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Oh K, Rymer WZ, Choi J. A pilot study: effect of somatosensory loss on motor corrections in response to unknown loads in a reaching task by chronic stroke survivors. Biomed Eng Lett 2024; 14:523-535. [PMID: 38645583 PMCID: PMC11026319 DOI: 10.1007/s13534-024-00348-5] [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: 09/06/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 04/23/2024] Open
Abstract
Despite recent studies indicating a significant correlation between somatosensory deficits and rehabilitation outcomes, how prevailing somatosensory deficits affect stroke survivors' ability to correct their movements and recover overall remains unclear. To explore how major deficits in somatosensory systems impede stroke survivors' motor correction to various external loads, we conducted a study with 13 chronic stroke survivors who had hemiparesis. An inertial, elastic, or viscous load, which was designed to impose perturbing forces with various force profiles, was introduced unexpectedly during the reaching task using a programmable haptic robot. Participants' proprioception and cutaneous sensation were also assessed using passive movement detection, finger-to-nose, mirror, repositioning, and Weinstein pressure tests. These measures were then analyzed to determine whether the somatosensory measures significantly correlated with the estimated reaching performance parameters, such as initial directional error, positional deviation, velocity deviations, and speed of motor correction were measured. Of 13 participants, 5 had impaired proprioception, as they could not recognize the passive movement of their elbow joint, and they kept showing larger initial directional errors even after the familiarization block. Such continuously found inaccurate initial movement direction might be correlated with the inability to develop the spatial body map especially for calculating the initial joint torques when starting the reaching movement. Regardless of whether proprioception was impaired or not, all participants could show the stabilized, constant reaching movement trajectories. This highlights the role of proprioception especially in the execution of a planned movement at the early stage of reaching movement.
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Affiliation(s)
- Keonyoung Oh
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - William Zev Rymer
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL USA
| | - Junho Choi
- Bionics Research Center, Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, 02792 Seoul, Republic of Korea
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Brunfeldt AT, Bregman BS, Lum PS. Responsiveness to exoskeleton loading during bimanual reaching is associated with corticospinal tract integrity in stroke. Front Neurosci 2024; 18:1348103. [PMID: 38500483 PMCID: PMC10944900 DOI: 10.3389/fnins.2024.1348103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
Background Device-based rehabilitation of upper extremity impairment following stroke often employs one-sized-fits-all approaches that do not account for individual differences in patient characteristics. Objective Determine if corticospinal tract lesion load could explain individual differences in the responsiveness to exoskeleton loading of the arms in chronic stroke participants. Methods Fourteen stroke participants performed a bimanual shared cursor reaching task in virtual reality while exoskeletons decreased the effective weight of the more-impaired arm and increased the effective weight of the less-impaired arm. We calculated the change in relative displacement between the arms (RC) and the change in relative muscle activity (MC) between the arms from the biceps and deltoids. We calculated corticospinal tract lesion load (wCSTLL) in a subset of 10 participants. Results Exoskeleton loading did not change RC (p = 0.07) or MC (p = 0.47) at the group level, but significant individual differences emerged. Participants with little overlap between the lesion and corticospinal tract responded to loading by decreasing muscle activity in the more-impaired arm relative to the less-impaired arm. The change in deltoid MC was associated with smaller wCSTLL (R2 = 0.43, p = 0.039); there was no such relationship for biceps MC (R2 < 0.001, p = 0.98). Conclusion Here we provide evidence that corticospinal tract integrity is a critical feature that determines one's ability to respond to upper extremity exoskeleton loading. Our work contributes to the development of personalized device-based interventions that would allow clinicians and researchers to titrate constraint levels during bimanual activities.
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Affiliation(s)
- Alexander T. Brunfeldt
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Barbara S. Bregman
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Peter S. Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
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Kanade-Mehta P, Bengtson M, Stoeckmann T, McGuire J, Ghez C, Scheidt RA. Spatial mapping of posture-dependent resistance to passive displacement of the hypertonic arm post-stroke. J Neuroeng Rehabil 2023; 20:163. [PMID: 38041164 PMCID: PMC10693118 DOI: 10.1186/s12984-023-01285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Muscles in the post-stroke arm commonly demonstrate abnormal reflexes that result in increased position- and velocity-dependent resistance to movement. We sought to develop a reliable way to quantify mechanical consequences of abnormal neuromuscular mechanisms throughout the reachable workspace in the hemiparetic arm post-stroke. METHODS Survivors of hemiparetic stroke (HS) and neurologically intact (NI) control subjects were instructed to relax as a robotic device repositioned the hand of their hemiparetic arm between several testing locations that sampled the arm's passive range of motion. During transitions, the robot induced motions at either the shoulder or elbow joint at three speeds: very slow (6°/s), medium (30°/s), and fast (90°/s). The robot held the hand at the testing location for at least 20 s after each transition. We recorded and analyzed hand force and electromyographic activations from selected muscles spanning the shoulder and elbow joints during and after transitions. RESULTS Hand forces and electromyographic activations were invariantly small at all speeds and all sample times in NI control subjects but varied systematically by transport speed during and shortly after movement in the HS subjects. Velocity-dependent resistance to stretch diminished within 2 s after movement ceased in the hemiparetic arms. Hand forces and EMGs changed very little from 2 s after the movement ended onward, exhibiting dependence on limb posture but no systematic dependence on movement speed or direction. Although each HS subject displayed a unique field of hand forces and EMG responses across the workspace after movement ceased, the magnitude of steady-state hand forces was generally greater near the outer boundaries of the workspace than in the center of the workspace for the HS group but not the NI group. CONCLUSIONS In the HS group, electromyographic activations exhibited abnormalities consistent with stroke-related decreases in the stretch reflex thresholds. These observations were consistent across repeated testing days. We expect that the approach described here will enable future studies to elucidate stroke's impact on the interaction between the neural mechanisms mediating control of upper extremity posture and movement during goal-directed actions such as reaching and pointing with the arm and hand.
