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Muurling M, Lötters FJB, Geelen JE, Schouten AC, Mugge W. A long-term effect of distal radius fracture on the sensorimotor control of the wrist joint in older adults. J Hand Ther 2021; 34:567-576. [PMID: 32893099 DOI: 10.1016/j.jht.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/19/2020] [Accepted: 07/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Sensorimotor control can be disturbed because of pain and trauma. There is scarce comprehension about which component of the sensorimotor system would benefit the most from treatment in distal radius fracture (DRF). PURPOSE OF THE STUDY The purpose of this study was to determine whether the sensorimotor control of subjects with a history of DRF impaired compared with healthy subjects. If so, which component of the sensorimotor system is most affected. METHODS Nine healthy participants and 11 participants with a DRF history executed posture and reproduction tasks in interaction with a robotic wrist manipulator. A posture task with force perturbations assess sensorimotor control. Position and force reproduction tasks assessed sensory feedback. Electromyography recorded the muscle activity to study the motor part of the sensorimotor system. STUDY DESIGN Cross-sectional case-control. RESULTS The results showed that the motor responses to the perturbations during the posture task did not differ significantly, whereas the position reproduction did significantly differ between the 2 groups. Moreover, participants with a DRF history did not adapt to the changed dynamics of the environment during the posture task, whereas the controls did. DISCUSSION The results of this study imply that processing of sensory position feedback is impaired in people with a DRF history while sensorimotor control during a posture task is unaffected. A possible explanation for these results is that different neural networks are involved during reproduction and posture tasks. CONCLUSIONS A history of DRF is related to disturbed processing of sensory feedback of the sensorimotor system, especially the Joint Position Sense, which leads to an impairment in detecting a changed environment and adapting to it. Impaired Joint Position Sense and thereby the inability to adapt adequately to a changing environment should be taken into account during the rehabilitation of patients with DRF.
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Affiliation(s)
- Marijn Muurling
- Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Freek J B Lötters
- Hand and Wrist Center, Hand and Wrist Rehabilitation, The Hague, The Netherlands.
| | - Jinne E Geelen
- Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alfred C Schouten
- Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Winfred Mugge
- Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
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2
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Zandvliet SB, Kwakkel G, Nijland RHM, van Wegen EEH, Meskers CGM. Is Recovery of Somatosensory Impairment Conditional for Upper-Limb Motor Recovery Early After Stroke? Neurorehabil Neural Repair 2021; 34:403-416. [PMID: 32391744 PMCID: PMC7222963 DOI: 10.1177/1545968320907075] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recovery influences motor recovery. Methods. Motor (Fugl-Meyer upper-extremity [FM-UE]) and somatosensory impairments (Erasmus modification of the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks and at 5, 12, and 26 weeks after a first-ever ischemic stroke. The longitudinal association between FM-UE and EmNSA-UE was examined in patients with motor and somatosensory impairments (FM-UE ≤ 60 and EmNSA-UE ≤ 37) at baseline. Results. A total of 94 patients were included in the longitudinal analysis. EmNSA-UE increased significantly up to 12 weeks poststroke. The longitudinal association between motor and somatosensory impairment disappeared when correcting for progress of time and was not significantly different for patients with severe baseline somatosensory impairment. Patients with a FM-UE score ≥18 at 26 weeks (n = 55) showed a significant positive association between motor and somatosensory impairments, irrespective of progress of time. Conclusions. Progress of time, as a reflection of spontaneous neurobiological recovery, is an important factor that drives recovery of upper-limb motor as well as somatosensory impairments in the first 12 weeks poststroke. Severe somatosensory impairment at baseline does not directly compromise motor recovery. The study rather suggests that spontaneous recovery of somatosensory impairment is a prerequisite for full motor recovery of the upper paretic limb.
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Affiliation(s)
- Sarah B Zandvliet
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Rinske H M Nijland
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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3
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Lemus D, Berry A, Jabeen S, Jayaraman C, Hohl K, van der Helm FCT, Jayaraman A, Vallery H. Controller synthesis and clinical exploration of wearable gyroscopic actuators to support human balance. Sci Rep 2020; 10:10412. [PMID: 32591577 PMCID: PMC7320159 DOI: 10.1038/s41598-020-66760-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Gyroscopic actuators are appealing for wearable applications due to their ability to provide overground balance support without obstructing the legs. Multiple wearable robots using this actuation principle have been proposed, but none has yet been evaluated with humans. Here we use the GyBAR, a backpack-like prototype portable robot, to investigate the hypothesis that the balance of both healthy and chronic stroke subjects can be augmented through moments applied to the upper body. We quantified balance performance in terms of each participant's ability to walk or remain standing on a narrow support surface oriented to challenge stability in either the frontal or the sagittal plane. By comparing candidate balance controllers, it was found that effective assistance did not require regulation to a reference posture. A rotational viscous field increased the distance healthy participants could walk along a 30mm-wide beam by a factor of 2.0, compared to when the GyBAR was worn but inactive. The same controller enabled individuals with chronic stroke to remain standing for a factor of 2.5 longer on a narrow block. Due to its wearability and versatility of control, the GyBAR could enable new therapy interventions for training and rehabilitation.
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Affiliation(s)
- Daniel Lemus
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Andrew Berry
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Chandrasekaran Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Frans C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands.
