Obstacle avoidance in novel visual environments improved by variable practice training

Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke

Objectives

To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke.

Methods

Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining.

Results

TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT.

Conclusions

Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.

Enhancing astronaut performance using sensorimotor adaptability training

Astronauts experience disturbances in balance and gait function when they return to Earth. The highly plastic human brain enables individuals to modify their behavior to match the prevailing environment. Subjects participating in specially designed variable sensory challenge training programs can enhance their ability to rapidly adapt to novel sensory situations. This is useful in our application because we aim to train astronauts to rapidly formulate effective strategies to cope with the balance and locomotor challenges associated with new gravitational environments—enhancing their ability to “learn to learn.” We do this by coupling various combinations of sensorimotor challenges with treadmill walking. A unique training system has been developed that is comprised of a treadmill mounted on a motion base to produce movement of the support surface during walking. This system provides challenges to gait stability. Additional sensory variation and challenge are imposed with a virtual visual scene that presents subjects with various combinations of discordant visual information during treadmill walking. This experience allows them to practice resolving challenging and conflicting novel sensory information to improve their ability to adapt rapidly. Information obtained from this work will inform the design of the next generation of sensorimotor countermeasures for astronauts.

Using low levels of stochastic vestibular stimulation to improve locomotor stability

Low levels of bipolar binaural white noise based imperceptible stochastic electrical stimulation to the vestibular system (stochastic vestibular stimulation, SVS) have been shown to improve stability during balance tasks in normal, healthy subjects by facilitating enhanced information transfer using stochastic resonance (SR) principles. We hypothesize that detection of time-critical sub-threshold sensory signals using low levels of bipolar binaural SVS based on SR principles will help improve stability of walking during support surface perturbations. In the current study 13 healthy subjects were exposed to short continuous support surface perturbations for 60 s while walking on a treadmill and simultaneously viewing perceptually matched linear optic flow. Low levels of bipolar binaural white noise based SVS were applied to the vestibular organs. Multiple trials of the treadmill locomotion test were performed with stimulation current levels varying in the range of 0–1500 μA, randomized across trials. The results show that subjects significantly improved their walking stability during support surface perturbations at stimulation levels with peak amplitude predominantly in the range of 100–500 μA consistent with the SR phenomenon. Additionally, objective perceptual motion thresholds were measured separately as estimates of internal noise while subjects sat on a chair with their eyes closed and received 1 Hz bipolar binaural sinusoidal electrical stimuli. The optimal improvement in walking stability was achieved on average with peak stimulation amplitudes of approximately 35% of perceptual motion threshold. This study shows the effectiveness of using low imperceptible levels of SVS to improve dynamic stability during walking on a laterally oscillating treadmill via the SR phenomenon.

Sensorimotor Adaptation Training’s Effect on Head Stabilization in Response to a Lateral Perturbation in Older Adults

The goal of this study was to determine if exposure to sensorimotor adaptation training improved head stabilization in older adults. Sixteen participants, age 66–81 yr, were assigned at random to the control group (n= 8) or the experimental group (n= 8). Both groups first completed 6 trials of walking a foam pathway consisting of a moveable platform that induced a lateral perturbation during walking. Head-in-space and trunk-in-space angular velocities were collected. Participants from both groups then trained twice per week for 4 wk. Both groups walked on a treadmill for 20 min. The control group viewed a static scene. The experimental group viewed a rotating visual scene that provided a perceptual-motor mismatch. After training, both groups were retested on the perturbation pathway test. The experimental group used a movement strategy that preserved head stabilization compared with the controls (p< .05). This training effect was not retained after 4 wk.

Posturography and locomotor tests of dynamic balance after long-duration spaceflight

The currently approved objective clinical measure of standing balance in astronauts after space flight is the Sensory Organization Test battery of computerized dynamic posturography. No tests of walking balance are currently approved for standard clinical testing of astronauts. This study determined the sensitivity and specificity of standing and walking balance tests for astronauts before and after long-duration space flight. Astronauts were tested on an obstacle avoidance test known as the Functional Mobility Test (FMT) and on the Sensory Organization Test using sway-referenced support surface motion with eyes closed (SOT 5) before and six months after (n=15) space flight on the International Space Station. They were tested two to seven days after landing. Scores on SOT tests decreased and scores on FMT increased significantly from pre- to post-flight. In other words, post-flight scores were worse than pre-flight scores. SOT and FMT scores were not significantly related. ROC analyses indicated supra-clinical cut-points for SOT 5 and for FMT. The standard clinical cut-point for SOT 5 had low sensitivity to post-flight astronauts. Higher cut-points increased sensitivity to post-flight astronauts but decreased specificity to pre-flight astronauts. Using an FMT cut-point that was moderately highly sensitive and highly specific plus SOT 5 at the standard clinical cut-point was no more sensitive than SOT 5, alone. FMT plus SOT 5 at higher cut-points was more specific and more sensitive. The total correctly classified was highest for FMT, alone, and for FMT plus SOT 5 at the highest cut-point. These findings indicate that standard clinical comparisons are not useful for identifying problems. Testing both standing and walking balance will be more likely to identify balance deficits.