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Affiliation(s)
- Priyanka Kanade-Mehta
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Maria Bengtson
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Tina Stoeckmann
- Department of Physical Therapy, Marquette University, Milwaukee, USA
| | - John McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, USA
| | - Claude Ghez
- Department of Neuroscience, Neurology, and Physiology, Columbia University Medical Center, New York, USA
| | - Robert A Scheidt
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA.
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Bandini V, Carpinella I, Marzegan A, Jonsdottir J, Frigo CA, Avanzino L, Pelosin E, Ferrarin M, Lencioni T. Surface-Electromyography-Based Co-Contraction Index for Monitoring Upper Limb Improvements in Post-Stroke Rehabilitation: A Pilot Randomized Controlled Trial Secondary Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:7320. [PMID: 37687775 PMCID: PMC10490112 DOI: 10.3390/s23177320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
Persons post-stroke experience excessive muscle co-contraction, and consequently the arm functions are compromised during the activities of daily living. Therefore, identifying instrumental outcome measures able to detect the motor strategy adopted after a stroke is a primary clinical goal. Accordingly, this study aims at verifying whether the surface electromyography (sEMG)-based co-contraction index (CCI) could be a new clinically feasible approach for assessing and monitoring patients' motor performance. Thirty-four persons post-stroke underwent clinical assessment and upper extremity kinematic analysis, including sEMG recordings. The participants were randomized into two treatment groups (robot and usual care groups). Ten healthy subjects provided a normative reference (NR). Frost's CCI was used to quantify the muscle co-contraction of three different agonist/antagonist muscle pairs during an object-placing task. Persons post-stroke showed excessive muscle co-contraction (mean (95% CI): anterior/posterior deltoid CCI: 0.38 (0.34-0.41) p = 0.03; triceps/biceps CCI: 0.46 (0.41-0.50) p = 0.01) compared to NR (anterior/posterior deltoid CCI: 0.29 (0.21-0.36); triceps/biceps CCI: 0.34 (0.30-0.39)). After robot therapy, persons post-stroke exhibited a greater improvement (i.e., reduced CCI) in proximal motor control (anterior/posterior deltoid change score of CCI: -0.02 (-0.07-0.02) p = 0.05) compared to usual care therapy (0.04 (0.00-0.09)). Finally, the findings of the present study indicate that the sEMG-based CCI could be a valuable tool in clinical practice.
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Affiliation(s)
- Virginia Bandini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Alberto Marzegan
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Carlo Albino Frigo
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy;
| | - Elisa Pelosin
- IRCCS Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy;
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genova, Italy
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
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Washabaugh EP, Augenstein TE, Koje M, Krishnan C. Functional Resistance Training With Viscous and Elastic Devices: Does Resistance Type Acutely Affect Knee Function? IEEE Trans Biomed Eng 2023; 70:1274-1285. [PMID: 36240034 PMCID: PMC10170553 DOI: 10.1109/tbme.2022.3214773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Functional resistance training (FRT) during walking is an emerging approach for rehabilitating individuals with neuromuscular or orthopedic injuries. During FRT, wearable exoskeleton/braces can target resistance to a weakened leg joint; however, the resistive properties of the training depend on the type of resistive elements used in the device. Hence, this study was designed to examine how the biomechanical and neural effects of functional resistance training differ with viscous and elastic resistances during both treadmill and overground walking. METHODS Fourteen able-bodied individuals were trained on two separate sessions with two devices that provided resistance to the knee (viscous and elastic) while walking on a treadmill. We measured gait biomechanics and muscle activation during training, as well as kinematic aftereffects and changes in peripheral fatigue and neural excitability after training. RESULTS We found the resistance type differentially altered gait kinetics during training-elastic resistance increased knee extension during stance while viscous resistance primarily affected swing. Also, viscous resistance increased power generation while elastic resistance could increase power absorption. Both devices resulted in significant kinematic and neural aftereffects. However, overground kinematic aftereffects and neural excitability did not differ between devices. CONCLUSION Different resistance types can be used to alter gait biomechanics during training. While there were no resistance-specific changes in acute neural adaptation following training, it is still possible that prolonged and repeated training could produce differential effects. SIGNIFICANCE Resistance type alters the kinetics of functional resistance training. Prolonged and repeated training sessions on patients will be needed to further measure the effects of these devices.
