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Nemanich S, Schindler-Ivens S. Age-Related Development of Bilateral Coordination of the Upper Limbs in Children and Adolescents. J Mot Behav 2024:1-9. [PMID: 39266011 DOI: 10.1080/00222895.2024.2396114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/24/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
Bilateral coordination of the upper limbs (UL) is important for activities of daily living and physical activities. Motor coordination improves from childhood through adolescence. However, age-coordination trajectories for bilateral UL movements are not well-established, and it is unclear if bimanual coordination develops slower than unilateral coordination. In this study we examined age-related changes in UL coordination from childhood to late adolescence. Typically-developing children (N = 29, aged 7-17 years) performed unilateral and bilateral, antiphase cycling tasks with their ULs. Variations in cycling velocity and interlimb phase errors were computed as measures of coordination. Linear regression was used to examine age-coordination effects. Given the sensorimotor processing for bilateral movements and gradual development of the corpus callosum, we hypothesized different relationships between age and coordination for bilateral and unilateral movements. Results showed UL coordination was significantly related to age, where coordination was better in older compared to younger children (p < 0.001); however, there were similar significant effects for unilateral movements. Differences in unilateral and bilateral coordination were not significantly explained by biological sex, although power to detect sex differences was low. We conclude that bilateral and unilateral UL coordination are age-dependent; each improves at similar rates through childhood and adolescence.
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Affiliation(s)
- Samuel Nemanich
- Department of Occupational Therapy, Marquette University, Milwaukee, USA
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Zaidi KF, Wei Q. Temporal localization of upper extremity bilateral synergistic coordination using wearable accelerometers. PeerJ 2024; 12:e17858. [PMID: 39247546 PMCID: PMC11378761 DOI: 10.7717/peerj.17858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/13/2024] [Indexed: 09/10/2024] Open
Abstract
Background The human upper extremity is characterized by inherent motor abundance, allowing a diverse array of tasks with agility and adaptability. Upper extremity functional limitations are a common sequela to Stroke, resulting in pronounced motor and sensory impairments in the contralesional arm. While many therapeutic interventions focus on rehabilitating the weaker arm, it is increasingly evident that it is necessary to consider bimanual coordination and motor control. Methods Participants were recruited to two groups differing in age (Group 1 (n = 10): 23.4 ± 2.9 years, Group 2 (n = 10): 55.9 ± 10.6 years) for an exploratory study on the use of accelerometry to quantify bilateral coordination. Three tasks featuring coordinated reaching were selected to investigate the acceleration of the upper arm, forearm, and hand during activities of daily living (ADLs). Subjects were equipped with acceleration and inclination sensors on each upper arm, each forearm, and each hand. Data was segmented in MATLAB to assess inter-limb and intra-limb coordination. Inter-limb coordination was indicated through dissimilarity indices and temporal locations of congruous movement between upper arm, forearm, or hand segments of the right and left limbs. Intra-limb coordination was likewise assessed between upper arm-forearm, upper arm-hand, and forearm-hand segment pairs of the dominant limb. Findings Acceleration data revealed task-specific movement features during the three distinct tasks. Groups demonstrated diminished similarity as task complexity increased. Groups differed significantly in the hand segments during the buttoning task, with Group 1 showing no coordination in the hand segments during buttoning, and strong coordination in reaching each button with the upper arm and forearm guiding extension. Group 2's dissimilarity scores and percentages of similarity indicated longer periods of inter-limb coordination, particularly towards movement completion. Group 1's dissimilarity scores and percentages of similarity indicated longer periods of intra-limb coordination, particularly in the coordination of the upper arm and forearm segments. Interpretation The Expanding Procrustes methodology can be applied to compute objective coordination scores using accessible and highly accurate wearable acceleration sensors. The findings of task duration, angular velocity, and peak roll angle are supported by previous studies finding older individuals to present with slower movements, reduced movement stability, and a reduction of laterality between the limbs. The theory of a shift towards ambidexterity with age is supported by the finding of greater inter-limb coordination in the group of subjects above the age of thirty-five. The group below the age of thirty was found to demonstrate longer periods of intra-limb coordination, with upper arm and forearm coordination emerging as a possible explanation for the demonstrated greater stability.
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Affiliation(s)
- Khadija F Zaidi
- Department of Bioengineering, George Mason University, Fairfax, VA, United States of America
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA, United States of America
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Ziccardi S, Timanus S, Ashrafzadehkian G, Guy SJ, Hawe RL. Characterization of bilateral reaching development using augmented reality games. Hum Mov Sci 2024; 96:103254. [PMID: 39084100 PMCID: PMC11404352 DOI: 10.1016/j.humov.2024.103254] [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: 04/07/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
Bilateral coordination is commonly impaired in neurodevelopmental conditions including cerebral palsy, developmental coordination disorder, and autism spectrum disorder. However, we lack objective clinical assessments that can quantify bilateral coordination in a clinically feasible manner and determine age-based norms to identify impairments. The objective of this study was to use augmented reality and computer vision to characterize bilateral reaching abilities in typically developing children. Typically developing children (n = 133) ages 6-17 years completed symmetric and asymmetric bilateral reaching tasks in an augmented reality game environment. We analyzed the number of target pairs they could reach in 50 s as well as the time lag between their hands reaching the targets. We found that performance on both tasks developed in parallel, with development slowing but not plateauing after age 12. Children performed better on the symmetric task than asymmetric, both in targets reached and with shorter hand lags. Variability between children in hand lag decreased with age. We also found gender differences with females outperforming males, which were most pronounced in the 10-11 year olds. Overall, this study demonstrates parallel development through childhood and adolescence of symmetric and asymmetric reaching abilities. Furthermore, it demonstrates the ability to quantify bilateral coordination using computer vision and augmented reality, which can be applied to assess clinical populations.
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Affiliation(s)
- Shelby Ziccardi
- Department of Computer Science and Engineering, University of Minnesota, Kenneth H. Keller Hall, 200 Union St SE, Minneapolis, MN 55455, United States of America
| | - Samantha Timanus
- Department of Computer Science and Engineering, University of Minnesota, Kenneth H. Keller Hall, 200 Union St SE, Minneapolis, MN 55455, United States of America
| | - Ghazaleh Ashrafzadehkian
- College of Design, University of Minnesota, 107 Rapson Hall, 89 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Stephen J Guy
- Department of Computer Science and Engineering, University of Minnesota, Kenneth H. Keller Hall, 200 Union St SE, Minneapolis, MN 55455, United States of America
| | - Rachel L Hawe
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE, Minneapolis, MN 55455, United States of America.
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Poitras I, Campeau-Lecours A, Mercier C. Relationship between somatosensory and visuo-perceptual impairments and motor functions in adults with hemiparetic cerebral palsy. Front Neurol 2024; 15:1425124. [PMID: 39087017 PMCID: PMC11290339 DOI: 10.3389/fneur.2024.1425124] [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: 04/29/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Children with cerebral palsy (CP) exhibit a variety of sensory impairments that can interfere with motor performance, but how these impairments persist into adulthood needs further investigation. The objective of this study was to describe the sensory impairments in adults having CP and how they relate to motor impairments. Methods Nineteen adults having CP performed a set of robotic and clinical assessments. These assessments were targeting different sensory functions and motor functions (bilateral and unilateral tasks). Frequency of each type of impairments was determined by comparing individual results to normative data. Association between the sensory and motor impairments was assessed with Spearman correlation coefficient. Results Impairment in stereognosis was the most frequent, affecting 57.9% of participants. Although less frequently impaired (26.3%), tactile discrimination was associated with all the motor tasks (unilateral and bilateral, either robotic or clinical). Performance in robotic motor assessments was more frequently associated with sensory impairments than with clinical assessments. Finally, sensory impairments were not more closely associated with bilateral tasks than with unilateral tasks. Discussion Somatosensory and visuo-perceptual impairments are frequent among adults with CP, with 84.2% showing impairments in at least one sensory function. These sensory impairments show a moderate association with motor impairments.
