusses the existence of motor learning mechanisms intrinsic to spinal cord circuits and circuit-level insights on how proprioception might contribute to spinal cord plasticity, adaptability, and learning, in addition to the logic in which proprioception helps to establish an internal motor command to execute motor output using spared circuits after a spinal cord injury.
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20
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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21
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Dingu N, Deumens R, Taccola G. Afferent Input Induced by Rhythmic Limb Movement Modulates Spinal Neuronal Circuits in an Innovative Robotic In Vitro Preparation. Neuroscience 2018; 394:44-59. [PMID: 30342198 DOI: 10.1016/j.neuroscience.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/30/2022]
Abstract
Locomotor patterns are mainly modulated by afferent feedback, but its actual contribution to spinal network activity during continuous passive limb training is still unexplored. To unveil this issue, we devised a robotic in vitro setup (Bipedal Induced Kinetic Exercise, BIKE) to induce passive pedaling, while simultaneously recording low-noise ventral and dorsal root (VR and DR) potentials in isolated neonatal rat spinal cords with hindlimbs attached. As a result, BIKE evoked rhythmic afferent volleys from DRs, reminiscent of pedaling speed. During BIKE, spontaneous VR activity remained unchanged, while a DR rhythmic component paired the pedaling pace. Moreover, BIKE onset rarely elicited brief episodes of fictive locomotion (FL) and, when trains of electrical pulses were simultaneously applied to a DR, it increased the amplitude, but not the number, of FL cycles. When BIKE was switched off after a 30-min training, the number of electrically induced FL oscillations was transitorily facilitated, without affecting VR reflexes or DR potentials. However, 90 min of BIKE no longer facilitated FL, but strongly depressed area of VR reflexes and stably increased antidromic DR discharges. Patch clamp recordings from single motoneurons after 90-min sessions indicated an increased frequency of both fast- and slow-decaying synaptic input to motoneurons. In conclusion, hindlimb rhythmic and alternated pedaling for different durations affects distinct dorsal and ventral spinal networks by modulating excitatory and inhibitory input to motoneurons. These results suggest defining new parameters for effective neurorehabilitation that better exploits spinal circuit activity.
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Affiliation(s)
- Nejada Dingu
- Neuroscience Department, International School for Advanced Studies (SISSA), via Bonomea 265, Trieste, TS, Italy; SPINAL (Spinal Person Injury Neurorehabilitation Applied Laboratory), Istituto di Medicina Fisica e Riabilitazione (IMFR), via Gervasutta 48, Udine, UD, Italy
| | - Ronald Deumens
- Institute of Neuroscience, Université catholique de Louvain, Av. Hippocrate 54, Brussels, Belgium
| | - Giuliano Taccola
- Neuroscience Department, International School for Advanced Studies (SISSA), via Bonomea 265, Trieste, TS, Italy; SPINAL (Spinal Person Injury Neurorehabilitation Applied Laboratory), Istituto di Medicina Fisica e Riabilitazione (IMFR), via Gervasutta 48, Udine, UD, Italy.
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22
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Humans control stride-to-stride stepping movements differently for walking and running, independent of speed. J Biomech 2018; 76:144-151. [PMID: 29914740 DOI: 10.1016/j.jbiomech.2018.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/09/2018] [Accepted: 05/30/2018] [Indexed: 11/24/2022]
Abstract
As humans walk or run, external (environmental) and internal (physiological) disturbances induce variability. How humans regulate this variability from stride-to-stride can be critical to maintaining balance. One cannot infer what is "controlled" based on analyses of variability alone. Assessing control requires quantifying how deviations are corrected across consecutive movements. Here, we assessed walking and running, each at two speeds. We hypothesized differences in speed would drive changes in variability, while adopting different gaits would drive changes in how people regulated stepping. Ten healthy adults walked/ran on a treadmill under four conditions: walk or run at comfortable speed, and walk or run at their predicted walk-to-run transition speed. Time series of relevant stride parameters were analyzed to quantify variability and stride-to-stride error-correction dynamics within a Goal-Equivalent Manifold (GEM) framework. In all conditions, participants' stride-to-stride control respected a constant-speed GEM strategy. At each consecutively faster speed, variability tangent to the GEM increased (p ≤ 0.031), while variability perpendicular to the GEM decreased (p ≤ 0.044). There were no differences (p ≥ 0.999) between gaits at the transition speed. Differences in speed determined how stepping variability was structured, independent of gait, confirming our first hypothesis. For running versus walking, measures of GEM-relevant statistical persistence were significantly less (p ≤ 0.004), but showed minimal-to-no speed differences (0.069 ≤ p ≤ 0.718). When running, people corrected deviations both more quickly and more directly, each indicating tighter control. Thus, differences in gait determined how stride-to-stride fluctuations were regulated, independent of speed, confirming our second hypothesis.