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Affiliation(s)
| | - Thomas E. Augenstein
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA; University of Michigan, Robotics Institute, Ann Arbor, MI, USA
| | - Mary Koje
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA; University of Michigan, Robotics Institute, Ann Arbor, MI, USA
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Washabaugh EP, Krishnan C. Functional resistance training methods for targeting patient-specific gait deficits: A review of devices and their effects on muscle activation, neural control, and gait mechanics. Clin Biomech (Bristol, Avon) 2022; 94:105629. [PMID: 35344781 DOI: 10.1016/j.clinbiomech.2022.105629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injuries to the neuromusculoskeletal system often result in weakness and gait impairments. Functional resistance training during walking-where patients walk while a device increases loading on the leg-is an emerging approach to combat these symptoms. However, there are many methods that can be used to resist the patient, which may alter the biomechanics of the training. Thus, all methods may not address patient-specific deficits. METHODS We performed a comprehensive electronic database search to identify articles that acutely (i.e., after a single training session) examined how functional resistance training during walking alters muscle activation, gait biomechanics, and neural plasticity. Only articles that examined these effects during training or following the removal of resistance (i.e., aftereffects) were included. FINDINGS We found 41 studies that matched these criteria. Most studies (24) used passive devices (e.g., weighted cuffs or resistance bands) while the remainder used robotic devices. Devices varied on if they were wearable (14) or externally tethered, and the type of resistance they applied (i.e., inertial [14], elastic [8], viscous [7], or customized [12]). Notably, these methods provided device-specific changes in muscle activation, biomechanics, and spatiotemporal and kinematic aftereffects. Some evidence suggests this training results in task-specific increases in neural excitability. INTERPRETATION These findings suggest that careful selection of resistive strategies could help target patient-specific strength deficits and gait impairments. Also, many approaches are low-cost and feasible for clinical or in-home use. The results provide new insights for clinicians on selecting an appropriate functional resistance training strategy to target patient-specific needs.
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Affiliation(s)
- Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA; Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics, University of Michigan, Ann Arbor, MI, USA.
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Kopke JV, Hargrove LJ, Ellis MD. Coupling of shoulder joint torques in individuals with chronic stroke mirrors controls, with additional non-load-dependent negative effects in a combined-torque task. J Neuroeng Rehabil 2021; 18:134. [PMID: 34496876 PMCID: PMC8425046 DOI: 10.1186/s12984-021-00924-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/23/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND After stroke, motor control is often negatively affected, leaving survivors with less muscle strength and coordination, increased tone, and abnormal synergies (coupled joint movements) in their affected upper extremity. Humeral internal and external rotation have been included in definitions of abnormal synergy but have yet to be studied in-depth. OBJECTIVE Determine the ability to generate internal and external rotation torque under different shoulder abduction and adduction loads in persons with chronic stroke (paretic and non-paretic arm) and uninjured controls. METHODS 24 participants, 12 with impairments after stroke and 12 controls, completed this study. A robotic device controlled abduction and adduction loading to 0, 25, and 50% of maximum strength in each direction. Once established against the vertical load, each participant generated maximum internal and external rotation torque in a dual-task paradigm. Four linear mixed-effects models tested the effect of group (control, non-paretic, and paretic), load (0, 25, 50% adduction or abduction), and their interaction on task performance; one model was created for each combination of dual-task directions (external or internal rotation during abduction or adduction). The protocol was then modeled using OpenSim to understand and explain the role of biomechanical (muscle action) constraints on task performance. RESULTS Group was significant in all task combinations. Paretic arms were less able to generate internal and external rotation during abduction and adduction, respectively. There was a significant effect of load in three of four load/task combinations for all groups. Load-level and group interactions were not significant, indicating that abduction and adduction loading affected each group in a similar manner. OpenSim musculoskeletal modeling mirrored the experimental results of control and non-paretic arms and also, when adjusted for weakness, paretic arm performance. Simulations incorporating increased co-activation mirrored the drop in performance observed across all dual-tasks in paretic arms. CONCLUSION Common biomechanical constraints (muscle actions) explain limitations in external and internal rotation strength during adduction and abduction dual-tasks, respectively. Additional non-load-dependent effects such as increased antagonist co-activation (hypertonia) may cause the observed decreased performance in individuals with stroke. The inclusion of external rotation in flexion synergy and of internal rotation in extension synergy may be over-simplifications.
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Affiliation(s)
- Joseph V. Kopke
- grid.16753.360000 0001 2299 3507Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, 2145 N Sheridan Rd, Evanston, IL 60208 USA
| | - Levi J. Hargrove
- grid.280535.90000 0004 0388 0584Center for Bionic Medicine, Shirley Ryan AbilityLab, 355 East Erie, Chicago, IL 60611 USA
| | - Michael D. Ellis
- grid.16753.360000 0001 2299 3507Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611 USA
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Oh K, Rymer WZ, Choi J. The speed of adaptation is dependent on the load type during target reaching by intact human subjects. Exp Brain Res 2021; 239:3091-3104. [PMID: 34401936 DOI: 10.1007/s00221-021-06189-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
When lifting or moving a novel object, humans are routinely able to quickly characterize the nature of the unknown load and swiftly achieve the desired movement trajectory. It appears that both tactile and proprioceptive feedback systems help humans develop an accurate prediction of load properties and determine how associated limb segments behave during voluntary movements. While various types of limb movement information, such as position, velocity, acceleration, and manipulating forces, can be detected using human tactile and proprioceptive systems, we know little about how the central nervous system decodes these various types of movement data, and in which order or priority they are used when developing predictions of joint motion during novel object manipulation. In this study, we tested whether the ability to predict motion is different between position- (elastic), velocity- (viscous), and acceleration-dependent (inertial) loads imposed using a multiaxial haptic robot. Using this protocol, we can learn if the prediction of the motion model is optimized for one or more of these types of mechanical load. We examined ten neurologically intact subjects. Our key findings indicated that inertial and viscous loads showed the fastest adaptation speed, whereas elastic loads showed the slowest adaptation speed. Different speeds of adaptation were observed across different magnitudes of the load, suggesting that human capabilities for predicting joint motion and manipulating loads may vary systematically with different load types and load magnitudes. Our results imply that human capabilities for load manipulation seems to be most sensitive to and potentially optimized for inertial loads.