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Affiliation(s)
- Isabelle Poitras
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- School of Rehabilitation Sciences, Laval University, Quebec City, QC, Canada
| | - Alexandre Campeau-Lecours
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Mechanical Engineering, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Mechanical Engineering, Laval University, Quebec City, QC, Canada
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Parhizi B, Barss TS, Dineros AM, Sivadasan G, Mann D, Mushahwar VK. Bimanual coordination and spinal cord neuromodulation: how neural substrates of bimanual movements are altered by transcutaneous spinal cord stimulation. J Neuroeng Rehabil 2024; 21:103. [PMID: 38890742 PMCID: PMC11184732 DOI: 10.1186/s12984-024-01395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
Humans use their arms in complex ways that often demand two-handed coordination. Neurological conditions limit this impressive feature of the human motor system. Understanding how neuromodulatory techniques may alter neural mechanisms of bimanual coordination is a vital step towards designing efficient rehabilitation interventions. By non-invasively activating the spinal cord, transcutaneous spinal cord stimulation (tSCS) promotes recovery of motor function after spinal cord injury. A multitude of research studies have attempted to capture the underlying neural mechanisms of these effects using a variety of electrophysiological tools, but the influence of tSCS on cortical rhythms recorded via electroencephalography remains poorly understood, especially during bimanual actions. We recruited 12 neurologically intact participants to investigate the effect of cervical tSCS on sensorimotor cortical oscillations. We examined changes in the movement kinematics during the application of tSCS as well as the cortical activation level and interhemispheric connectivity during the execution of unimanual and bimanual arm reaching movements that represent activities of daily life. Behavioral assessment of the movements showed improvement of movement time and error during a bimanual common-goal movement when tSCS was delivered, but no difference was found in the performance of unimanual and bimanual dual-goal movements with the application of tSCS. In the alpha band, spectral power was modulated with tSCS in the direction of synchronization in the primary motor cortex during unimanual and bimanual dual-goal movements and in the somatosensory cortex during unimanual movements. In the beta band, tSCS significantly increased spectral power in the primary motor and somatosensory cortices during the performance of bimanual common-goal and unimanual movements. A significant increase in interhemispheric connectivity in the primary motor cortex in the alpha band was only observed during unimanual tasks in the presence of tSCS. Our observations provide, for the first time, information regarding the supra-spinal effects of tSCS as a neuromodulatory technique applied to the spinal cord during the execution of bi- and unimanual arm movements. They also corroborate the suppressive effect of tSCS at the cortical level reported in previous studies. These findings may guide the design of improved rehabilitation interventions using tSCS for the recovery of upper-limb function in the future.
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Affiliation(s)
- Behdad Parhizi
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
| | - Trevor S Barss
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Katz Group-Rexall Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Alphonso Martin Dineros
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Gokul Sivadasan
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Darren Mann
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vivian K Mushahwar
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Katz Group-Rexall Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Rozaire J, Paquin C, Henry L, Agopyan H, Bard-Pondarré R, Naaim A, Duprey S, Chaleat-Valayer E. A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions. J Neuroeng Rehabil 2024; 21:56. [PMID: 38622731 PMCID: PMC11020208 DOI: 10.1186/s12984-024-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility. METHODS A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria. RESULTS A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article. CONCLUSION Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.
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Affiliation(s)
- Julie Rozaire
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Clémence Paquin
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
- Texisense, Torcy, France
| | - Lauren Henry
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Hovannes Agopyan
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Rachel Bard-Pondarré
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Alexandre Naaim
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Sonia Duprey
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuelle Chaleat-Valayer
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
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Yamada M, Jacob J, Hesling J, Johnson T, Wittenberg G, Kantak S. Goal conceptualization has distinct effects on spatial and temporal bimanual coordination after left- and right- hemisphere stroke. Hum Mov Sci 2024; 94:103196. [PMID: 38402657 PMCID: PMC10939720 DOI: 10.1016/j.humov.2024.103196] [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: 08/04/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Perception of task goal influences motor performance and coordination. In bimanual actions, it is unclear how one's perception of task goals influences bimanual coordination and performance in individuals with unilateral stroke. We characterized inter-limb coordination differences in individuals with chronic right- and left-hemisphere damaged (RCVA: n = 24, LCVA: n = 24) stroke and age-matched neurotypical controls (n = 24) as they completed bimanual reaching tasks under distinct goal conditions. In the dual-goal condition, participants reached to move two virtual bricks (cursors) assigned to each hand toward independent targets. In the common-goal condition, they moved a central common virtual brick representing both hands to a single, central target. Spatial and temporal coordination (cross-correlation coefficients of hand velocity and their time-lag), the redundant axis deviations (the hand deviations in the axis orthogonal to the axis along the cursor-target direction), and the contribution ratio of the paretic hand were measured. Compared to the dual-goal condition, reaching actions to the common-goal demonstrated better spatial bimanual coordination in all three participant groups. Temporal coordination was better during common-goal than dual-goal actions only for the LCVA group. Additionally, and novel to this field, sex, as a biological variable, differently influenced movement time and redundant axis deviation in participants with stroke under the common-goal condition. Specifically, female stroke survivors showed larger movements in the redundant axes and, consequently, longer movement times, which was more prominent in the LCVA group. Our results indicate that perception of task goals influences bimanual coordination, with common goal improving spatial coordination in neurotypical individuals and individuals with unilateral stroke and providing additional advantage for temporal coordination in those with LCVA. Sex influences bimanual performance in stroke survivors and needs to be considered in future investigations.
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Affiliation(s)
- Masahiro Yamada
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Kinesiology, Whittier College, Science & Learning Center 304, Whittier, CA, United States of America
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America
| | - Jessica Hesling
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America
| | - Tessa Johnson
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, United States of America
| | - George Wittenberg
- Department of Neurology, Physical Medicine & Rehabilitation, and Bioengineering, University of Pittsburgh, Geriatrics Research, Education and Clinical Center, Human Engineering Research Laboratory, VA Pittsburgh Healthcare System, United States of America
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Physical Therapy, Arcadia University, Glenside, PA, United States of America.
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Arya KN, Pandian S, Joshi AK, Chaudhary N, Agarwal GG, Ahmed SS. Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects. Top Stroke Rehabil 2024; 31:281-292. [PMID: 37690032 DOI: 10.1080/10749357.2023.2253629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role. OBJECTIVE To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects. METHODS The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA). RESULTS The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side. CONCLUSION In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Akshay Kumar Joshi
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Neera Chaudhary
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - G G Agarwal
- Department of Statistics, Lucknow University, Lucknow, India
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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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Rizvi A, Bell K, Yang D, Montenegro MP, Kim H, Bao S, Wright DL, Buchanan JJ, Lei Y. Effects of transcranial direct current stimulation over human motor cortex on cognitive-motor and sensory-motor functions. Sci Rep 2023; 13:20968. [PMID: 38017091 PMCID: PMC10684512 DOI: 10.1038/s41598-023-48070-z] [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: 08/07/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023] Open
Abstract
The primary motor cortex (M1) is broadly acknowledged for its crucial role in executing voluntary movements. Yet, its contributions to cognitive and sensory functions remain largely unexplored. Transcranial direct current stimulation (tDCS) is a noninvasive neurostimulation method that can modify brain activity, thereby enabling the establishment of a causal link between M1 activity and behavior. This study aimed to investigate the online effects of tDCS over M1 on cognitive-motor and sensory-motor functions. Sixty-four healthy participants underwent either anodal or sham tDCS while concurrently performing a set of standardized robotic tasks. These tasks provided sensitive and objective assessments of brain functions, including action selection, inhibitory control, cognitive control of visuomotor skills, proprioceptive sense, and bimanual coordination. Our results revealed that anodal tDCS applied to M1 enhances decision-making capacity in selecting appropriate motor actions and avoiding distractors compared to sham stimulation, suggesting improved action selection and inhibitory control capabilities. Furthermore, anodal tDCS reduces the movement time required to accomplish bimanual movements, suggesting enhanced bimanual performance. However, we found no impact of anodal tDCS on cognitive control of visuomotor skills and proprioceptive sense. This study suggests that augmenting M1 activity via anodal tDCS influences cognitive-motor and sensory-motor functions in a task-dependent manner.
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Affiliation(s)
- Aoun Rizvi
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Kara Bell
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Daniel Yang
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Maria P Montenegro
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Hakjoo Kim
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Shancheng Bao
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - David L Wright
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - John J Buchanan
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA
| | - Yuming Lei
- Program of Motor Neuroscience, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, 77843, USA.
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Altermatt M, Jordan H, Ho K, Byblow WD. Modulation of ipsilateral motor evoked potentials during bimanual coordination tasks. Front Hum Neurosci 2023; 17:1219112. [PMID: 37736146 PMCID: PMC10509758 DOI: 10.3389/fnhum.2023.1219112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction Ipsilateral motor evoked potentials (iMEPs) are difficult to obtain in distal upper limb muscles of healthy participants but give a direct insight into the role of ipsilateral motor control. Methods We tested a new high-intensity double pulse transcranial magnetic stimulation (TMS) protocol to elicit iMEPs in wrist extensor and flexor muscles during four different bimanual movements (cooperative-asymmetric, cooperative-symmetric, non-cooperative-asymmetric and non-cooperative-symmetric) in 16 participants. Results Nine participants showed an iMEP in the wrist extensor in at least 20% of the trials in each of the conditions and were classified as iMEP+ participants. iMEP persistence was greater for cooperative (50.5 ± 28.8%) compared to non-cooperative (31.6 ± 22.1%) tasks but did not differ between asymmetric and symmetric tasks. Area and amplitude of iMEPs were also increased during cooperative (area = 5.41 ± 3.4 mV × ms; amplitude = 1.60 ± 1.09 mV) compared to non-cooperative (area = 3.89 ± 2.0 mV × ms; amplitude = 1.12 ± 0.56 mV) tasks and unaffected by task-symmetry. Discussion The upregulation of iMEPs during common-goal cooperative tasks shows a functional relevance of ipsilateral motor control in bimanual movements. The paired-pulse TMS protocol is a reliable method to elicit iMEPs in healthy participants and can give new information about neural control of upper limb movements. With this work we contribute to the research field in two main aspects. First, we describe a reliable method to elicit ipsilateral motor evoked potentials in healthy participants which will be useful in further advancing research in the area of upper limb movements. Second, we add new insight into the motor control of bimanual movements. We were able to show an upregulation of bilateral control represented by increased ipsilateral motor evoked potentials in cooperative, object-oriented movements compared to separate bimanual tasks. This result might also have an impact on neurorehabilitation after stroke.