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23
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Harbourne RT, Dusing SC, Lobo MA, Westcott-McCoy S, Bovaird J, Sheridan S, Galloway JC, Chang HJ, Hsu LY, Koziol N, Marcinowski EC, Babik I. Sitting Together And Reaching To Play (START-Play): Protocol for a Multisite Randomized Controlled Efficacy Trial on Intervention for Infants With Neuromotor Disorders. Phys Ther 2018; 98:494-502. [PMID: 29767802 DOI: 10.1093/ptj/pzy033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/15/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is limited research examining the efficacy of early physical therapy on infants with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy. OBJECTIVE The aim of this project is to evaluate the efficacy of Sitting Together And Reaching To Play (START-Play), an intervention designed to target sitting, reaching, and motor-based problem solving to advance global development in infants with motor delays or neuromotor dysfunction. DESIGN This study is a longitudinal multisite randomized controlled trial. Infants in the START-Play group are compared to infants receiving usual care in early intervention (EI). SETTING The research takes place in homes in Pennsylvania, Delaware, Washington, and Virginia. PARTICIPANTS There will be 140 infants with neuromotor dysfunction participating, beginning between 7 to 16 months of age. Infants will have motor delays and emerging sitting skill. INTERVENTION START-Play provides individualized twice-weekly home intervention for 12 weeks with families to enhance cognition through sitting, reaching, and problem-solving activities for infants. Ten interventionists provide the intervention, with each child assigned 1 therapist. MEASUREMENTS The primary outcome measure is the Bayley III Scales of Infant Development. Secondary measures include change in the Early Problem Solving Indicator, change in the Gross Motor Function Measure, and change in the type and duration of toy contacts during reaching. Additional measures include sitting posture control and parent-child interaction. LIMITATIONS Limitations include variability in usual EI care and the lack of blinding for interventionists and families. CONCLUSIONS This study describes usual care in EI across 4 US regions and compares outcomes of the START-Play intervention to usual care.
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Affiliation(s)
- Regina T Harbourne
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA 15282 (USA)
| | - Stacey C Dusing
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia. Dr Dusing is a board-certified pediatric clinical specialist
| | - Michele A Lobo
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Sarah Westcott-McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - James Bovaird
- Nebraska Center for Research on Children, Youth, Families, and Schools, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Susan Sheridan
- Nebraska Center for Research on Children, Youth, Families, and Schools, University of Nebraska-Lincoln
| | - James C Galloway
- Department of Physical Therapy and Psychology, University of Delaware
| | - Hui-Ju Chang
- Rangos School of Health Sciences, Physical Therapy, Duquesne University
| | - Lin-Ya Hsu
- Department of Rehabilitation Medicine, University of Washington
| | - Natalie Koziol
- Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska-Lincoln
| | | | - Iryna Babik
- Department of Physical Therapy, University of Delaware
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24
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Liu W. A narrative review of gait training after stroke and a proposal for developing a novel gait training device that provides minimal assistance. Top Stroke Rehabil 2018; 25:375-383. [PMID: 29718796 DOI: 10.1080/10749357.2018.1466970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gait impairment is common in stroke survivors. Recovery of walking ability is one of the most pressing objectives in stroke rehabilitation. OBJECTIVES Of this report are to briefly review recent progress in gait training after stroke including the use of partial body weight-supported treadmill training (PBWSTT) and robot-assisted step training (RAST), and propose a minimal assistance strategy that may overcome some of limitations of current RAST. METHODS The literature review emphasizes a dilemma that recent randomized clinical trials did not support the use of RAST. The unsatisfactory results of current RAST clinical trials may be partially due to a lack of careful analysis of movement deficiencies and their relevance to gait training task specificity after stroke. Normal movement pattern is implied to be part of task specificity in the current RAST. Limitations of such task specificity are analyzed. RESULTS Based on the review, we redefine an alternative set of gait training task specificity that represents a minimal assistance strategy in terms of assisted body movements and amount of assistance. Specifically, assistances are applied only to hip flexion and ankle dorsiflexion of the affected lower limb during swing phase. Furthermore, we propose a conceptual design of a novel device that may overcome limitations of current RAST in gait training after stroke. The novel device uses a pulling cable, either manually operated by a therapist or automated by a servomotor, to provide assistive forces to help hip flexion and ankle dorsiflexion of the affected lower limb during gait training. CONCLUSION The proposed minimal assistance strategy may help to design better devices for gait or other motor training.
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Affiliation(s)
- Wen Liu
- a Department of Physical Therapy & Rehabilitation Science , University of Kansas Medical Center , Kansas City , KS , USA
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25
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Abstract
The phenomenon of agonist-antagonist muscle coactivation is discussed with respect to its consequences for movement mechanics (such as increasing joint apparent stiffness, facilitating faster movements, and effects on action stability), implication for movement optimization, and involvement of different neurophysiological structures. Effects of coactivation on movement stability are ambiguous and depend on the effector representing a kinematic chain with a fixed origin or free origin. Furthermore, coactivation is discussed within the framework of the equilibrium-point hypothesis and the idea of hierarchical control with spatial referent coordinates. Relations of muscle coactivation to changes in one of the basic commands, the c-command, are discussed and illustrated. A hypothesis is suggested that agonist-antagonist coactivation reflects a deliberate neural control strategy to preserve effector-level control and avoid making it degenerate and facing the necessity to control at the level of signals to individual muscles. This strategy, in particular, allows stabilizing motor actions by covaried adjustments in spaces of control variables. This hypothesis is able to account for higher levels of coactivation in young healthy persons performing challenging tasks and across various populations with movement impairments.
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Affiliation(s)
- Mark L Latash
- Department of Kinesiology, The Pennsylvania State University , University Park, Pennsylvania
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26
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Hoffman RM, Corr BB, Stuberg WA, Arpin DJ, Kurz MJ. Changes in lower extremity strength may be related to the walking speed improvements in children with cerebral palsy after gait training. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 73:14-20. [PMID: 29245044 DOI: 10.1016/j.ridd.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cerebral palsy (CP) has a high probability of resulting in lower extremity strength and walking deficits. Numerous studies have shown that gait training has the potential to improve the walking abilities of these children; however, the factors governing these improvements are unknown. AIMS This study aimed to evaluate the relationship between change in lower extremity strength, walking speed and endurance of children with CP following gait training. METHODS AND PROCEDURES Eleven children with CP (GMFCS levels=II-III) completed a gait training protocol three days a week for six weeks. Outcome measures included a 10m fast-as-possible walk test, 6min walking endurance test and lower extremity strength. OUTCOMES AND RESULTS The group results indicated there were improvements in walking speed, walking endurance and lower extremity strength. In addition, there was a positive correlation between percent change in lower extremity strength and walking speed and a negative correlation between the percent change in lower extremity strength and the child's age. CONCLUSIONS Our results imply that changes in lower extremity strength might be related to the degree of the walking speed changes seen after gait training. Younger children may be more likely to show improvements in lower extremity strength after gait training.