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Affiliation(s)
- Keonyoung Oh
- Shirley Ryan AbilityLab (formerly RIC), Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Shirley Ryan AbilityLab (formerly RIC), Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Junho Choi
- Center for Bionics, Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, Seoul, 02792, Republic of Korea.
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Oh K, Rymer WZ, Plenzio I, Mussa-Ivaldi FA, Park S, Choi J. Development of a Planar Haptic Robot With Minimized Impedance. IEEE Trans Biomed Eng 2020; 68:1441-1449. [PMID: 33206599 DOI: 10.1109/tbme.2020.3038896] [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: 11/09/2022]
Abstract
Several studies have reported that stroke survivors displayed improved voluntary planar movements when forces supporting the upper limb increased, and when impeding forces decreased. Earlier haptic devices interacting with the human upper limb were potentially impacted by undesired residual friction force and device inertia. To explore natural, undisturbed voluntary motor control in stroke survivors, we describe the development of a Decoupled-Operational space Robot for wide Impedance Switching (DORIS) with minimized mechanical impedances. This design is based on a novel decoupling mechanism separating the end effector from a manipulator. While the user manipulates the end effector freely inside the workspace of the decoupling mechanism, to which a manipulator of the robot is attached, the robot detects such change in position using a lightweight linkage system. The manipulator of the robot then follows such movements of the end effector swiftly. Consequently, the user can explore the extended workspace, which can be as large as the manipulator's workspace. Since the end effector is mechanically decoupled from the manipulators and actuators, the user can remain unaffected by the mechanical impedances of the manipulator. Mechanical impedances perceived by the user and bandwidth of the control system were estimated. The developed robot was capable of detecting larger maximum acceleration and larger jerk of the reaching movement in chronic stroke survivors with hemiparesis. We propose that this device can be utilized for evaluating voluntary motor control of the upper limb while minimizing the impact of robot inertia and friction forces on limb behavior.
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Washabaugh EP, Augenstein TE, Ebenhoeh AM, Qiu J, Ford KA, Krishnan C. Design and Preliminary Assessment of a Passive Elastic Leg Exoskeleton for Resistive Gait Rehabilitation. IEEE Trans Biomed Eng 2020; 68:1941-1950. [PMID: 33201805 DOI: 10.1109/tbme.2020.3038582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This article aimed to develop a unique exoskeleton to provide different types of elastic resistances (i.e., resisting flexion, extension, or bidirectionally) to the leg muscles during walking. METHODS We created a completely passive leg exoskeleton, consisting of counteracting springs, pulleys, and clutches, to provide different types of elastic resistance to the knee. We first used a benchtop setting to calibrate the springs and validate the resistive capabilities of the device. We then tested the device's ability to alter gait mechanics, muscle activation, and kinematic aftereffects when walking on a treadmill under the three resistance types. RESULTS Benchtop testing indicated that the device provided a nearly linear torque profile and could be accurately configured to alter the angle where the spring system was undeformed (i.e., the resting position). Treadmill testing indicated the device could specifically target knee flexors, extensors, or both, and increase eccentric loading at the joint. Additionally, these resistance types elicited different kinematic aftereffects that could be used to target user-specific spatiotemporal gait deficits. CONCLUSION These results indicate that the elastic device can provide various types of targeted resistance training during walking. SIGNIFICANCE The proposed elastic device can provide a diverse set of resistance types that could potentially address user-specific muscle weaknesses and gait deficits through functional resistance training.
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Buoite Stella A, Morelli ME, Giudici F, Sartori A, Manganotti P, di Prampero PE. Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis. Eur J Appl Physiol 2020; 120:551-566. [PMID: 31919582 DOI: 10.1007/s00421-019-04295-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022]
Abstract
Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05-1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17-0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2-3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Maria Elisa Morelli
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Fabiola Giudici
- Unit of Statistics, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Pietro Enrico di Prampero
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
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van der Krogt H, Kouwijzer I, Klomp A, Meskers CGM, Arendzen JH, de Groot JH. Loss of selective wrist muscle activation in post-stroke patients. Disabil Rehabil 2019; 42:779-787. [PMID: 30634868 DOI: 10.1080/09638288.2018.1509241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Loss of selective muscle activation after stroke contributes to impaired arm function, is difficult to quantify and is not systematically assessed yet. The aim of this study was to describe and validate a technique for quantification of selective muscle activation of wrist flexor and extensor muscles in a cohort of post-stroke patients. Patterns of selective muscle activation were compared to healthy volunteers and test-retest reliability was assessed.Materials and methods: Activation Ratios describe selective activation of a muscle during its expected optimal activation as agonist and antagonist. Activation Ratios were calculated from electromyography signals during an isometric maximal torque task in 31 post-stroke patients and 14 healthy volunteers. Participants with insufficient voluntary muscle activation (maximal electromyography signal <3SD higher than baseline) were excluded.Results: Activation Ratios at the wrist were reliably quantified (Intraclass correlation coefficients 0.77-0.78). Activation Ratios were significantly lower in post-stroke patients compared to healthy participants (p < 0.05).Conclusion: Activation Ratios allow for muscle-specific quantification of selective muscle activation at the wrist in post-stroke patients. Loss of selective muscle activation may be a relevant determinant in assigning and evaluating therapy to improve functional outcome.Implications for RehabilitationLoss of selective muscle activation after stroke contributes to impaired arm function, is difficult to quantify and is not systematically assessed yet.The ability for selective muscle activation is a relevant determinant in assigning and evaluating therapy to improve functional outcome, e.g., botulinum toxin.Activation Ratios allow for reliable and muscle-specific quantification of selective muscle activation in post-stroke patients.