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Affiliation(s)
- Miriam Altermatt
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Harry Jordan
- Clinical Neuroscience Laboratory, Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Kelly Ho
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
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12
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Nguyen H, Phan T, Shadmehr R, Lee SW. Impact of unilateral and bilateral impairments on bimanual force production following stroke. J Neurophysiol 2023; 130:608-618. [PMID: 37529847 DOI: 10.1152/jn.00125.2023] [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: 03/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/03/2023] Open
Abstract
Large bilateral asymmetry and task deficits are typically observed during bimanual actions of stroke survivors. Do these abnormalities originate from unilateral impairments affecting their more-impaired limb, such as weakness and abnormal synergy, or from bilateral impairments such as incoordination of two limbs? To answer this question, 23 subjects including 10 chronic stroke survivors and 13 neurologically intact subjects participated in an experiment where they produced bimanual forces at different hand locations. The force magnitude and directional deviation of the more-impaired arm were measured for unilateral impairments and bimanual coordination across locations for bilateral impairments. Force asymmetry and task error were used to define task performance. Significant unilateral impairments were observed in subjects with stroke; the maximal force capacity of their more-impaired arm was significantly lower than that of their less-impaired arm, with a higher degree of force deviation. However, its force contribution during submaximal tasks was greater than its relative force capacity. Significant bilateral impairments were also observed, as stroke survivors modulated two forces to a larger degree across hand locations but in a less coordinated manner than control subjects did. But only unilateral, not bilateral, impairments explained a significant amount of between-subject variability in force asymmetry across subjects with stroke. Task error, in contrast, was correlated with neither unilateral nor bilateral impairments. Our results suggest that unilateral impairments of the more-impaired arm of stroke survivors mainly contribute to its reduced recruitment, but that the degree of its participation in bimanual task may be greater than their capacity as they attempt to achieve symmetry.NEW & NOTEWORTHY We studied how unilateral and bilateral impairments in stroke survivors affect their bimanual task performance. Unilateral impairments of the more-impaired limb, both weakness and loss of directional control, mainly contribute to bimanual asymmetry, but stroke survivors generally produce higher force with their more-impaired limb than their relative capacity. Bilateral force coordination was significantly impaired in stroke survivors, but its degree of impairment was not related to their unilateral impairments.
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Affiliation(s)
- Hien Nguyen
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Thanh Phan
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Reza Shadmehr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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13
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Beyaz O, Eyraud V, Demirhan G, Akpinar S, Przybyla A. Effects of Short-Term Novice Archery Training on Reaching Movement Performance and Interlimb Asymmetries. J Mot Behav 2023; 56:78-90. [PMID: 37586703 DOI: 10.1080/00222895.2023.2245352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Previous studies showed numerous evidence for the interlimb asymmetries in motor performance during arm reaching movements. Furthermore, these interlimb asymmetries have been shown to associate with spatial patterns of hand selection behavior. Importantly, these interlimb asymmetries can be modified systematically by occlusion of visual feedback, or a long-term sports training. In this study, we asked about the effects of a short-term training on interlimb asymmetries. Eighteen healthy young participants underwent a 12-week novice traditional archery training (TAT). Their unimanual dominant and nondominant arm reaching movement performance was assessed before and after TAT. We found that movement accuracy, movement precision, and movement efficiency in the experimental group have all improved significantly as a result of TAT. These improvements were comparable across both arms, thus the interlimb differences in movement performance were not affected by the short-term TAT and remained similar. These results suggest that while short-term training may contribute positively to reaching performance, it is unlikely to have a significant impact on the differences observed between the dominant and nondominant arms. This unique characteristics of dominant and nondominant arm should be taken into consideration when developing targeted sports and rehabilitation programs for athletes or individuals with acute or chronic motor deficits.
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Affiliation(s)
- Ozkan Beyaz
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Virginie Eyraud
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
| | - Gıyasettin Demirhan
- Department of Physical Education and Sports, Faculty of Sport Science, Hacettepe University, Ankara, Turkey
| | - Selcuk Akpinar
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Andrzej Przybyla
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
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14
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Sethi A, Acharya A, Raj S, Dounskaia N. Control of paretic and non-paretic upper extremity during bimanual reaching after stroke. J Mot Behav 2023; 55:513-524. [PMID: 36966815 DOI: 10.1080/00222895.2023.2187751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/28/2023]
Abstract
Most actions of daily life engage the two upper extremities (UEs) in a highly coordinated manner. While it is recognized that bimanual movements are impaired post-stroke, understanding how the paretic and non-paretic UE contributes to this impairment is important for future interventions. We investigated kinetic and kinematics at the shoulder, elbow, and wrist joints in the paretic and non-paretic UE in 8 individuals with chronic stroke and non-dominant UE in 8 healthy controls during unimanual and bimanual tasks. Kinematic analysis revealed little effect of stroke. However, kinetic analysis revealed that during unimanual movements, joint control was impaired during unimanual and bimanual movements in both UEs, although to a lesser extent in the non-paretic than paretic UE. During bimanual movements, joint control did not change in the paretic UE, and it further deteriorated in the non-paretic UE compared with the unimanual movements. Our findings suggest that a single session of bimanual task performance does not improve joint control of the paretic UE and it impairs control of the non-paretic UE, making it more like that of the paretic UE.
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Affiliation(s)
- Amit Sethi
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sandesh Raj
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Natalia Dounskaia
- Department of Kinesiology, Arizona State University, Phoenix, AZ, USA
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15
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Angerhöfer C, Vermehren M, Colucci A, Nann M, Koßmehl P, Niedeggen A, Kim WS, Chang WK, Paik NJ, Hömberg V, Soekadar SR. The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application. J Neuroeng Rehabil 2023; 20:17. [PMID: 36707885 PMCID: PMC9881328 DOI: 10.1186/s12984-023-01137-4] [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: 09/11/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Assistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance. METHODS Fourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test. RESULTS The BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance. CONCLUSION The BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.
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Affiliation(s)
- Cornelius Angerhöfer
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Mareike Vermehren
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Annalisa Colucci
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Marius Nann
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Koßmehl
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Andreas Niedeggen
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Won-Seok Kim
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Won Kee Chang
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Volker Hömberg
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R. Soekadar
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
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16
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Peña-Pérez N, Eden J, Ivanova E, Farkhatdinov I, Burdet E. How virtual and mechanical coupling impact bimanual tracking. J Neurophysiol 2023; 129:102-114. [PMID: 36475891 PMCID: PMC9844510 DOI: 10.1152/jn.00057.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Bilateral training systems look to promote the paretic hand's use in individuals with hemiplegia. Although this is normally achieved using mechanical coupling (i.e., a physical connection between the hands), a virtual reality system relying on virtual coupling (i.e., through a shared virtual object) would be simpler to use and prevent slacking. However, it is not clear whether different coupling modes differently impact task performance and effort distribution between the hands. We explored how 18 healthy right-handed participants changed their motor behaviors in response to the uninstructed addition of mechanical coupling, and virtual coupling using a shared cursor mapped to the average hands' position. In a second experiment, we then studied the impact of connection stiffness on performance, perception, and effort imbalance. The results indicated that both coupling types can induce the hands to actively contribute to the task. However, the task asymmetry introduced by using a cursor mapped to either the left or right hand only modulated the hands' contribution when not mechanically coupled. The tracking performance was similar for all coupling types, independent of the connection stiffness, although the mechanical coupling was preferred and induced the hands to move with greater correlation. These findings suggest that virtual coupling can induce the hands to actively contribute to a task in healthy participants without hindering their performance. Further investigation on the coupling types' impact on the performance and hands' effort distribution in patients with hemiplegia could allow for the design of simpler training systems that promote the affected hand's use.NEW & NOTEWORTHY We showed that the uninstructed addition of a virtual and/or a mechanical coupling can induce both hands to actively contribute in a continuous redundant bimanual tracking task without impacting performance. In addition, we showed that the task asymmetry can only alter the effort distribution when the hands are not connected, independent of the connection stiffness. Our findings suggest that virtual coupling could be used in the development of simpler VR-based training devices.