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Affiliation(s)
- Rashelle M Hoffman
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Bradley B Corr
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Wayne A Stuberg
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, USA.
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27
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Moraud EM, von Zitzewitz J, Miehlbradt J, Wurth S, Formento E, DiGiovanna J, Capogrosso M, Courtine G, Micera S. Closed-loop control of trunk posture improves locomotion through the regulation of leg proprioceptive feedback after spinal cord injury. Sci Rep 2018; 8:76. [PMID: 29311614 PMCID: PMC5758718 DOI: 10.1038/s41598-017-18293-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023] Open
Abstract
After spinal cord injury (SCI), sensory feedback circuits critically contribute to leg motor execution. Compelled by the importance to engage these circuits during gait rehabilitation, assistive robotics and training protocols have primarily focused on guiding leg movements to reinforce sensory feedback. Despite the importance of trunk postural dynamics on gait and balance, trunk assistance has comparatively received little attention. Typically, trunk movements are either constrained within bodyweight support systems, or manually adjusted by therapists. Here, we show that real-time control of trunk posture re-established dynamic balance amongst bilateral proprioceptive feedback circuits, and thereby restored left-right symmetry, loading and stepping consistency in rats with severe SCI. We developed a robotic system that adjusts mediolateral trunk posture during locomotion. This system uncovered robust relationships between trunk orientation and the modulation of bilateral leg kinematics and muscle activity. Computer simulations suggested that these modulations emerged from corrections in the balance between flexor- and extensor-related proprioceptive feedback. We leveraged this knowledge to engineer control policies that regulate trunk orientation and postural sway in real-time. This dynamical postural interface immediately improved stepping quality in all rats regardless of broad differences in deficits. These results emphasize the importance of trunk regulation to optimize performance during rehabilitation.
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Affiliation(s)
- Eduardo Martin Moraud
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.
| | - Joachim von Zitzewitz
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Jenifer Miehlbradt
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Sophie Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Emanuele Formento
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Jack DiGiovanna
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | | | - Grégoire Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
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28
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Gad P, Gerasimenko Y, Zdunowski S, Turner A, Sayenko D, Lu DC, Edgerton VR. Weight Bearing Over-ground Stepping in an Exoskeleton with Non-invasive Spinal Cord Neuromodulation after Motor Complete Paraplegia. Front Neurosci 2017. [PMID: 28642680 PMCID: PMC5462970 DOI: 10.3389/fnins.2017.00333] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We asked whether coordinated voluntary movement of the lower limbs could be regained in an individual having been completely paralyzed (>4 year) and completely absent of vision (>15 year) using two novel strategies-transcutaneous electrical spinal cord stimulation at selected sites over the spine as well as pharmacological neuromodulation by buspirone. We also asked whether these neuromodulatory strategies could facilitate stepping assisted by an exoskeleton (EKSO, EKSO Bionics, CA) that is designed so that the subject can voluntarily complement the work being performed by the exoskeleton. We found that spinal cord stimulation and drug enhanced the level of effort that the subject could generate while stepping in the exoskeleton. In addition, stimulation improved the coordination patterns of the lower limb muscles resulting in a more continuous, smooth stepping motion in the exoskeleton along with changes in autonomic functions including cardiovascular and thermoregulation. Based on these data from this case study it appears that there is considerable potential for positive synergistic effects after complete paralysis by combining the over-ground step training in an exoskeleton, combined with transcutaneous electrical spinal cord stimulation either without or with pharmacological modulation.
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Affiliation(s)
- Parag Gad
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Yury Gerasimenko
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States.,Pavlov Institute of PhysiologySt. Petersburg, Russia
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Amanda Turner
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Dimitry Sayenko
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los AngelesLos Angeles, CA, United States.,Brain Research Institute, University of California, Los AngelesLos Angeles, CA, United States
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States.,Department of Neurosurgery, University of California, Los AngelesLos Angeles, CA, United States.,Brain Research Institute, University of California, Los AngelesLos Angeles, CA, United States.,Department of Neurobiology, University of California, Los AngelesLos Angeles, CA, United States.,Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de BarcelonaBarcelona, Spain
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29
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Gerasimenko Y, Sayenko D, Gad P, Liu CT, Tillakaratne NJK, Roy RR, Kozlovskaya I, Edgerton VR. Feed-Forwardness of Spinal Networks in Posture and Locomotion. Neuroscientist 2016; 23:441-453. [PMID: 28403746 DOI: 10.1177/1073858416683681] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We present a new perspective on the concept of feed-forward compared to feedback mechanisms for motor control. We propose that conceptually all sensory information in real time provided to the brain and spinal cord can be viewed as a feed-forward phenomenon. We also propose that the spinal cord continually adapts to a broad array of ongoing sensory information that is used to adjust the probability of making timely and predictable decisions of selected networks that will execute a given response. One interpretation of the term feedback historically entails responses with short delays. We propose that feed-forward mechanisms, however, range in timeframes of milliseconds to an evolutionary perspective, that is, "evolutionary learning." Continuously adapting events enable a high level of automaticity within the sensorimotor networks that mediate "planned" motor tasks. We emphasize that either a very small or a very large proportion of motor responses can be under some level of conscious vs automatic control. Furthermore, we make a case that a major component of automaticity of the neural control of movement in vertebrates is located within spinal cord networks. Even without brain input, the spinal cord routinely uses feed-forward processing of sensory information, particularly proprioceptive and cutaneous, to continuously make fundamental decisions that define motor responses. In effect, these spinal networks may be largely responsible for executing coordinated sensorimotor tasks, even those under normal "conscious" control.