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Affiliation(s)
- Hanneke van der Krogt
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid Kouwijzer
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Asbjørn Klomp
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J Hans Arendzen
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurriaan H de Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Why orthotic devices could be of help in the management of Movement Disorders in the young. J Neuroeng Rehabil 2018; 15:118. [PMID: 30547807 PMCID: PMC6295089 DOI: 10.1186/s12984-018-0466-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention. Main body This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis. Conclusions Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.
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Washabaugh E, Guo J, Chang CK, Remy D, Krishnan C. A Portable Passive Rehabilitation Robot for Upper-Extremity Functional Resistance Training. IEEE Trans Biomed Eng 2018; 66:496-508. [PMID: 29993459 DOI: 10.1109/tbme.2018.2849580] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Loss of arm function is common in individuals with neurological damage, such as stroke or cerebral palsy. Robotic devices that address muscle strength deficits in a task-specific manner can assist in the recovery of arm function; however, current devices are typically large, bulky, and expensive to be routinely used in the clinic or at home. This study sought to address this issue by developing a portable planar passive rehabilitation robot, PaRRo. METHODS We designed PaRRo with a mechanical layout that incorporated kinematic redundancies to generate forces that directly oppose the user's movement. Cost-efficient eddy current brakes were used to provide scalable resistances. The lengths of the robot's linkages were optimized to have a reasonably large workspace for human planar reaching. We then performed theoretical analysis of the robot's resistive force generating capacity and steerable workspace using MATLAB simulations. We also validated the device by having a subject move the end-effector along different paths at a set velocity using a metronome while simultaneously collecting surface electromyography (EMG) and end-effector forces felt by the user. RESULTS Results from simulation experiments indicated that the robot was capable of producing sufficient end-effector forces for functional resistance training. We also found the endpoint forces from the user were similar to the theoretical forces expected at any direction of motion. EMG results indicated that the device was capable of providing adjustable resistances based on subjects' ability levels, as the muscle activation levels scaled with increasing magnet exposures. CONCLUSION These results indicate that PaRRo is a feasible approach to provide functional resistance training to the muscles along the upper extremity. SIGNIFICANCE The proposed robotic device could provide a technological breakthrough that will make rehabilitation robots accessible for small outpatient rehabilitation centers and in-home therapy.
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Park SK, Yang DJ, Uhm YH, Yoon JH, Kim JH. Effects of extracorporeal shock wave therapy on upper extremity muscle tone in chronic stroke patients. J Phys Ther Sci 2018; 30:361-364. [PMID: 29581652 PMCID: PMC5857439 DOI: 10.1589/jpts.30.361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of extracorporeal shock
wave therapy (ESWT) on upper extremity muscle tone in chronic stroke patients. [Subjects
and Methods] For this study, 30 stroke patients participated in this study and they were
divided into ESWT group and sham-ESWT group, each group consisted of 15 patients. ESWT and
sham-ESWT was performed by the patients for two times a week, for eight weeks. MyotonPRO
was used to measure muscle tone. [Results] According to the results of the comparisons
between the groups, after intervention, upper extremity muscle tone were significantly
higher in the ESWT group than in the sham-ESWT group. [Conclusion] This study showed that
ESWT is effective for improving decrease of muscle tone in chronic stroke patients.