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Affiliation(s)
- Nuria Peña-Pérez
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
- Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Jonathan Eden
- Mechanical Engineering Department, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Ekaterina Ivanova
- Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Ildar Farkhatdinov
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
- Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
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Gular K, Sivasubramanian V, Reddy RS, Tedla JS, Dixit S. The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15644. [PMID: 36497718 PMCID: PMC9738511 DOI: 10.3390/ijerph192315644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. METHODS This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk's stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). RESULTS The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. CONCLUSIONS The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.
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Affiliation(s)
- Kumar Gular
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Viswanathan Sivasubramanian
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
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18
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Krebs F, Asfour T. A Bimanual Manipulation Taxonomy. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3196158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Franziska Krebs
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tamim Asfour
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Johnson T, Ridgeway G, Luchmee D, Jacob J, Kantak S. Bimanual coordination during reach-to-grasp actions is sensitive to task goal with distinctions between left- and right-hemispheric stroke. Exp Brain Res 2022; 240:2359-2373. [PMID: 35869986 PMCID: PMC10077867 DOI: 10.1007/s00221-022-06419-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
The perceptual feature of a task such as how a task goal is perceived influences performance and coordination of bimanual actions in neurotypical adults. To assess how bimanual task goal modifies paretic and non-paretic arm performance and bimanual coordination in individuals with stroke affecting left and right hemispheres, 30 participants with hemispheric stroke (15 right-hemisphere damage-RHD); 15 left-hemisphere damage-LHD) and 10 age-matched controls performed reach-to-grasp and pick-up actions under bimanual common-goal (i.e., two physically coupled dowels), bimanual independent-goal (two physically uncoupled dowels), and unimanual conditions. Reach-to-grasp time and peak grasp aperture indexed motor performance, while time lags between peak reach velocities, peak grasp apertures, and peak pick-up velocities of the two hands characterized reach, grasp, and pick-up coordination, respectively. Compared to unimanual actions, bimanual actions significantly slowed non-paretic arm speed to match paretic arm speed, thus affording no benefit to paretic arm performance. Detriments in non-paretic arm performance during bimanual actions was more pronounced in the RHD group. Under common-goal conditions, movements were faster with smaller peak grasp apertures compared to independent-goal conditions for all groups. Compared to controls, individuals with stroke demonstrated poor grasp and pick-up coordination. Of the patient groups, patients with LHD showed more pronounced deficits in grasp coordination between hands. Finally, grasp coordination deficits related to paretic arm motor deficits (upper extremity Fugl-Meyer score) for LHD group, and to Trail-Making Test performance for RHD group. Findings suggest that task goal and distinct clinical deficits influence bimanual performance and coordination in patients with left- and right-hemispheric stroke.
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Affiliation(s)
- Tessa Johnson
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Gordon Ridgeway
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Dustin Luchmee
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA.
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
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20
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De Laet C, Herman B, Riga A, Bihin B, Regnier M, Leeuwerck M, Raymackers JM, Vandermeeren Y. Bimanual motor skill learning after stroke: Combining robotics and anodal tDCS over the undamaged hemisphere: An exploratory study. Front Neurol 2022; 13:882225. [PMID: 36061986 PMCID: PMC9433746 DOI: 10.3389/fneur.2022.882225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSince a stroke can impair bimanual activities, enhancing bimanual cooperation through motor skill learning may improve neurorehabilitation. Therefore, robotics and neuromodulation with transcranial direct current stimulation (tDCS) are promising approaches. To date, tDCS has failed to enhance bimanual motor control after stroke possibly because it was not integrating the hypothesis that the undamaged hemisphere becomes the major poststroke hub for bimanual control.ObjectiveWe tested the following hypotheses: (I) In patients with chronic hemiparetic stroke training on a robotic device, anodal tDCS applied over the primary motor cortex of the undamaged hemisphere enhances bimanual motor skill learning compared to sham tDCS. (II) The severity of impairment correlates with the effect of tDCS on bimanual motor skill learning. (III) Bimanual motor skill learning is less efficient in patients than in healthy individuals (HI).MethodsA total of 17 patients with chronic hemiparetic stroke and 7 healthy individuals learned a complex bimanual cooperation skill on the REAplan® neurorehabilitation robot. The bimanual speed/accuracy trade-off (biSAT), bimanual coordination (biCo), and bimanual force (biFOP) scores were computed for each performance. In patients, real/sham tDCS was applied in a crossover, randomized, double-blind approach.ResultsCompared to sham, real tDCS did not enhance bimanual motor skill learning, retention, or generalization in patients, and no correlation with impairment was noted. The healthy individuals performed better than patients on bimanual motor skill learning, but generalization was similar in both groups.ConclusionA short motor skill learning session with a robotic device resulted in the retention and generalization of a complex skill involving bimanual cooperation. The tDCS strategy that would best enhance bimanual motor skill learning after stroke remains unknown.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT02308852, identifier: NCT02308852.
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Affiliation(s)
- Chloë De Laet
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Materials and Civil Engineering (iMMC), Institute of Mechanics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Audrey Riga
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Jean-Marc Raymackers
- Department of Neurology and Neurosurgery, Clinique Saint-Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | - Yves Vandermeeren
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
- *Correspondence: Yves Vandermeeren
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Stoykov ME, Biller OM, Wax A, King E, Schauer JM, Fogg LF, Corcos DM. Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial. Trials 2022; 23:523. [PMID: 35733202 PMCID: PMC9214193 DOI: 10.1186/s13063-022-06465-9] [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: 12/03/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has potential to significantly change clinical practice. Bilateral motor priming uses the Exsurgo priming device (Exsurgo Rehabilitation, Auckland, NZ) so that the less affected limb drives the more affected limb in bilateral symmetrical wrist flexion and extension. The aim of this study is to determine the effects of a 5-week protocol of bilateral motor priming in combination with task-specific training on motor impairment of the affected limb, bimanual motor function, and interhemispheric inhibition in moderate to severely impaired people with stroke. METHODS Seventy-six participants will be randomized to receive either 15, 2-h sessions, 3 times per week for 5 weeks (30 h of intervention) of bilateral motor priming and task-specific training (experimental group) or the same dose of control priming plus the task-specific training protocol. The experimental group performs bilateral symmetrical arm movements via the Exsurgo priming device which allows both wrists to move in rhythmic, symmetrical wrist flexion and extension for 15 min. The goal is one cycle (wrist flexion and wrist extension) per second. The control priming group receives transcutaneous electrical stimulation below sensory threshold for 15 min prior to the same 45 min of task-specific training. Outcome measures are collected at pre-intervention, post-intervention, and follow-up (8 weeks post-intervention). The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function. The secondary outcome is the Chedoke Arm and Hand Activity Index-Nine, an assessment of bimanual functional tasks. DISCUSSION To date, there are only 6 studies documenting the efficacy of priming using bilateral movements, 4 of which are pilot or feasibility studies. This is the first large-scale clinical trial of bilateral priming plus task-specific training. We have previously completed a feasibility intervention study of bilateral motor priming plus task-specific training and have considerable experience using this protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT03517657 . Retrospectively registered on May 7, 2018.
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Affiliation(s)
- Mary Ellen Stoykov
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Olivia M Biller
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexandra Wax
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Think & Speak Lab, Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, USA
| | - Erin King
- Interdepartmental Institution of Neuroscience, Northwestern University, Chicago, USA
| | - Jacob M Schauer
- Department of Preventive Medicine - Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Louis F Fogg
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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22
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Noronha B, Ng CY, Little K, Xiloyannis M, Kuah CWK, Wee SK, Kulkarni SR, Masia L, Chua KSG, Accoto D. Soft, lightweight wearable robots to support the upper limb in activities of daily living: a feasibility study on chronic stroke patients. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1401-1411. [PMID: 35576429 DOI: 10.1109/tnsre.2022.3175224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Stroke can be a devastating condition that impairs the upper limb and reduces mobility. Wearable robots can aid impaired users by supporting performance of Activities of Daily Living (ADLs). In the past decade, soft devices have become popular due to their inherent malleable and low-weight properties that makes them generally safer and more ergonomic. In this study, we present an improved version of our previously developed gravity-compensating upper limb exosuit and introduce a novel hand exoskeleton. The latter uses 3D-printed structures that are attached to the back of the fingers which prevent undesired hyperextension of joints. We explored the feasibility of using this integrated system in a sample of 10 chronic stroke patients who performed 10 ADLs.We observed a significant reduction of 30.3 ± 3.5% (mean ± standard error), 31.2 ± 3.2% and 14.0 ± 5.1% in the mean muscular activity of the Biceps Brachii (BB), Anterior Deltoid (AD) and Extensor Digitorum Communis muscles, respectively. Additionally, we observed a reduction of 14.0 ± 11.5%, 14.7 ± 6.9% and 12.8 ± 4.4% in the coactivation of the pairs of muscles BB and Triceps Brachii (TB), BB and AD, and TB and Pectoralis Major (PM), respectively, typically associated to pathological muscular synergies, without significant degradation of healthy muscular coactivation. There was also a significant increase of elbow flexion angle (12.1±1.5°). These results further cement the potential of using lightweight wearable devices to assist impaired users.