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Affiliation(s)
- Yury Gerasimenko
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,2 Pavlov Institute of Physiology, St. Petersburg, Russia.,3 Russian Federation State Scientific Center, Institute for Bio-Medical Problems, Russian Academy of Sciences, Moscow, Russia.,4 Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dimitry Sayenko
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Parag Gad
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Chao-Tuan Liu
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Niranjala J K Tillakaratne
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,5 Brain Research Institute, University of California, Los Angeles, CA, USA
| | - Roland R Roy
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,5 Brain Research Institute, University of California, Los Angeles, CA, USA
| | | | - V Reggie Edgerton
- 1 Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,5 Brain Research Institute, University of California, Los Angeles, CA, USA.,6 Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,7 Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,8 Institute Guttmann. Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain
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30
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Davies BL, Arpin DJ, Liu M, Reelfs H, Volkman KG, Healey K, Zabad R, Kurz MJ. Two Different Types of High-Frequency Physical Therapy Promote Improvements in the Balance and Mobility of Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:2095-2101.e3. [DOI: 10.1016/j.apmr.2016.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/22/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
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Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury. Phys Ther 2016; 96:1919-1929. [PMID: 27313241 PMCID: PMC5131185 DOI: 10.2522/ptj.20150646] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/12/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND High-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited. OBJECTIVE The purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance. DESIGN A single-day, repeated-measures, pretraining-posttraining study design was used. METHODS Nineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations. RESULTS The results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination. LIMITATIONS Measures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown. CONCLUSIONS High-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.
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Leving MT, Vegter RJK, de Groot S, van der Woude LHV. Effects of variable practice on the motor learning outcomes in manual wheelchair propulsion. J Neuroeng Rehabil 2016; 13:100. [PMID: 27881124 PMCID: PMC5120477 DOI: 10.1186/s12984-016-0209-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/11/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. It has been suggested that more variability in propulsion technique benefits the motor learning process of wheelchair propulsion. The purpose of this study was to determine the influence of variable practice on the motor learning outcomes of wheelchair propulsion in able-bodied participants. Variable practice was introduced in the form of wheelchair basketball practice and wheelchair-skill practice. Motor learning was operationalized as improvements in mechanical efficiency and propulsion technique. METHODS Eleven Participants in the variable practice group and 12 participants in the control group performed an identical pre-test and a post-test. Pre- and post-test were performed in a wheelchair on a motor-driven treadmill (1.11 m/s) at a relative power output of 0.23 W/kg. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated. Between the pre- and the post-test the variable practice group received 7 practice sessions. During the practice sessions participants performed one-hour of variable practice, consisting of five wheelchair-skill tasks and a 30 min wheelchair basketball game. The control group did not receive any practice between the pre- and the post-test. RESULTS Comparison of the pre- and the post-test showed that the variable practice group significantly improved the mechanical efficiency (4.5 ± 0.6% → 5.7 ± 0.7%) in contrast to the control group (4.5 ± 0.6% → 4.4 ± 0.5%) (group x time interaction effect p < 0.001).With regard to propulsion technique, both groups significantly reduced the push frequency and increased the contact angle of the hand with the handrim (within group, time effect). No significant group × time interaction effects were found for propulsion technique. With regard to propulsion variability, the variable practice group increased variability when compared to the control group (interaction effect p < 0.001). CONCLUSIONS Compared to a control, variable practice, resulted in an increase in mechanical efficiency and increased variability. Interestingly, the large relative improvement in mechanical efficiency was concomitant with only moderate improvements in the propulsion technique, which were similar in the control group, suggesting that other factors besides propulsion technique contributed to the lower energy expenditure.
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Affiliation(s)
- Marika T. Leving
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Riemer J. K. Vegter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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33
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Neuromodulation of the neural circuits controlling the lower urinary tract. Exp Neurol 2016; 285:182-189. [PMID: 27381425 DOI: 10.1016/j.expneurol.2016.06.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 01/01/2023]
Abstract
The inability to control timely bladder emptying is one of the most serious challenges among the many functional deficits that occur after a spinal cord injury. We previously demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis and can be used to enable voiding in spinal rats. In the present study, we examined the neuromodulation of lower urinary tract function associated with acute epidural spinal cord stimulation, locomotion, and peripheral nerve stimulation in adult rats. Herein we demonstrate that electrically evoked potentials in the hindlimb muscles and external urethral sphincter are modulated uniquely when the rat is stepping bipedally and not voiding, immediately pre-voiding, or when voiding. We also show that spinal cord stimulation can effectively neuromodulate the lower urinary tract via frequency-dependent stimulation patterns and that neural peripheral nerve stimulation can activate the external urethral sphincter both directly and via relays in the spinal cord. The data demonstrate that the sensorimotor networks controlling bladder and locomotion are highly integrated neurophysiologically and behaviorally and demonstrate how these two functions are modulated by sensory input from the tibial and pudental nerves. A more detailed understanding of the high level of interaction between these networks could lead to the integration of multiple neurophysiological strategies to improve bladder function. These data suggest that the development of strategies to improve bladder function should simultaneously engage these highly integrated networks in an activity-dependent manner.