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Affiliation(s)
- Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Jong Hyuk Yoon
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
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Mrotek LA, Bengtson M, Stoeckmann T, Botzer L, Ghez CP, McGuire J, Scheidt RA. The Arm Movement Detection (AMD) test: a fast robotic test of proprioceptive acuity in the arm. J Neuroeng Rehabil 2017; 14:64. [PMID: 28659156 PMCID: PMC5490232 DOI: 10.1186/s12984-017-0269-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background We examined the validity and reliability of a short robotic test of upper limb proprioception, the Arm Movement Detection (AMD) test, which yields a ratio-scaled, objective outcome measure to be used for evaluating the impact of sensory deficits on impairments of motor control, motor adaptation and functional recovery in stroke survivors. Methods Subjects grasped the handle of a horizontal planar robot, with their arm and the robot hidden from view. The robot applied graded force perturbations, which produced small displacements of the handle. The AMD test required subjects to respond verbally to queries regarding whether or not they detected arm motions. Each participant completed ten, 60s trials; in five of the trials, force perturbations were increased in small increments until the participant detected motion while in the others, perturbations were decreased until the participant could no longer detect motion. The mean and standard deviation of the 10 movement detection thresholds were used to compute a Proprioceptive Acuity Score (PAS). Based on the sensitivity and consistency of the estimated thresholds, the PAS quantifies the likelihood that proprioception is intact. Lower PAS scores correspond to higher proprioceptive acuity. Thirty-nine participants completed the AMD test, consisting of 25 neurologically intact control participants (NIC), seven survivors of stroke with intact proprioception in the more affected limb (HSS+P), and seven survivors of stroke with impaired or absent proprioception in the more affected limb (HSS-P). Results Significant group differences were found, with the NIC and HSS+P groups having lower (i.e., better) PAS scores than the HSS-P group. A subset of the participants completed the AMD test multiple times and the AMD test was found to be reliable across repetitions. Conclusions The AMD test required less than 15 min to complete and provided an objective, ratio-scaled measure of proprioceptive acuity in the upper limb. In the future, this test could be utilized to evaluate the contributions of sensory deficits to motor recovery following stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0269-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leigh Ann Mrotek
- Marquette University, Biomedical Engineering 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA. .,University of Wisconsin Oshkosh, Department of Kinesiology, 800 Algoma Boulevard, Oshkosh, WI, 54901-8630, USA.
| | - Maria Bengtson
- Marquette University, Biomedical Engineering 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
| | - Tina Stoeckmann
- Marquette University, Physical Therapy P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Lior Botzer
- Marquette University, Biomedical Engineering 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
| | - Claude P Ghez
- Columbia University, Neuroscience Kolb Annex, 1051 Riverside Drive, New York, NY, 10032, USA
| | - John McGuire
- Medical College of Wisconsin, Physical Medicine and Rehabilitation 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Robert A Scheidt
- Marquette University, Biomedical Engineering 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA.,Northwestern University Feinberg School of Medicine, Physical Medicine and Rehabilitation 710 North Lake Shore Drive #1022, Chicago, IL, 60611, USA
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Santos GL, García-Salazar LF, Souza MB, Oliveira AB, Camargo PR, Russo TL. Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects. J Electromyogr Kinesiol 2016; 30:151-60. [PMID: 27451360 DOI: 10.1016/j.jelekin.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation. METHODS Thirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper. RESULTS Paretic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation. CONCLUSION Chronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.
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Affiliation(s)
- Gabriela Lopes Santos
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Luisa Fernanda García-Salazar
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil; Physical Therapy Program, School of Medicine and Health Science, University of Rosario, Bogotá, D.C., Colombia
| | - Matheus Bragança Souza
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Beatriz Oliveira
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Paula Rezende Camargo
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Thiago Luiz Russo
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Roh J, Rymer WZ, Beer RF. Evidence for altered upper extremity muscle synergies in chronic stroke survivors with mild and moderate impairment. Front Hum Neurosci 2015; 9:6. [PMID: 25717296 PMCID: PMC4324145 DOI: 10.3389/fnhum.2015.00006] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022] Open
Abstract
Previous studies indicate that motor coordination may be achieved by assembling task-dependent combinations of a few muscle synergies, defined here as fixed patterns of activation across a set of muscles. Our recent study of severely impaired chronic stroke survivors showed that some muscle synergies underlying isometric force generation at the hand are altered in the affected arm. However, whether similar alterations are evident in stroke survivors with lesser impairment remains unclear. Accordingly, we examined muscle synergies underlying spatial patterns of elbow and shoulder muscle activation recorded during an isometric force target matching protocol performed by 16 chronic stroke survivors, evenly divided across mild and moderate impairment levels. We applied non-negative matrix factorization to identify the muscle synergies and compared their structure across groups, including previously collected data from six age-matched control subjects and eight severely impaired stroke survivors. For all groups, EMG spatial patterns were well explained by task-dependent combinations of only a few (typically 4) muscle synergies. Broadly speaking, elbow-related synergies were conserved across stroke survivors, regardless of impairment level. In contrast, the shoulder-related synergies of some stroke survivors with mild and moderate impairment differed from controls, in a manner similar to severely impaired subjects. Cluster analysis of pooled synergies for the 30 subjects identified seven distinct clusters (synergies). Subsequent analysis confirmed that the incidences of three elbow-related synergies were independent of impairment level, while the incidences of four shoulder-related synergies were systematically correlated with impairment level. Overall, our results suggest that alterations in the shoulder muscle synergies underlying isometric force generation appear prominently in mild and moderate stroke, as in most cases of severe stroke, in an impairment level-dependent manner.