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23
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Chen S, Qiu Y, Bassile CC, Lee A, Chen R, Xu D. Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:875794. [PMID: 35547621 PMCID: PMC9082277 DOI: 10.3389/fnagi.2022.875794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Bilateral arm training (BAT) presents as a promising approach in upper extremity (UE) rehabilitation after a stroke as it may facilitate neuroplasticity. However, the effectiveness of BAT is inconclusive, and no systematic reviews and meta-analyses have investigated the impact of different factors on the outcomes of BAT. This systematic review and meta-analysis aimed to (1) compare the effects of bilateral arm training (BAT) with unilateral arm training (UAT) and conventional therapy (CT) on the upper limb (UL) motor impairments and functional performance post-stroke, and (2) investigate the different contributing factors that may influence the success of BAT. A comprehensive literature search was performed in five databases. Randomized control trials (RCTs) that met inclusion criteria were selected and assessed for methodological qualities. Data relating to outcome measures, characteristics of participants (stroke chronicity and severity), and features of intervention (type of BAT and dose) were extracted for meta-analysis. With 25 RCTs meeting the inclusion criteria, BAT demonstrated significantly greater improvements in motor impairments as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) than CT (MD = 3.94, p = < 0.001), but not in functional performance as measured by the pooled outcomes of Action Research Arm Test (ARAT), Box and Block Test (BBT), and the time component of Motor Function Test (WMFT-time) (SMD = 0.28, p = 0.313). The superior motor impairment effects of BAT were associated with recruiting mildly impaired individuals in the chronic phase of stroke (MD = 6.71, p < 0.001), and applying a higher dose of intervention (MD = 6.52, p < 0.001). Subgroup analysis showed that bilateral functional task training (BFTT) improves both motor impairments (MD = 7.84, p < 0.001) and functional performance (SMD = 1.02, p = 0.049). No significant differences were detected between BAT and UAT for motor impairment (MD = -0.90, p = 0.681) or functional performance (SMD = -0.09, p = 0.457). Thus, our meta-analysis indicates that BAT may be more beneficial than CT in addressing post-stroke UL motor impairment, particularly in the chronic phase with mild UL paresis. The success of BAT may be dose-dependent, and higher doses of intervention may be required. BFTT appears to be a valuable form of BAT that could be integrated into stroke rehabilitation programs. BAT and UAT are generally equivalent in improving UL motor impairments and functional performance.
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Affiliation(s)
- Siyun Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Clare C. Bassile
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anita Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Ruifeng Chen
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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24
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Gerardin E, Bontemps D, Babuin NT, Herman B, Denis A, Bihin B, Regnier M, Leeuwerck M, Deltombe T, Riga A, Vandermeeren Y. Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients, and healthy individuals. J Neuroeng Rehabil 2022; 19:28. [PMID: 35300709 PMCID: PMC8928664 DOI: 10.1186/s12984-022-01009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs). METHODS Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions. RESULTS Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28-55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale. CONCLUSIONS Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019. https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1.
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Affiliation(s)
- Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.
- Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium.
| | - Damien Bontemps
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
- Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Nicolas-Thomas Babuin
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
- Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Adrien Denis
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Audrey Riga
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
| | - Yves Vandermeeren
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
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25
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Zhang M, Sun C, Liu Y, Wu X. A Robotic System to Deliver Multiple Physically Bimanual Tasks via Varying Force Fields. IEEE Trans Neural Syst Rehabil Eng 2022; 30:688-698. [PMID: 35271445 DOI: 10.1109/tnsre.2022.3158339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Individuals with physical limb disabilities are often restricted to perform activities of daily life (ADLs). While efficacy of bilateral training has been demonstrated in improving physical coordination of human limbs, few robots have been developed in simulating people's ADLs integrated with task-specific force field control. This study sought to develop a bilateral robot for better task rendering of general ADLs (gADLs), where gADL-consistent workspace is achieved by setting linear motors in series, and haptic rendering of multiple bimanual tasks (coupled, uncoupled and semi-coupled) is enabled by regulating force fields between robotic handles. Experiments were conducted with human users, and our results present a viable method of a single robotic system in simulating multiple physically bimanual tasks. In future, the proposed robotic system is expected to be serving as a coordination training device, and its clinical efficacy will be also investigated.
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Effect of Cervical Transcutaneous Spinal Cord Stimulation on Sensorimotor Cortical Activity during Upper-Limb Movements in Healthy Individuals. J Clin Med 2022; 11:jcm11041043. [PMID: 35207314 PMCID: PMC8878243 DOI: 10.3390/jcm11041043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/14/2022] Open
Abstract
Transcutaneous spinal cord stimulation (tSCS) can improve upper-limb motor function after spinal cord injury. A number of studies have attempted to deduce the corticospinal mechanisms which are modulated following tSCS, with many relying on transcranial magnetic stimulation to provide measures of corticospinal excitability. Other metrics, such as cortical oscillations, may provide an alternative and complementary perspective on the physiological effect of tSCS. Hence, the present study recorded EEG from 30 healthy volunteers to investigate if and how cortical oscillatory dynamics are altered by 10 min of continuous cervical tSCS. Participants performed repetitive upper-limb movements and resting-state tasks while tSCS was delivered to the posterior side of the neck as EEG was recorded simultaneously. The intensity of tSCS was tailored to each participant based on their maximum tolerance (mean: 50 ± 20 mA). A control session was conducted without tSCS. Changes to sensorimotor cortical activity during movement were quantified in terms of event-related (de)synchronisation (ERD/ERS). Our analysis revealed that, on a group level, there was no consistency in terms of the direction of ERD modulation during tSCS, nor was there a dose-effect between tSCS and ERD/ERS. Resting-state oscillatory power was compared before and after tSCS but no statistically significant difference was found in terms of alpha peak frequency or alpha power. However, participants who received the highest stimulation intensities had significantly weakened ERD/ERS (10% ERS) compared to when tSCS was not applied (25% ERD; p = 0.016), suggestive of cortical inhibition. Overall, our results demonstrated that a single 10 min session of tSCS delivered to the cervical region of the spine was not sufficient to induce consistent changes in sensorimotor cortical activity among the entire cohort. However, under high intensities there may be an inhibitory effect at the cortical level. Future work should investigate, with a larger sample size, the effect of session duration and tSCS intensity on cortical oscillations.
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27
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Poitras I, Clouâtre J, Campeau-Lecours A, Mercier C. Accelerometry-Based Metrics to Evaluate the Relative Use of the More Affected Arm during Daily Activities in Adults Living with Cerebral Palsy. SENSORS 2022; 22:s22031022. [PMID: 35161767 PMCID: PMC8839842 DOI: 10.3390/s22031022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023]
Abstract
Adults living with cerebral palsy (CP) report bimanual and unimanual difficulties that interfere with their participation in activities of daily living (ADL). There is a lack of quantitative methods to assess the impact of these motor dysfunctions on the relative use of each arm. The objective of this study was to evaluate the concurrent and discriminative validity of accelerometry-based metrics when used to assess bimanual and unimanual functions. METHODS A group of control subjects and hemiplegic adults living with CP performed six ADL tasks, during which they were wearing an Actigraph GT9X on each wrist and being filmed. Four bimanual and unimanual metrics were calculated from both accelerometry-based and video-based data; these metrics were then compared to one other with an intraclass correlation coefficient (ICC). Some of these metrics were previously validated in other clinical population, while others were novel. The discriminative validity was assessed through comparisons between groups and between tasks. RESULTS The concurrent validity was considered as good to excellent (ICC = 0.61-0.97) depending on the experience of the raters. The tasks made it possible to discriminate between groups. CONCLUSION The proposed accelerometry-based metrics are a promising tool to evaluate bimanual and unimanual functions in adults living with CP.
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Affiliation(s)
- Isabelle Poitras
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jade Clouâtre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence:
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28
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Akremi H, Higgins J, Aissaoui R, Nadeau S. Bilateral motor coordination during upper limb symmetric pushing movements at two levels of force resistance in healthy and post-stroke individuals. Hum Mov Sci 2021; 81:102913. [PMID: 34952321 DOI: 10.1016/j.humov.2021.102913] [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: 02/12/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impairments of the upper limb (UL) are common after a stroke and may affect bilateral coordination. A better understanding of UL bilateral coordination is required for designing innovative rehabilitation strategies. OBJECTIVE To assess bilateral coordination after stroke using time-distance, velocity and force parameters during an UL bilateral task performed by simultaneously pushing handles on a bilateral exerciser at two levels of force. METHODS Two groups were included to assess bilateral coordination on a newly designed bimanual exerciser- One group of individuals at least 3 months post-stroke (n = 19) with moderate impairment and one group of healthy individuals (n = 20). Participants performed linear movements by pushing simultaneously with both hands on instrumented handles. The task consisted of two one-minute trials performed in sitting at two levels of participants' maximum force (MF): 30% and 15%, with visual feedback. Time-distance parameters, spatial, velocity and force profiles were compared between groups, between levels of resistance and the first part (0-50%) and entire duration of the pushing cycles (0-100%). RESULTS The mean pushing time was longer at 30% MF compared to 15% MF in the stroke group. Spatial profiles, represented by hand positions on the rail, revealed that the paretic hand lagged slightly behind throughout the cycle. For velocity, both groups displayed good coordination. It was less coupled at 30% than 15% MF and a trend was observed toward more lag occurrence in the stroke group. Except for lower forces on the paretic side in the stroke group, the shape of the force profiles was similar between groups, sides and levels of resistance. For all parameters, the coordination was good up to 75% of the pushing cycle and decreased toward the end of the cycle. CONCLUSIONS Individuals after stroke presented with overall spatial and temporal coupling of the UL during bilateral pushing movements. The relay of information at different levels of the nervous system might explain the coordinated pushing movements and might be interesting for training UL coordination.