Gait adaptability training is affected by visual dependency

As part of a larger gait adaptability training study, we designed a program that presented combinations of visual flow and support-surface manipulations to investigate the response of healthy adults to walking on a treadmill in novel discordant sensorimotor conditions. A visual dependence score was determined for each subject, and this score was used to explore how visual dependency was linked to locomotor performance (1) during three training sessions and (2) in a new discordant environment presented at the conclusion of training. Performance measures included reaction time (RT), stride frequency (SF), and heart rate (HR), which respectively served as indicators of cognitive load, postural stability, and anxiety. We hypothesized that training would affect performance measures differently for highly visually dependent individuals than for their less visually dependent counterparts. A seemingly unrelated estimation analysis of RT, SF, and HR revealed a significant omnibus interaction of visual dependency by session (p < 0.001), suggesting that the magnitude of differences in these measures across training day 1 (TD1), training day 3 (TD3), and exposure to a novel test is dependent on subjects' levels of visual dependency. The RT result, in particular, suggested that highly visually dependent subjects successfully trained to one set of sensory discordant conditions but were unable to apply their adapted skills when introduced to a new sensory discordant environment. This finding augments rationale for developing customized gait training programs that are tailored to an individual. It highlights one factor--personal level of visual dependency--to consider when designing training conditions for a subject or patient. Finally, the link between visual dependency and locomotor performance may offer predictive insight regarding which subjects in a normal population will require more training when preparing for specific novel locomotor conditions.

Facilitation of learning induced by both random and gradual visuomotor task variation

Motor task variation has been shown to be a key ingredient in skill transfer, retention, and structural learning. However, many studies only compare training of randomly varying tasks to either blocked or null training, and it is not clear how experiencing different nonrandom temporal orderings of tasks might affect the learning process. Here we study learning in human subjects who experience the same set of visuomotor rotations, evenly spaced between −60° and +60°, either in a random order or in an order in which the rotation angle changed gradually. We compared subsequent learning of three test blocks of +30°→−30°→+30° rotations. The groups that underwent either random or gradual training showed significant (P < 0.01) facilitation of learning in the test blocks compared with a control group who had not experienced any visuomotor rotations before. We also found that movement initiation times in the random group during the test blocks were significantly (P < 0.05) lower than for the gradual or the control group. When we fit a state-space model with fast and slow learning processes to our data, we found that the differences in performance in the test block were consistent with the gradual or random task variation changing the learning and retention rates of only the fast learning process. Such adaptation of learning rates may be a key feature of ongoing meta-learning processes. Our results therefore suggest that both gradual and random task variation can induce meta-learning and that random learning has an advantage in terms of shorter initiation times, suggesting less reliance on cognitive processes.

Gait training improves performance in healthy adults exposed to novel sensory discordant conditions

Recent evidence shows that the ability to adapt to a novel discordant sensorimotor environment can be increased through prior training. We aimed to determine whether gait adaptability could be increased and then retained using a training system comprised of a treadmill placed on a motion base facing a virtual visual scene that provided a variety of sensory challenges that served as training modalities. Ten healthy adults participated in three training sessions during which they walked on a treadmill at 1.1 m/s while receiving discordant support-surface and visual manipulations. Upon completion, participants were presented with a novel sensorimotor challenge designed to test for transfer of adaptive skills. During this test, stride frequency, reaction time, and heart rate data were collected as measures of postural stability, cognitive load, and anxiety, respectively. Compared to 10 untrained controls, trained participants showed enhanced overall performance on the Novel Test, which was administered 20 min after their final training session. Subjects in both groups had greater stride frequency, reaction time, and heart rate when exposed to the new sensory environment; however, these increases were less pronounced in the trained subjects than in the controls. The Novel Test was re-administered to both groups 1 week, 1 month, 3 months, and 6 months later. Trained subjects maintained their level of performance for 6 months. Untrained subjects continued to improve in these measures at each subsequent test session, suggesting that a lasting sensorimotor adaptability training effect can be achieved with very short, repeated exposures to discordant sensory conditions.