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Affiliation(s)
- Jinsook Roh
- Department of Kinesiology, Temple University Philadelphia, PA, USA ; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | - William Z Rymer
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Chicago, IL, USA ; Sensory Motor Performance Program, Rehabilitation Institute of Chicago Chicago, IL, USA ; Department of Biomedical Engineering, Northwestern University Chicago, IL, USA
| | - Randall F Beer
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Chicago, IL, USA ; Sensory Motor Performance Program, Rehabilitation Institute of Chicago Chicago, IL, USA
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Silva CC, Silva A, Sousa A, Pinheiro AR, Bourlinova C, Silva A, Salazar A, Borges C, Crasto C, Correia MV, Vilas-Boas JP, Santos R. Co-activation of upper limb muscles during reaching in post-stroke subjects: an analysis of the contralesional and ipsilesional limbs. J Electromyogr Kinesiol 2014; 24:731-8. [PMID: 24882699 DOI: 10.1016/j.jelekin.2014.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 04/01/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022] Open
Abstract
The purpose of this study was to analyze the change in antagonist co-activation ratio of upper-limb muscle pairs, during the reaching movement, of both ipsilesional and contralesional limbs of post-stroke subjects. Nine healthy and nine post-stroke subjects were instructed to reach and grasp a target, placed in the sagittal and scapular planes of movement. Surface EMG was recorded from postural control and movement related muscles. Reaching movement was divided in two sub-phases, according to proximal postural control versus movement control demands, during which antagonist co-activation ratios were calculated for the muscle pairs LD/PM, PD/AD, TRIlat/BB and TRIlat/BR. Post-stroke's ipsilesional limb presented lower co-activation in muscles with an important role in postural control (LD/PM), comparing to the healthy subjects during the first sub-phase, when the movement was performed in the sagittal plane (p<0.05). Conversely, the post-stroke's contralesional limb showed in general an increased co-activation ratio in muscles related to movement control, comparing to the healthy subjects. Our findings demonstrate that, in post-stroke subjects, the reaching movement performed with the ipsilesional upper limb seems to show co-activation impairments in muscle pairs associated to postural control, whereas the contralesional upper limb seems to have signs of impairment of muscle pairs related to movement.
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Affiliation(s)
- Cláudia C Silva
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal.
| | - Augusta Silva
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal
| | - Andreia Sousa
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal
| | - Ana Rita Pinheiro
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal
| | - Catarina Bourlinova
- Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Silva
- INESC-TEC and Faculty of Engineering, University of Porto, Porto, Portugal
| | - António Salazar
- INESC-TEC and Faculty of Engineering, University of Porto, Porto, Portugal
| | - Carla Borges
- INESC-TEC and Faculty of Engineering, University of Porto, Porto, Portugal
| | - Carlos Crasto
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal
| | | | - João Paulo Vilas-Boas
- CIFI2D, Faculty of Sport, and Porto Biomechanics Laboratory, University of Porto, Porto, Portugal
| | - Rubim Santos
- Centro de Estudos do Movimento e Actividade Humana (CEMAH), ESTSP-IPP, V. N. Gaia, Portugal
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Simo L, Botzer L, Ghez C, Scheidt RA. A robotic test of proprioception within the hemiparetic arm post-stroke. J Neuroeng Rehabil 2014; 11:77. [PMID: 24885197 PMCID: PMC4011167 DOI: 10.1186/1743-0003-11-77] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 04/17/2014] [Indexed: 12/02/2022] Open
Abstract
Background Proprioception plays important roles in planning and control of limb posture and movement. The impact of proprioceptive deficits on motor function post-stroke has been difficult to elucidate due to limitations in current tests of arm proprioception. Common clinical tests only provide ordinal assessment of proprioceptive integrity (eg. intact, impaired or absent). We introduce a standardized, quantitative method for evaluating proprioception within the arm on a continuous, ratio scale. We demonstrate the approach, which is based on signal detection theory of sensory psychophysics, in two tasks used to characterize motor function after stroke. Methods Hemiparetic stroke survivors and neurologically intact participants attempted to detect displacement- or force-perturbations robotically applied to their arm in a two-interval, two-alternative forced-choice test. A logistic psychometric function parameterized detection of limb perturbations. The shape of this function is determined by two parameters: one corresponds to a signal detection threshold and the other to variability of responses about that threshold. These two parameters define a space in which proprioceptive sensation post-stroke can be compared to that of neurologically-intact people. We used an auditory tone discrimination task to control for potential comprehension, attention and memory deficits. Results All but one stroke survivor demonstrated competence in performing two-alternative discrimination in the auditory training test. For the remaining stroke survivors, those with clinically identified proprioceptive deficits in the hemiparetic arm or hand had higher detection thresholds and exhibited greater response variability than individuals without proprioceptive deficits. We then identified a normative parameter space determined by the threshold and response variability data collected from neurologically intact participants. By plotting displacement detection performance within this normative space, stroke survivors with and without intact proprioception could be discriminated on a continuous scale that was sensitive to small performance variations, e.g. practice effects across days. Conclusions The proposed method uses robotic perturbations similar to those used in ongoing studies of motor function post-stroke. The approach is sensitive to small changes in the proprioceptive detection of hand motions. We expect this new robotic assessment will empower future studies to characterize how proprioceptive deficits compromise limb posture and movement control in stroke survivors.