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Affiliation(s)
- Haifa Akremi
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P.6128 Succ. Centre-ville, Montréal, QC H3C 3J7, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Canada
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P.6128 Succ. Centre-ville, Montréal, QC H3C 3J7, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Canada
| | - Rachid Aissaoui
- Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Canada; École de Technologie Supérieure (ETS) and Imaging and Orthopaedics Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Sylvie Nadeau
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P.6128 Succ. Centre-ville, Montréal, QC H3C 3J7, Canada; Laboratoire de pathokinésiologie, Institut universitaire sur la réadaptation en déficience physique de Montréal-Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Canada.
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29
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Aging and Bimanual Effects on Finger Center of Pressure during Precision Grip: Different Strategies for Spatial Stability. SENSORS 2021; 21:s21248396. [PMID: 34960489 PMCID: PMC8705253 DOI: 10.3390/s21248396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F1,140 = 46.17, p < 0.01) and index finger (F1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.
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30
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Molad R, Levin MF. Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke. Neurorehabil Neural Repair 2021; 36:49-60. [PMID: 34715755 PMCID: PMC8721533 DOI: 10.1177/15459683211058092] [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] [Indexed: 11/15/2022]
Abstract
Background Coordination impairments are under-evaluated in patients with stroke due to the lack of validated assessments resulting in an unclear relationship between coordination deficits and functional limitations. Objective Determine the construct validity of the new clinical upper-limb (UL) Interlimb Coordination test (ILC2) in individuals with chronic stroke. Methods Thirteen individuals with stroke, ≥40 years, with ≥30° isolated supination of the more-affected (MAff) arm, who could understand instructions and 13 healthy controls of similar age participated in a cross-sectional study. Participants performed synchronous bilateral anti-phase forearm rotations for 10 seconds in 4 conditions: self-paced internally-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Primary (continuous relative phase-CRP, cross-correlation, lag) and secondary outcome measures (UL and trunk kinematics) were compared between groups. Results Participants with stroke made slower UL movements than controls in all conditions, except EP1. Cross-correlation coefficients were lower (i.e., closer to 0) in stroke in IP1, but CRP and lag were similar between groups. In IP1 and matched-speed conditions (IP1 for healthy and IP2 for stroke), stroke participants used compensatory trunk and shoulder movements. The synchronicity sub-scale and total scores of ILC2 were related to temporal coordination in IP2. Interlimb Coordination test total score was related to greater shoulder rotation of the MAff arm. Interlimb Coordination test scores were not related to clinical scores. Conclusion Interlimb Coordination test is a valid clinical measure that may be used to objectively assess UL interlimb coordination in individuals with chronic stroke. Further reliability testing is needed to determine the clinical utility of the scale.
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Affiliation(s)
- Roni Molad
- School of Physical and Occupational Therapy, 5620McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Centre, 60387Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, 5620McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Centre, 60387Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
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David A, Subash T, Varadhan SKM, Melendez-Calderon A, Balasubramanian S. A Framework for Sensor-Based Assessment of Upper-Limb Functioning in Hemiparesis. Front Hum Neurosci 2021; 15:667509. [PMID: 34366809 PMCID: PMC8341809 DOI: 10.3389/fnhum.2021.667509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
The ultimate goal of any upper-limb neurorehabilitation procedure is to improve upper-limb functioning in daily life. While clinic-based assessments provide an assessment of what a patient can do, they do not completely reflect what a patient does in his/her daily life. The use of compensatory strategies such as the use of the less affected upper-limb or excessive use of trunk in daily life is a common behavioral pattern seen in patients with hemiparesis. To this end, there has been an increasing interest in the use of wearable sensors to objectively assess upper-limb functioning. This paper presents a framework for assessing upper-limb functioning using sensors by providing: (a) a set of definitions of important constructs associated with upper-limb functioning; (b) different visualization methods for evaluating upper-limb functioning; and (c) two new measures for quantifying how much an upper-limb is used and the relative bias in their use. The demonstration of some of these components is presented using data collected from inertial measurement units from a previous study. The proposed framework can help guide the future technical and clinical work in this area to realize valid, objective, and robust tools for assessing upper-limb functioning. This will in turn drive the refinement and standardization of the assessment of upper-limb functioning.
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Affiliation(s)
- Ann David
- Department of Applied Mechanics, Indian Institute of Technology - Madras, Chennai, India
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - Tanya Subash
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - S. K. M. Varadhan
- Department of Applied Mechanics, Indian Institute of Technology - Madras, Chennai, India
| | - Alejandro Melendez-Calderon
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, Australia
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Li YC, Lin KC, Chen CL, Yao G, Chang YJ, Lee YY, Liu CT. A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation. Front Neurol 2021; 12:658567. [PMID: 34322077 PMCID: PMC8310953 DOI: 10.3389/fneur.2021.658567] [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: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear. Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors. Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl-Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data. Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data. Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.
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Affiliation(s)
- Yi-chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-ting Liu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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David A, ReethaJanetSureka S, Gayathri S, Annamalai SJ, Samuelkamleshkumar S, Kuruvilla A, Magimairaj HP, Varadhan S, Balasubramanian S. Quantification of the relative arm use in patients with hemiparesis using inertial measurement units. J Rehabil Assist Technol Eng 2021; 8:20556683211019694. [PMID: 34290880 PMCID: PMC8273871 DOI: 10.1177/20556683211019694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Accelerometry-based activity counting for measuring arm use is prone to overestimation due to non-functional movements. In this paper, we used an inertial measurement unit (IMU)-based gross movement (GM) score to quantify arm use. Methods In this two-part study, we first characterized the GM by comparing it to annotated video recordings of 5 hemiparetic patients and 10 control subjects performing a set of activities. In the second part, we tracked the arm use of 5 patients and 5 controls using two wrist-worn IMUs for 7 and 3 days, respectively. The IMU data was used to develop quantitative measures (total and relative arm use) and a visualization method for arm use. Results From the characterization study, we found that GM detects functional activities with 50–60% accuracy and eliminates non-functional activities with >90% accuracy. Continuous monitoring of arm use showed that the arm use was biased towards the dominant limb and less paretic limb for controls and patients, respectively. Conclusions The gross movement score has good specificity but low sensitivity in identifying functional activity. The at-home study showed that it is feasible to use two IMU-watches to monitor relative arm use and provided design considerations for improving the assessment method. Clinical trial registry number: CTRI/2018/09/015648
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Affiliation(s)
- Ann David
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India.,Department of Bioengineering, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | | | - Sankaralingam Gayathri
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | | | - Selvaraj Samuelkamleshkumar
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anju Kuruvilla
- Department of Psychiatry, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | - Henry Prakash Magimairaj
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Skm Varadhan
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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The modulation of short and long-latency interhemispheric inhibition during bimanually coordinated movements. Exp Brain Res 2021; 239:1507-1516. [PMID: 33687518 DOI: 10.1007/s00221-021-06074-z] [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: 12/08/2020] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Bimanual coordination is essential for the performance of many everyday tasks. There are several types of bimanually coordinated movements, classified according to whether the arms are acting to achieve a single goal (cooperative) or separate goals (independent), and whether the arms are moving symmetrically or asymmetrically. Symmetric bimanual movements are thought to facilitate corticomotor excitability (CME), while asymmetric bimanual movements are thought to recruit interhemispheric inhibition to reduce functional coupling between the motor cortices. The influences of movement symmetry and goal conceptualisation on interhemispheric interactions have not been studied together, and not during bimanually active dynamic tasks. The present study used transcranial magnetic stimulation (TMS) to investigate the modulation of CME and short- and long-latency interhemispheric inhibition (SIHI and LIHI, respectively) during bimanually active dynamic tasks requiring different types of bimanual coordination. Twenty healthy right-handed adults performed four bimanual tasks in which they held a dumbbell in each hand (independent) or a custom device between both hands (cooperative) while rhythmically flexing and extending their wrists symmetrically or asymmetrically. Motor-evoked potentials were recorded from the right extensor carpi ulnaris. We found CME was greater during asymmetric tasks than symmetric tasks, and movement symmetry did not modulate SIHI or LIHI. There was no effect of goal conceptualisation nor any interaction with movement symmetry for CME, SIHI or LIHI. Based on these results, movement symmetry and goal conceptualisation may not modulate interhemispheric inhibition during dynamic bimanual tasks. These findings contradict prevailing thinking about the roles of CME and interhemispheric inhibition in bimanual coordination.