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Dose F, Taccola G. Two Distinct Stimulus Frequencies Delivered Simultaneously at Low Intensity Generate Robust Locomotor Patterns. Neuromodulation 2016; 19:563-75. [PMID: 26968869 DOI: 10.1111/ner.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Explore the primary characteristics of afferent noisy stimuli, which optimally activate locomotor patterns at low intensity. MATERIALS AND METHODS Intracellular and extracellular electrophysiological traces were derived from single motoneurons and from ventral roots, respectively. From these recordings, we obtained noisy stimulating protocols, delivered to a dorsal root (DR) of an isolated neonatal rat spinal cord, while recording fictive locomotion (FL) from ventral roots. RESULTS We decreased complexity of efficient noisy stimulating protocols down to single cell spikes. Then, we identified four main components within the power spectrum of these signals and used them to construct a basic multifrequency protocol of rectangular impulses, able to induce FL. Further disassembling generated the minimum stimulation paradigm that activated FL, which consisted of a pair of 35 and 172 Hz frequency pulse trains, strongly effective at low intensity when delivered either jointly to one lumbosacral DR or as single simultaneous trains to two distinct DRs. This simplified pulse schedule always activated a locomotor rhythm, even when delivered for a very short time (500 ms). One prerequisite for the two-frequency protocol to activate FL at low intensity when applied to sacrocaudal afferents was the ability to induce ascending volleys of greater amplitude. CONCLUSION Multifrequency protocols can support future studies in defining the most effective characteristics for electrical stimulation to reactivate stepping following motor injury.
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Affiliation(s)
- Francesco Dose
- Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, TS, Italy.,SPINAL (Spinal Person Injury Neurorehabilitation Applied Laboratory), Istituto di Medicina Fisica e Riabilitazione (IMFR), Udine, UD, Italy
| | - Giuliano Taccola
- Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, TS, Italy.,SPINAL (Spinal Person Injury Neurorehabilitation Applied Laboratory), Istituto di Medicina Fisica e Riabilitazione (IMFR), Udine, UD, Italy
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Meuleman J, van Asseldonk E, van Oort G, Rietman H, van der Kooij H. LOPES II--Design and Evaluation of an Admittance Controlled Gait Training Robot With Shadow-Leg Approach. IEEE Trans Neural Syst Rehabil Eng 2015; 24:352-63. [PMID: 26731771 DOI: 10.1109/tnsre.2015.2511448] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robotic gait training is gaining ground in rehabilitation. Room for improvement lies in reducing donning and doffing time, making training more task specific and facilitating active balance control, and by allowing movement in more degrees of freedom. Our goal was to design and evaluate a robot that incorporates these improvements. LOPES II uses an end-effector approach with parallel actuation and a minimum amount of clamps. LOPES II has eight powered degrees of freedom (hip flexion/extension, hip abduction/adduction, knee flexion/extension, pelvis forward/aft and pelvis mediolateral). All other degrees of freedom can be left free and pelvis frontal- and transversal rotation can be constrained. Furthermore arm swing is unhindered. The end-effector approach eliminates the need for exact alignment, which results in a donning time of 10-14 min for first-time training and 5-8 min for recurring training. LOPES II is admittance controlled, which allows for the control over the complete spectrum from low to high impedance. When the powered degrees of freedom are set to minimal impedance, walking in the device resembles free walking, which is an important requisite to allow task-specific training. We demonstrated that LOPES II can provide sufficient support to let severely affected patients walk and that we can provide selective support to impaired aspects of gait of mildly affected patients.
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36
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Sciancalepore M, Coslovich T, Lorenzon P, Ziraldo G, Taccola G. Extracellular stimulation with human “noisy” electromyographic patterns facilitates myotube activity. J Muscle Res Cell Motil 2015; 36:349-57. [DOI: 10.1007/s10974-015-9424-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 02/02/2023]
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37
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Foffani G, Shumsky J, Knudsen EB, Ganzer PD, Moxon KA. Interactive Effects Between Exercise and Serotonergic Pharmacotherapy on Cortical Reorganization After Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:479-89. [PMID: 26338432 DOI: 10.1177/1545968315600523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In rat models of spinal cord injury, at least 3 different strategies can be used to promote long-term cortical reorganization: (1) active exercise above the level of the lesion; (2) passive exercise below the level of the lesion; and (3) serotonergic pharmacotherapy. Whether and how these potential therapeutic strategies-and their underlying mechanisms of action-interact remains unknown. Methods In spinally transected adult rats, we compared the effects of active exercise above the level of the lesion (treadmill), passive exercise below the level of the lesion (bike), serotonergic pharmacotherapy (quipazine), and combinations of the above therapies (bike+quipazine, treadmill+quipazine, bike+treadmill+quipazine) on long-term cortical reorganization (9 weeks after the spinal transection). Cortical reorganization was measured as the percentage of cells recorded in the deafferented hindlimb cortex that responded to tactile stimulation of the contralateral forelimb. Results Bike and quipazine are "competing" therapies for cortical reorganization, in the sense that quipazine limits the cortical reorganization induced by bike, whereas treadmill and quipazine are "collaborative" therapies, in the sense that the reorganization induced by quipazine combined with treadmill is greater than the reorganization induced by either quipazine or treadmill. CONCLUSIONS These results uncover the interactive effects between active/passive exercise and serotonergic pharmacotherapy on cortical reorganization after spinal cord injury, emphasizing the importance of understanding the effects of therapeutic strategies in spinal cord injury (and in other forms of deafferentation) from an integrated system-level approach.