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Affiliation(s)
| | | | | | - Robert A Scheidt
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Avila MA, Romaguera F, Oliveira AB, Camargo PR, Salvini TF. Bilateral impairments of shoulder abduction in chronic hemiparesis: Electromyographic patterns and isokinetic muscle performance. J Electromyogr Kinesiol 2013; 23:712-20. [DOI: 10.1016/j.jelekin.2012.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/07/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022] Open
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Naik SK, Patten C, Lodha N, Coombes SA, Cauraugh JH. Force control deficits in chronic stroke: grip formation and release phases. Exp Brain Res 2011; 211:1-15. [PMID: 21448576 DOI: 10.1007/s00221-011-2637-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 02/22/2011] [Indexed: 11/26/2022]
Abstract
The aim of the study was to develop a novel approach for quantifying stair-stepping in a trajectory tracking task with the goal of understanding how age and stroke-related differences in motor control contribute to force control deficits. Nine stroke participants, nine age-matched controls, and nine young healthy adults performed an isometric gripping task while squeezing, holding, and releasing a cylindrical device. The visual tracking task involved three different rates of force production (5, 10, and 20% maximal force/s). Four outcome measures determined force control deficits: (a) root mean square error, (b) standard deviation, (c) step number, and (d) mean pause duration. Our findings indicate that step number, and especially mean pause duration, differentiated force control deficits in the three groups more effectively than the traditional root mean square error. Moreover, stroke participants showed the largest force control deficits during the grip release phase compared to age-matched and young healthy controls. Importantly, step number and mean pause duration quantified stair-stepping while measuring different constructs than root mean square error. Distinct step and duration interruptions in force modulation by persons post-stroke during the grip release phase provide new information with implications for motor recovery during rehabilitation.
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Affiliation(s)
- Sagar K Naik
- Department of Applied Physiology and Kinesiology, University of Florida, 132 C, Motor Behavior Laboratory, Gainesville, FL 32611, USA.
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Raimundo KC, Silveira LS, Kishi MS, Fernandes LFRM, Sande de Souza LAP. Análise cinemática e eletromiográfica do alcance em pacientes com acidente vascular encefálico. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O movimento de alcance é muito estudado na literatura, no entanto, poucos estudos realizam análise cinemática e eletromiográfica desse movimento em sujeitos hemiparéticos. OBJETIVO: Avaliar o alcance de indivíduos hemiparéticos pós-acidente vascular encefálico (AVE) em seus aspectos cinemáticos e eletromiográficos. MATERIAIS E MÉTODOS: Foram selecionados quatro indivíduos, idade média de 54,5 ± 10,7 anos, com diagnóstico de AVE associado à hemiparesia. Realizou-se a avaliação cinemática e eletromiográfica concomitantemente do movimento de alcance na postura sentada, tanto do lado parético quanto do não parético. RESULTADOS: Houve diferença significativa entre os sujeitos com relação ao deslocamento (F(3,63) = 3.081, p = 0.03), porém, não ocorreu diferença significativa entre os lados (F(1,63) = 1.441, p = 0.23). Com relação às articulações (ombro, cotovelo e punho), houve diferença significativa entre os deslocamentos de cada uma (F(2,63) = 27.496, p = 0.00), assim como entre as coordenadas x, y e z (F(2,63) = 36.702, p = 0.00). Na análise dos dados eletromiográficos, não houve diferença significativa entre os sujeitos (F(3,31) = 2.437, p = 0.08), entre os lados (F(1,31) = 3.384, p = 0.07) e entre os músculos (F(4,31) = 0.942, p = 0.45). Existiu diferença no tempo de execução dos movimentos quando comparado o lado não acometido com o acometido. CONCLUSÃO: As análises cinemática e eletromiográfica, de um modo geral, mostraram resultados semelhantes aos encontrados na literatura. No entanto, este estudo acrescenta uma visão mais sistematizada do movimento de alcance, considerando seus aspectos funcionais, diferindo de outros estudos por apresentar, concomitantemente, análises cinemática e eletromiográfica e por investigar ambos os membros superiores.
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Scheidt RA, Lillis KP, Emerson SJ. Visual, motor and attentional influences on proprioceptive contributions to perception of hand path rectilinearity during reaching. Exp Brain Res 2010; 204:239-54. [PMID: 20532489 PMCID: PMC2935593 DOI: 10.1007/s00221-010-2308-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/19/2010] [Indexed: 11/27/2022]
Abstract
We examined how proprioceptive contributions to perception of hand path straightness are influenced by visual, motor and attentional sources of performance variability during horizontal planar reaching. Subjects held the handle of a robot that constrained goal-directed movements of the hand to the paths of controlled curvature. Subjects attempted to detect the presence of hand path curvature during both active (subject driven) and passive (robot driven) movements that either required active muscle force production or not. Subjects were less able to discriminate curved from straight paths when actively reaching for a target versus when the robot moved their hand through the same curved paths. This effect was especially evident during robot-driven movements requiring concurrent activation of lengthening but not shortening muscles. Subjects were less likely to report curvature and were more variable in reporting when movements appeared straight in a novel "visual channel" condition previously shown to block adaptive updating of motor commands in response to deviations from a straight-line hand path. Similarly, compromised performance was obtained when subjects simultaneously performed a distracting secondary task (key pressing with the contralateral hand). The effects compounded when these last two treatments were combined. It is concluded that environmental, intrinsic and attentional factors all impact the ability to detect deviations from a rectilinear hand path during goal-directed movement by decreasing proprioceptive contributions to limb state estimation. In contrast, response variability increased only in experimental conditions thought to impose additional attentional demands on the observer. Implications of these results for perception and other sensorimotor behaviors are discussed.
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Affiliation(s)
- Robert A Scheidt
- Department of Biomedical Engineering, Marquette University, Olin Engineering Center, 303, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA.
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