Structure learning in action

'Learning to learn' phenomena have been widely investigated in cognition, perception and more recently also in action. During concept learning tasks, for example, it has been suggested that characteristic features are abstracted from a set of examples with the consequence that learning of similar tasks is facilitated-a process termed 'learning to learn'. From a computational point of view such an extraction of invariants can be regarded as learning of an underlying structure. Here we review the evidence for structure learning as a 'learning to learn' mechanism, especially in sensorimotor control where the motor system has to adapt to variable environments. We review studies demonstrating that common features of variable environments are extracted during sensorimotor learning and exploited for efficient adaptation in novel tasks. We conclude that structure learning plays a fundamental role in skill learning and may underlie the unsurpassed flexibility and adaptability of the motor system.

Obstacle stepping and body scale modulating parameters

The purpose of this study was to investigate gait spatial parameters at the point of departure, with obstacle heights adjusted to individual body scale. Undergraduate student volunteers (M age = 22.4 yr., SD = 2.1; 6 women, 1 man) were asked to step once, then cross over an obstacle and stop. This behavior was video recorded to extract kinematic data. The obstacle heights corresponded to high (knee-height) and low obstacles (half the knee-height). Points of departure corresponded to far (length of the lower limb) and close (half the length of the lower limb). The close point of departure influenced the trailing foot's placement ahead of the obstacle as well as step length. The high obstacle influenced the trailing foot's toe clearance. An interaction between factors was observed for leading foot toe clearance. Results indicate that body scale affected the participants' locomotor behavior during the obstacle-avoidance task.

Strategies of healthy adults walking on a laterally oscillating treadmill

We mounted a treadmill on top of a six degree-of-freedom motion base platform to investigate locomotor responses produced by healthy adults introduced to a dynamic walking surface. The experiment examined self-selected strategies employed by participants when exposed to continuous, sinusoidal lateral motion of the support surface while walking. Torso translation and step width were used to classify responses used to stabilize gait in this novel, dynamic environment. Two response categories emerged. Participants tended to either fix themselves in space (FIS), allowing the treadbelt to move laterally beneath them, or fix themselves to the base (FTB), moving laterally as the motion base oscillated. The degree of fixation in both extremes varied across participants. This finding suggests that normal adults have innate and varied preferences for optimizing gait stability, some depending more heavily on vision (FIS group) and others on proprioception (FTB group).

Improvement of obstacle avoidance on a compliant surface during transfer to a novel visual task after variable practice under unusual visual conditions

Previous work has shown that variable practice facilitates adaptation to novel visuomotor changes during throwing tasks and obstacle avoidance on a solid floor. To assess whether locomotor skill on an obstacle-avoidance task performed on a compliant surface and in a novel visuomotor environment improved after training with variable practice, 61 normal adults practiced traversing the obstacle course. Half the trials were performed with no visual changes and half with either sham lenses or visually distorting lenses; the latter were either single or multiple lenses. On transfer tests on the obstacle course while wearing novel lenses, scores were significantly better with multiple lenses than sham; the single-lens group did not differ from sham or multiple-lens groups. Thus, performance in a novel visual environment on a compliant surface improved most with variable practice.

Critical features of training that facilitate adaptive generalization of over ground locomotion

When subjects learn motor tasks under novel visuomotor conditions variations in sensory input during training facilitate adaptive generalization. We tested the hypotheses that training with multiple sensory input variations is more effective than a single or no variation and that training must include critical features of the criterion task. Normal adults were pre- and post-tested on an obstacle avoidance task while wearing visual distortion lenses after treadmill walking (Experiment 1), or balance training (Experiment 2). Subjects were randomized to training groups in which they wore either: (1) three different visual distortion lenses, (2) a single pair of visual distortion lenses, or (3) sham lenses. Post-tests were done while wearing novel lenses. In Experiment 1 subjects who trained with multiple lenses adapted better than single or sham lens groups. The single lens-training group with magnifying lenses adapted better than the other single lens groups. In Experiment 2, training for dynamic balance, alone, did not increase training efficacy. Thus, training for an obstacle avoidance task in a novel visual environment required a critical feature of the criterion task: locomotion. Constant practice with a single lens was successful only if the best lens was selected, but the best lens could not be known ahead of time. Therefore variable practice with multiple lenses on a task that included a critical feature of the criterion task was the best training strategy to enhance adaptive generalization.