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Affiliation(s)
- Guglielmo Foffani
- Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla-La Mancha, Toledo, Spain Hospitales de Madrid, Móstoles, Spain CEU-San Pablo University, Madrid, Spain
| | - Jed Shumsky
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Karen A Moxon
- Drexel University College of Medicine, Philadelphia, PA, USA Drexel University, Philadelphia, PA, USA
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Leving MT, Vegter RJK, Hartog J, Lamoth CJC, de Groot S, van der Woude LHV. Effects of visual feedback-induced variability on motor learning of handrim wheelchair propulsion. PLoS One 2015; 10:e0127311. [PMID: 25992626 PMCID: PMC4439159 DOI: 10.1371/journal.pone.0127311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/14/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND It has been suggested that a higher intra-individual variability benefits the motor learning of wheelchair propulsion. The present study evaluated whether feedback-induced variability on wheelchair propulsion technique variables would also enhance the motor learning process. Learning was operationalized as an improvement in mechanical efficiency and propulsion technique, which are thought to be closely related during the learning process. METHODS 17 Participants received visual feedback-based practice (feedback group) and 15 participants received regular practice (natural learning group). Both groups received equal practice dose of 80 min, over 3 weeks, at 0.24 W/kg at a treadmill speed of 1.11 m/s. To compare both groups the pre- and post-test were performed without feedback. The feedback group received real-time visual feedback on seven propulsion variables with instruction to manipulate the presented variable to achieve the highest possible variability (1st 4-min block) and optimize it in the prescribed direction (2nd 4-min block). To increase motor exploration the participants were unaware of the exact variable they received feedback on. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated to evaluate the amount of intra-individual variability. RESULTS The feedback group, which practiced with higher intra-individual variability, improved the propulsion technique between pre- and post-test to the same extent as the natural learning group. Mechanical efficiency improved between pre- and post-test in the natural learning group but remained unchanged in the feedback group. CONCLUSION These results suggest that feedback-induced variability inhibited the improvement in mechanical efficiency. Moreover, since both groups improved propulsion technique but only the natural learning group improved mechanical efficiency, it can be concluded that the improvement in mechanical efficiency and propulsion technique do not always appear simultaneously during the motor learning process. Their relationship is most likely modified by other factors such as the amount of the intra-individual variability.
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Affiliation(s)
- Marika T. Leving
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Riemer J. K. Vegter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
| | - Johanneke Hartog
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Claudine J. C. Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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39
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Dingwell JB, Cusumano JP. Identifying stride-to-stride control strategies in human treadmill walking. PLoS One 2015; 10:e0124879. [PMID: 25910253 PMCID: PMC4409060 DOI: 10.1371/journal.pone.0124879] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/18/2015] [Indexed: 01/05/2023] Open
Abstract
Variability is ubiquitous in human movement, arising from internal and external noise, inherent biological redundancy, and from the neurophysiological control actions that help regulate movement fluctuations. Increased walking variability can lead to increased energetic cost and/or increased fall risk. Conversely, biological noise may be beneficial, even necessary, to enhance motor performance. Indeed, encouraging more variability actually facilitates greater improvements in some forms of locomotor rehabilitation. Thus, it is critical to identify the fundamental principles humans use to regulate stride-to-stride fluctuations in walking. This study sought to determine how humans regulate stride-to-stride fluctuations in stepping movements during treadmill walking. We developed computational models based on pre-defined goal functions to compare if subjects, from each stride to the next, tried to maintain the same speed as the treadmill, or instead stay in the same position on the treadmill. Both strategies predicted average behaviors empirically indistinguishable from each other and from that of humans. These strategies, however, predicted very different stride-to-stride fluctuation dynamics. Comparisons to experimental data showed that human stepping movements were generally well-predicted by the speed-control model, but not by the position-control model. Human subjects also exhibited no indications they corrected deviations in absolute position only intermittently: i.e., closer to the boundaries of the treadmill. Thus, humans clearly do not adopt a control strategy whose primary goal is to maintain some constant absolute position on the treadmill. Instead, humans appear to regulate their stepping movements in a way most consistent with a strategy whose primary goal is to try to maintain the same speed as the treadmill at each consecutive stride. These findings have important implications both for understanding how biological systems regulate walking in general and for being able to harness these mechanisms to develop more effective rehabilitation interventions to improve locomotor performance.
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Affiliation(s)
- Jonathan B Dingwell
- Department of Kinesiology & Health Education, University of Texas, Austin, Texas, United States of America
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, Pennsylvania, United States of America
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Lam T, Pauhl K, Ferguson A, Malik RN, Krassioukov A, Eng JJ. Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study. ACTA ACUST UNITED AC 2015; 52:113-29. [DOI: 10.1682/jrrd.2014.03.0090] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/10/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Amanda Ferguson
- NeuroMotion Physical Therapy, Vancouver, British Columbia, Canada
| | | | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, the University of British Columbia, Vancouver, British Columbia, Canada;Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J. Eng
- International Collaboration on Repair Discoveries, the University of British Columbia, Vancouver, British Columbia, Canada;GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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41
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van Dijk W, van der Kooij H, Koopman B, van Asseldonk EHF, van der Kooij H. Improving the transparency of a rehabilitation robot by exploiting the cyclic behaviour of walking. IEEE Int Conf Rehabil Robot 2014; 2013:6650393. [PMID: 24187212 DOI: 10.1109/icorr.2013.6650393] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To promote active participation of neurological patients during robotic gait training, controllers, such as "assist as needed" or "cooperative control", are suggested. Apart from providing support, these controllers also require that the robot should be capable of resembling natural, unsupported, walking. This means that they should have a transparent mode, where the interaction forces between the human and the robot are minimal. Traditional feedback-control algorithms do not exploit the cyclic nature of walking to improve the transparency of the robot. The purpose of this study was to improve the transparent mode of robotic devices, by developing two controllers that use the rhythmic behavior of gait. Both controllers use adaptive frequency oscillators and kernel-based non-linear filters. Kernelbased non-linear filters can be used to estimate signals and their time derivatives, as a function of the gait phase. The first controller learns the motor angle, associated with a certain joint angle pattern, and acts as a feed-forward controller to improve the torque tracking (including the zero-torque mode). The second controller learns the state of the mechanical system and compensates for the dynamical effects (e.g. the acceleration of robot masses). Both controllers have been tested separately and in combination on a small subject population. Using the feedforward controller resulted in an improved torque tracking of at least 52 percent at the hip joint, and 61 percent at the knee joint. When both controllers were active simultaneously, the interaction power between the robot and the human leg was reduced by at least 40 percent at the thigh, and 43 percent at the shank. These results indicate that: if a robotic task is cyclic, the torque tracking and transparency can be improved by exploiting the predictions of adaptive frequency oscillator and kernel-based nonlinear filters.