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Lench DH, Hutchinson S, Woodbury ML, Hanlon CA. Kinematic Measures of Bimanual Performance are Associated With Callosum White Matter Change in People With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 2:100075. [PMID: 33543100 PMCID: PMC7853365 DOI: 10.1016/j.arrct.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the relationship between bimanual performance deficits measured using kinematics and callosum (CC) white matter changes that occur in people with chronic stroke. Design Cross-sectional, observational study of participants with chronic stroke and age-matched controls. Setting Recruitment and assessments occurred at a stroke recovery research center. Behavioral assessments were performed in a controlled laboratory setting. Magnetic resonance imaging scans were performed at the Center for Biomedical Imaging. Participants Individuals were enrolled and completed the study (N=39; 21 participants with chronic stroke; 18 age-matched controls with at least 2 stroke risk factors). Main Outcome Measures Diffusion imaging metrics were obtained for each individual’s CC and corticospinal tract (CST), including mean kurtosis (MK) and fractional anisotropy (FA). A battery of motor assessments, including bimanual kinematics, were collected from individuals while performing bimanual reaching. Results Participants with stroke had lower FA and MK in the CST of the lesioned hemisphere when compared with the non-lesioned hemisphere. The FA and MK values in the CST were correlated with measures of unimanual hand performance. In addition, participants with stroke had significantly lower FA and MK in the CC than matched controls. CC diffusion metrics positively correlated with hand asymmetry and trunk displacement during bimanual performance, even when correcting for age and lesion volume. Conclusions These data confirm previous studies that linked CST integrity to unimanual performance and provide new data demonstrating a link between CC integrity and both bimanual motor deficits and compensatory movements. Fractional anisotropy and mean kurtosis in the corpus callosum are lower in participants with stroke. Hand position symmetry and trunk displacement are disrupted during bimanual tasks. Corpus callosum white matter correlated with bimanual kinematics in participants with stroke.
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Key Words
- ANOVA, analysis of variance
- ARAT, Action Research Arm Test
- CC, corpus callosum
- CST, corticospinal tract
- DKI, diffusion kurtosis imaging
- DTI, diffusion tensor imaging
- Diffusion
- FA, fractional anisotropy
- FMA, Fugl-Meyer Assessment
- M1, primary motor cortex
- MK, mean kurtosis
- MRI, magnetic resonance imaging
- Motor Activity
- Pyramidal Tracts
- ROI, region of interest
- Rehabilitation
- SMA, supplementary motor area
- Stroke
- UE, upper extremity
- WMFT, Wolf Motor Function Test
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Affiliation(s)
- Daniel H. Lench
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott Hutchinson
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Michelle L. Woodbury
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Colleen A. Hanlon
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Cancer Biology, College of Medicine, Wake Forest Health Sciences, Winston-Salem, NC
- Corresponding author Colleen A. Hanlon, PhD, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
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Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot enhanced stroke therapy optimizes rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil 2021; 18:10. [PMID: 33478563 PMCID: PMC7819212 DOI: 10.1186/s12984-021-00804-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
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Affiliation(s)
- Alexa B. Keeling
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Mark Piitz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Jennifer A. Semrau
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE USA
| | - Michael D. Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
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Yeganeh Doost M, Herman B, Denis A, Sapin J, Galinski D, Riga A, Laloux P, Bihin B, Vandermeeren Y. Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial. Neural Regen Res 2021; 16:1566-1573. [PMID: 33433485 PMCID: PMC8323667 DOI: 10.4103/1673-5374.301030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.
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Affiliation(s)
- Maral Yeganeh Doost
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Herman
- UCLouvain, Louvain Bionics; UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Adrien Denis
- UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | | | | | - Audrey Riga
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Patrice Laloux
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur - site Mont-Godinne, Yvoir, Belgium
| | - Yves Vandermeeren
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E, Jones TA. Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behav Brain Res 2020; 396:112900. [PMID: 32941880 DOI: 10.1016/j.bbr.2020.112900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.
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Affiliation(s)
| | | | | | | | - Evan Nudi
- Psychology Department, United States
| | - Theresa A Jones
- Institute for Neuroscience, United States; Psychology Department, United States.
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The probability of choosing both hands depends on an interaction between motor capacity and limb-specific control in chronic stroke. Exp Brain Res 2020; 238:2569-2579. [PMID: 32880681 DOI: 10.1007/s00221-020-05909-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
A goal of rehabilitation after stroke is to promote pre-stroke levels of arm use for every day, frequently bimanual, functional activities. We reasoned that, after a stroke, the choice to use one or both hands for bimanual tasks might depend not only on residual motor capacity, but also the specialized demands imposed by the task on the paretic hand. To capture spontaneous, task-specific choices, we covertly observed 50 pre-stroke right-handed chronic stroke survivors (25 each of left, LHD, and right-hemisphere damage, RHD) and 11 age-similar control adults and recorded their hand use strategies for two pairs of bimanual tasks with distinct demands: one with greater precision requirements (photo-album tasks), and another with greater stabilization requirements (letter-envelope tasks). The primary outcome was the choice to use one or both hands. Logistic regression was used to test the two hypotheses that the probability of choosing a bimanual strategy would be greater in those with less severe motor impairment and also in those with LHD. When collapsed across the four tasks, we found support for these hypotheses. Notably, however, the influence of these factors on bimanual choice varied based on task demands. For the photo-album pair, the probability of a bimanual strategy was greater for those with LHD compared to RHD, regardless of the degree of motor impairment. For the letter-envelope pair, we found a significant interaction between impairment and side of lesion in determining the likelihood of choosing both hands. Therefore, the manner in which side of lesion moderates the effect of impairment on hand use depends on the task.
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Carson RG. Inter‐hemispheric inhibition sculpts the output of neural circuits by co‐opting the two cerebral hemispheres. J Physiol 2020; 598:4781-4802. [DOI: 10.1113/jp279793] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/04/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Richard G. Carson
- Trinity College Institute of Neuroscience and School of Psychology Trinity College Dublin Dublin 2 Ireland
- School of Psychology Queen's University Belfast Belfast BT7 1NN UK
- School of Human Movement and Nutrition Sciences University of Queensland St Lucia QLD 4072 Australia
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Transient changes in paretic and non-paretic isometric force control during bimanual submaximal and maximal contractions. J Neuroeng Rehabil 2020; 17:64. [PMID: 32410626 PMCID: PMC7227276 DOI: 10.1186/s12984-020-00693-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to investigate transient bimanual effects on the force control capabilities of the paretic and non-paretic arms in individuals post stroke across submaximal and maximal force control tasks. Methods Fourteen chronic stroke patients (mean age = 63.8 ± 15.9; stroke duration = 38.7 ± 45.2 months) completed two isometric force control tasks: (a) submaximal control and (b) maximal sustained force production. Participants executed both tasks with their wrist and fingers extending across unimanual (paretic and non-paretic arms) and bimanual conditions. Mean force, force variability using coefficient of variation, force regularity using sample entropy were calculated for each condition. Results During the submaximal force control tasks (i.e., 5, 25, and 50% of maximum voluntary contraction), the asymmetrical mean force between the paretic and non-paretic arms decreased from unimanual to bimanual conditions. The asymmetry of force variability and regularity between the two arms while executing unimanual force control tended to decrease in the bimanual condition because of greater increases in the force variability and regularity for the non-paretic arm than those for the paretic arm. During the maximal sustained force production tasks (i.e., 100% of maximum voluntary contraction), the paretic arm increased maximal forces and decreased force variability in the bimanual condition, whereas the non-paretic arm reduced maximal forces and elevated force variability from unimanual to bimanual conditions. Conclusions The current findings support a proposition that repetitive bimanual isometric training with higher execution intensity may facilitate progress toward stroke motor recovery.
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Demers M, Levin MF. Kinematic Validity of Reaching in a 2D Virtual Environment for Arm Rehabilitation After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:679-686. [PMID: 32031942 DOI: 10.1109/tnsre.2020.2971862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Increasing evidence supports the use of virtual reality for stroke rehabilitation. However, movement performance and quality may be diminished by the attributes of the virtual environment (VE), which may be detrimental to motor relearning. Our aim was to determine whether reach-to-grasp movements made in a low-cost 2DVE were kinematically similar to those made in a comparable physical environment (PE) in healthy subjects and subjects with stroke. Subjects (healthy = 15, stroke = 22) made unilateral and bilateral reach-to-grasp movements in a 2DVE and a similar PE. Arm and trunk kinematics were recorded with an optoelectronic measurement system (23 markers; 120 Hz). Temporal and spatial characteristics of the endpoint trajectory, arm and trunk movement patterns were compared between environments and groups. In each group, hand positioning at object contact time and trunk displacement were unaffected by the environment. Compared to PE, in VE, unilateral movements were less smooth and time to peak velocity was prolonged. In healthy subjects, bilateral movements were simultaneous and symmetrical in both environments. In subjects with stroke, movements were less symmetrical in VE. Aside from differences in endpoint displacement between environments, movement quality variables were unaffected by the 2DVE. Thus, using a low-cost 2DVE may be a valid approach for sensorimotor rehabilitation following stroke.