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42
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Kurz MJ, Reelfs H. Taking steps towards improving the mobility of children with cerebral palsy. Dev Med Child Neurol 2014; 56:1137-1138. [PMID: 25174951 DOI: 10.1111/dmcn.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Max J Kurz
- Department of Physical Therapy, Munroe-Myer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Reelfs
- Department of Physical Therapy, Munroe-Myer Institute, University of Nebraska Medical Center, Omaha, NE, USA
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43
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Knaepen K, Beyl P, Duerinck S, Hagman F, Lefeber D, Meeusen R. Human–Robot Interaction: Kinematics and Muscle Activity Inside a Powered Compliant Knee Exoskeleton. IEEE Trans Neural Syst Rehabil Eng 2014; 22:1128-37. [DOI: 10.1109/tnsre.2014.2324153] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sawers A, Ting LH. Perspectives on human-human sensorimotor interactions for the design of rehabilitation robots. J Neuroeng Rehabil 2014; 11:142. [PMID: 25284060 PMCID: PMC4197261 DOI: 10.1186/1743-0003-11-142] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 01/26/2023] Open
Abstract
Physical interactions between patients and therapists during rehabilitation have served as motivation for the design of rehabilitation robots, yet we lack a fundamental understanding of the principles governing such human-human interactions (HHI). Here we review the literature and pose important open questions regarding sensorimotor interaction during HHI that could facilitate the design of human-robot interactions (HRI) and haptic interfaces for rehabilitation. Based on the goals of physical rehabilitation, three subcategories of sensorimotor interaction are identified: sensorimotor collaboration, sensorimotor assistance, and sensorimotor education. Prior research has focused primarily on sensorimotor collaboration and is generally limited to relatively constrained visuomotor tasks. Moreover, the mechanisms by which performance improvements are achieved during sensorimotor cooperation with haptic interaction remains unknown. We propose that the effects of role assignment, motor redundancy, and skill level in sensorimotor cooperation should be explicitly studied. Additionally, the importance of haptic interactions may be better revealed in tasks that do not require visual feedback. Finally, cooperative motor tasks that allow for motor improvement during solo performance to be examined may be particularly relevant for rehabilitation robotics. Identifying principles that guide human-human sensorimotor interactions may lead to the development of robots that can physically interact with humans in more intuitive and biologically inspired ways, thereby enhancing rehabilitation outcomes.
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Affiliation(s)
| | - Lena H Ting
- Wallace H, Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 313 Ferst Drive NE, U,A, Whitaker Bldg, 3242, Atlanta, GA 30332, USA.
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Vasudevan EVL. One step backwards, two steps ahead: Amplifying movement errors to improve walking post-stroke. Clin Neurophysiol 2014; 125:869-71. [DOI: 10.1016/j.clinph.2013.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Erin V L Vasudevan
- Motor Learning Laboratory, Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, USA.
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46
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Ward PJ, Herrity AN, Smith RR, Willhite A, Harrison BJ, Petruska JC, Harkema SJ, Hubscher CH. Novel multi-system functional gains via task specific training in spinal cord injured male rats. J Neurotrauma 2014; 31:819-33. [PMID: 24294909 DOI: 10.1089/neu.2013.3082] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Locomotor training (LT) after spinal cord injury (SCI) is a rehabilitative therapy used to enhance locomotor recovery. There is evidence, primarily anecdotal, also associating LT with improvements in bladder function and reduction in some types of SCI-related pain. In the present study, we determined if a step training paradigm could improve outcome measures of locomotion, bladder function, and pain/allodynia. After a T10 contusive SCI trained animals (adult male Wistar rats), trained animals began quadrupedal step training beginning 2 weeks post-SCI for 1 h/day. End of study experiments (3 months of training) revealed significant changes in limb kinematics, gait, and hindlimb flexor-extensor bursting patterns relative to non-trained controls. Importantly, micturition function, evaluated with terminal transvesical cystometry, was significantly improved in the step trained group (increased voiding efficiency, intercontraction interval, and contraction amplitude). Because both SCI and LT affect neurotrophin signaling, and neurotrophins are involved with post-SCI plasticity in micturition pathways, we measured bladder neurotrophin mRNA. Training regulated the expression of nerve growth factor (NGF) but not BDNF or NT3. Bladder NGF mRNA levels were inversely related to bladder function in the trained group. Monitoring of overground locomotion and neuropathic pain throughout the study revealed significant improvements, beginning after 3 weeks of training, which in both cases remained consistent for the study duration. These novel findings, improving non-locomotor in addition to locomotor functions, demonstrate that step training post-SCI could contribute to multiple quality of life gains, targeting patient-centered high priority deficits.
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Affiliation(s)
- Patricia J Ward
- 1 Department of Anatomical Sciences and Neurobiology, University of Louisville , Louisville, Kentucky
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Fleerkotte BM, Koopman B, Buurke JH, van Asseldonk EHF, van der Kooij H, Rietman JS. The effect of impedance-controlled robotic gait training on walking ability and quality in individuals with chronic incomplete spinal cord injury: an explorative study. J Neuroeng Rehabil 2014; 11:26. [PMID: 24594284 PMCID: PMC3975927 DOI: 10.1186/1743-0003-11-26] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 02/14/2014] [Indexed: 12/22/2022] Open
Abstract
Background There is increasing interest in the use of robotic gait-training devices in walking rehabilitation of incomplete spinal cord injured (iSCI) individuals. These devices provide promising opportunities to increase the intensity of training and reduce physical demands on therapists. Despite these potential benefits, robotic gait-training devices have not yet demonstrated clear advantages over conventional gait-training approaches, in terms of functional outcomes. This might be due to the reduced active participation and step-to-step variability in most robotic gait-training strategies, when compared to manually assisted therapy. Impedance-controlled devices can increase active participation and step-to-step variability. The aim of this study was to assess the effect of impedance-controlled robotic gait training on walking ability and quality in chronic iSCI individuals. Methods A group of 10 individuals with chronic iSCI participated in an explorative clinical trial. Participants trained three times a week for eight weeks using an impedance-controlled robotic gait trainer (LOPES: LOwer extremity Powered ExoSkeleton). Primary outcomes were the 10-meter walking test (10MWT), the Walking Index for Spinal Cord Injury (WISCI II), the six-meter walking test (6MWT), the Timed Up and Go test (TUG) and the Lower Extremity Motor Scores (LEMS). Secondary outcomes were spatiotemporal and kinematics measures. All participants were tested before, during, and after training and at 8 weeks follow-up. Results Participants experienced significant improvements in walking speed (0.06 m/s, p = 0.008), distance (29 m, p = 0.005), TUG (3.4 s, p = 0.012), LEMS (3.4, p = 0.017) and WISCI after eight weeks of training with LOPES. At the eight-week follow-up, participants retained the improvements measured at the end of the training period. Significant improvements were also found in spatiotemporal measures and hip range of motion. Conclusion Robotic gait training using an impedance-controlled robot is feasible in gait rehabilitation of chronic iSCI individuals. It leads to improvements in walking ability, muscle strength, and quality of walking. Improvements observed at the end of the training period persisted at the eight-week follow-up. Slower walkers benefit the most from the training protocol and achieve the greatest relative improvement in speed and walking distance.
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Asín Prieto G, Cano-de-la-Cuerda R, López-Larraz E, Metrot J, Molinari M, van Dokkum LEH. Emerging Perspectives in Stroke Rehabilitation. BIOSYSTEMS & BIOROBOTICS 2014. [DOI: 10.1007/978-3-642-38556-8_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Meuleman J, Meuleman J, van Asseldonk EHF, van der Kooij H. Novel actuation design of a gait trainer with shadow leg approach. IEEE Int Conf Rehabil Robot 2013; 2013:6650369. [PMID: 24187188 DOI: 10.1109/icorr.2013.6650369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robotic gait training has developed since the end of the 20(th) century, yet there is much room for improvement in the design of the robots. With the conventional exoskeleton structures, donning of patients in a gait trainer usually is a cumbersome process due to the need of joint alignments and normal walking is often hindered due to obstructed arm swing. Our goal was to design a gait training robots that overcomes these limitations. We propose a novel design in which these drawbacks are reduced to a great amount. By using a parallel structure behind the patient (shadow leg) that is connected to the patient joints with rods, little alignment is needed, the area lateral to the hip is left free, and thus arm swing is not obstructed. The construction is lightweight, because the actuators are mounted on a fixed base and the transmission of power is executed with light weight rods. An end stop in the shadow leg prevents hyper extension of the patient's knee. The relationship between motor displacement and human joint rotations is nonlinear. In this paper we derive the nonlinear relationships between motors and patient joints and verify these. calculations with a measurement. The device has been built, now tests with subjects are required to assess if subjects can indeed walk normally in the robot.
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50
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Dose F, Menosso R, Taccola G. Rat locomotor spinal circuits in vitro are activated by electrical stimulation with noisy waveforms sampled from human gait. Physiol Rep 2013; 1:e00025. [PMID: 24303112 PMCID: PMC3831921 DOI: 10.1002/phy2.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/08/2013] [Accepted: 06/11/2013] [Indexed: 12/25/2022] Open
Abstract
Noisy waveforms, sampled from an episode of fictive locomotion (FL) and delivered to a dorsal root (DR), are a novel electrical stimulating protocol demonstrated as the most effective for generating the locomotor rhythm in the rat isolated spinal cord. The present study explored if stimulating protocols constructed by sampling real human locomotion could be equally efficient to activate these locomotor networks in vitro. This approach may extend the range of usable stimulation protocols and provide a wide palette of noisy waveforms for this purpose. To this end, recorded electromyogram (EMG) from leg muscles of walking adult volunteers provided a protocol named ReaListim (Real Locomotion-induced stimulation) that applied to a single DR successfully activated FL. The smoothed kinematic profile of the same gait failed to do so like nonphasic noisy patterns derived from standing and isometric contraction. Power spectrum analysis showed distinctive low-frequency domains in ReaListim, along with the high-frequency background noise. The current study indicates that limb EMG signals (recorded during human locomotion) applied to DR of the rat spinal cord are more effective than EMG traces taken during standing or isometric contraction of the same muscles to activate locomotor networks. Finally, EMGs recorded during various human motor tasks demonstrated that noisy waves of the same periodicity as ReaListim, could efficiently activate the in vitro central pattern generator (CPG), regardless of the motor task from which they had been sampled. These data outline new strategies to optimize functional stimulation of spinal networks after injury.
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Affiliation(s)
- Francesco Dose
- Neuroscience Department, International School for Advanced Studies (SISSA) via Bonomea 265, Trieste, Italy ; SPINAL (Spinal Person Injury Neurorehabilitation Applied Laboratory), Istituto di Medicina Fisica e Riabilitazione (IMFR) via Gervasutta 48, Udine, Italy
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