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Lee-Miller T, Santello M, Gordon AM. Hand forces and placement are modulated and covary during anticipatory control of bimanual manipulation. J Neurophysiol 2019; 121:2276-2290. [DOI: 10.1152/jn.00760.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dexterous object manipulation relies on the feedforward and feedback control of kinetics (forces) and kinematics (hand shaping and digit placement). Lifting objects with an uneven mass distribution involves the generation of compensatory moments at object lift-off to counter object torques. This is accomplished through the modulation and covariation of digit forces and placement, which has been shown to be a general feature of unimanual manipulation. These feedforward anticipatory processes occur before performance-specific feedback. Whether this adaptation is a feature unique to unimanual dexterous manipulation or general across unimanual and bimanual manipulation is not known. We investigated the generation of compensatory moments through hand placement and force modulation during bimanual manipulation of an object with variable center of mass. Participants were instructed to prevent object roll during the lift. Similar to unimanual grasping, we found modulation and covariation of hand forces and placement for successful performance. Thus this motor adaptation of the anticipatory control of compensatory moment is a general feature across unimanual and bimanual effectors. Our results highlight the involvement of high-level representation of manipulation goals and underscore a sensorimotor circuitry for anticipatory control through a continuum of force and placement modulation of object manipulation across a range of effectors. NEW & NOTEWORTHY This is the first study, to our knowledge, to show that successful bimanual manipulation of objects with asymmetrical centers of mass is performed through the modulation and covariation of hand forces and placements to generate compensatory moments. Digit force-to-placement modulation is thus a general phenomenon across multiple effectors, such as the fingers of one hand, and both hands. This adds to our understanding of integrating low-level internal representations of object properties into high-level task representations.
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Affiliation(s)
- Trevor Lee-Miller
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
| | - Marco Santello
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | - Andrew M. Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
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Doost MY, Orban de Xivry JJ, Herman B, Vanthournhout L, Riga A, Bihin B, Jamart J, Laloux P, Raymackers JM, Vandermeeren Y. Learning a Bimanual Cooperative Skill in Chronic Stroke Under Noninvasive Brain Stimulation: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 33:486-498. [PMID: 31088342 DOI: 10.1177/1545968319847963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Transcranial direct current stimulation (tDCS) has been suggested to improve poststroke recovery. However, its effects on bimanual motor learning after stroke have not previously been explored. Objective. We investigated whether dual-tDCS of the primary motor cortex (M1), with cathodal and anodal tDCS applied over undamaged and damaged hemispheres, respectively, improves learning and retention of a new bimanual cooperative motor skill in stroke patients. Method. Twenty-one chronic hemiparetic patients were recruited for a randomized, double-blinded, cross-over, sham-controlled trial. While receiving real or sham dual-tDCS, they trained on a bimanual cooperative task called CIRCUIT. Changes in performance were quantified via bimanual speed/accuracy trade-off (Bi-SAT) and bimanual coordination factor (Bi-Co) before, during, and 0, 30, and 60 minutes after dual-tDCS, as well as one week later to measure retention. A generalization test then followed, where patients were asked to complete a new CIRCUIT layout. Results. The patients were able to learn and retain the bimanual cooperative skill. However, a general linear mixed model did not detect a significant difference in retention between the real and sham dual-tDCS conditions for either Bi-SAT or Bi-Co. Similarly, no difference in generalization was detected for Bi-SAT or Bi-Co. Conclusion. The chronic hemiparetic stroke patients learned and retained the complex bimanual cooperative task and generalized the newly acquired skills to other tasks, indicating that bimanual CIRCUIT training is promising as a neurorehabilitation approach. However, bimanual motor skill learning was not enhanced by dual-tDCS in these patients.
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Affiliation(s)
- Maral Yeganeh Doost
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Jean-Jacques Orban de Xivry
- 4 Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Belgium.,5 Leuven Brain Institute, KU Leuven, Belgium
| | - Benoît Herman
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Léna Vanthournhout
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Audrey Riga
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Jacques Jamart
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Patrice Laloux
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium
| | | | - Yves Vandermeeren
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
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Washabaugh EP, Treadway E, Gillespie RB, Remy CD, Krishnan C. Self-powered robots to reduce motor slacking during upper-extremity rehabilitation: a proof of concept study. Restor Neurol Neurosci 2019; 36:693-708. [PMID: 30400120 DOI: 10.3233/rnn-180830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic rehabilitation is a highly promising approach to recover lost functions after stroke or other neurological disorders. Unfortunately, robotic rehabilitation currently suffers from "motor slacking", a phenomenon in which the human motor system reduces muscle activation levels and movement excursions, ostensibly to minimize metabolic- and movement-related costs. Consequently, the patient remains passive and is not fully engaged during therapy. To overcome this limitation, we envision a new class of body-powered robots and hypothesize that motor slacking could be reduced if individuals must provide the power to move their impaired limbs via their own body (i.e., through the motion of a healthy limb). OBJECTIVE To test whether a body-powered exoskeleton (i.e. robot) could reduce motor slacking during robotic training. METHODS We developed a body-powered robot that mechanically coupled the motions of the user's elbow joints. We tested this passive robot in two groups of subjects (stroke and able-bodied) during four exercise conditions in which we controlled whether the robotic device was powered by the subject or by the experimenter, and whether the subject's driven arm was engaged or at rest. Motor slacking was quantified by computing the muscle activation changes of the elbow flexor and extensor muscles using surface electromyography. RESULTS Subjects had higher levels of muscle activation in their driven arm during self-powered conditions compared to externally-powered conditions. Most notably, subjects unintentionally activated their driven arm even when explicitly told to relax when the device was self-powered. This behavior was persistent throughout the trial and did not wane after the initiation of the trial. CONCLUSIONS Our findings provide novel evidence indicating that motor slacking can be reduced by self-powered robots; thus demonstrating promise for rehabilitation of impaired subjects using this new class of wearable system. The results also serve as a foundation to develop more sophisticated body-powered robots (e.g., with controllable transmissions) for rehabilitation purposes.
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Affiliation(s)
- Edward P Washabaugh
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Emma Treadway
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - R Brent Gillespie
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - C David Remy
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
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Ranganathan R, Gebara R, Andary M, Sylvain J. Chronic stroke survivors show task-dependent modulation of motor variability during bimanual coordination. J Neurophysiol 2019; 121:756-763. [PMID: 30601671 DOI: 10.1152/jn.00218.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stroke often results in hemiparesis, leaving one side of the body "affected" relative to the other side. Prior research has shown that the affected arm has higher variability; however, the extent to which this variability can be modulated is unclear. Here we used a shared bimanual task to examine the degree to which participants could modulate the variability in the affected arm after stroke. Participants with chronic stroke ( n = 11) and age-matched controls ( n = 11) performed unimanual and bimanual reaching movements to move a cursor on a screen to different targets. In the unimanual condition, the cursor was controlled only by the movement of a single arm, whereas, in the bimanual condition, the cursor position was "shared" between the two arms by using a weighted average of the two hand positions. Unknown to the participants, we altered the weightings of the affected and unaffected arms to cursor motion and examined how the movement variability on each arm changed depending on its contribution to the task. Results showed that stroke survivors had higher movement variability on the affected arm; however, like age-matched controls, they were able to modulate the variability in both the affected and unaffected arms according to the weighting condition. Specifically, as the weighting on a particular arm increased (i.e., it became more important to the task), the movement variability decreased. These results show that stroke survivors are capable of modulating variability depending on the task context, and this feature may potentially be exploited for rehabilitation paradigms. NEW & NOTEWORTHY We show that chronic stroke survivors, similar to age-matched controls, are able to modulate variability in their affected and unaffected limbs in redundant bimanual tasks as a function of how these limbs contribute to the task. Specifically, in both affected and unaffected limbs, the variability of the limb increases as its contribution to the task decreases. This feature may potentially be exploited in rehabilitation paradigms using bimanual tasks.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, Michigan.,Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Rani Gebara
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Michael Andary
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Jim Sylvain
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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Winstein C, Varghese R. Been there, done that, so what’s next for arm and hand rehabilitation in stroke? NeuroRehabilitation 2018; 43:3-18. [DOI: 10.3233/nre-172412] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rini Varghese
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Pixa NH, Berger A, Steinberg F, Doppelmayr M. Parietal, but Not Motor Cortex, HD-atDCS Deteriorates Learning Transfer of a Complex Bimanual Coordination Task. JOURNAL OF COGNITIVE ENHANCEMENT 2018. [DOI: 10.1007/s41465-018-0088-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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