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4
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Piña-Fuentes D, Beudel M, Little S, van Zijl J, Elting JW, Oterdoom DLM, van Egmond ME, van Dijk JMC, Tijssen MAJ. Toward adaptive deep brain stimulation for dystonia. Neurosurg Focus 2019; 45:E3. [PMID: 30064317 DOI: 10.3171/2018.5.focus18155] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The presence of abnormal neural oscillations within the cortico-basal ganglia-thalamo-cortical (CBGTC) network has emerged as one of the current principal theories to explain the pathophysiology of movement disorders. In theory, these oscillations can be used as biomarkers and thereby serve as a feedback signal to control the delivery of deep brain stimulation (DBS). This new form of DBS, dependent on different characteristics of pathological oscillations, is called adaptive DBS (aDBS), and it has already been applied in patients with Parkinson's disease. In this review, the authors summarize the scientific research to date on pathological oscillations in dystonia and address potential biomarkers that might be used as a feedback signal for controlling aDBS in patients with dystonia.
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Affiliation(s)
- Dan Piña-Fuentes
- Departments of1Neurosurgery and.,2Neurology, University Medical Center Groningen, University of Groningen
| | - Martijn Beudel
- 2Neurology, University Medical Center Groningen, University of Groningen.,3Department of Neurology, Isala Klinieken, Zwolle, The Netherlands; and
| | - Simon Little
- 4Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Jonathan van Zijl
- 2Neurology, University Medical Center Groningen, University of Groningen
| | - Jan Willem Elting
- 2Neurology, University Medical Center Groningen, University of Groningen
| | | | | | | | - Marina A J Tijssen
- 2Neurology, University Medical Center Groningen, University of Groningen
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Zandvliet SB, Meskers CGM, Kwakkel G, van Wegen EEH. Short-Term Effects of Cerebellar tDCS on Standing Balance Performance in Patients with Chronic Stroke and Healthy Age-Matched Elderly. THE CEREBELLUM 2018; 17:575-589. [PMID: 29797226 PMCID: PMC6132826 DOI: 10.1007/s12311-018-0939-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transcranial direct current stimulation (tDCS) may serve as an adjunct approach in stroke rehabilitation. The cerebellum could be a target during standing balance training due to its role in motor adaptation. We tested whether cerebellar tDCS can lead to short-term effects on standing balance performance in patients with chronic stroke. Fifteen patients with a chronic stroke were stimulated with anodal stimulation on the contra-lesional cerebellar hemisphere, ipsi-lesional cerebellar hemisphere, or sham stimulation, for 20 min with 1.5 mA in three sessions in randomized order. Ten healthy controls participated in two sessions with cerebellar stimulation ipsi-lateral to their dominant leg or sham stimulation. During stimulation, subjects performed a medio-lateral postural tracking task on a force platform. Standing balance performance was measured directly before and after each training session in several standing positions. Outcomes were center of pressure (CoP) amplitude and its standard deviation, and velocity and its standard deviation and range, subsequently combined into a CoP composite score (comp-score) as a qualitative outcome parameter. In the patient group, a decrease in comp-score in the tandem position was found after contra-lesional tDCS: β = − 0.25, CI = − 0.48 to − 0.03, p = 0.03. No significant differences in demographics and clinical characteristics were found between patients who responded (N = 10) and patients who did not respond (N = 5) to the stimulation. Contra-lesional cerebellar tDCS shows promise for improving standing balance performance. Exploration of optimal timing, dose, and the relation between qualitative parameters and clinical improvements are needed to establish whether tDCS can augment standing balance performance after stroke.
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Affiliation(s)
- Sarah B Zandvliet
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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6
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van Kordelaar J, Pasma JH, Cenciarini M, Schouten AC, van der Kooij H, Maurer C. The Reliance on Vestibular Information During Standing Balance Control Decreases With Severity of Vestibular Dysfunction. Front Neurol 2018; 9:371. [PMID: 29915556 PMCID: PMC5994722 DOI: 10.3389/fneur.2018.00371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
The vestibular system is involved in gaze stabilization and standing balance control. However, it is unclear whether vestibular dysfunction affects both processes to a similar extent. Therefore, the objective of this study was to determine how the reliance on vestibular information during standing balance control is related to gaze stabilization deficits in patients with vestibular dysfunction. Eleven patients with vestibular dysfunction and twelve healthy subjects were included. Gaze stabilization deficits were established by spontaneous nystagmus examination, caloric test, rotational chair test, and head impulse test. Standing balance control was assessed by measuring the body sway (BS) responses to continuous support surface rotations of 0.5° and 1.0° peak-to-peak while subjects had their eyes closed. A balance control model was fitted on the measured BS responses to estimate balance control parameters, including the vestibular weight, which represents the reliance on vestibular information. Using multivariate analysis of variance, balance parameters were compared between patients with vestibular dysfunction and healthy subjects. Robust regression was used to investigate correlations between gaze stabilization and the vestibular weight. Our results showed that the vestibular weight was smaller in patients with vestibular dysfunction than in healthy subjects (F = 7.67, p = 0.011). The vestibular weight during 0.5° peak-to-peak support surface rotations decreased with increasing spontaneous nystagmus eye velocity (ρ = −0.82, p < 0.001). In addition, the vestibular weight during 0.5° and 1.0° peak-to-peak support surface rotations decreased with increasing ocular response bias during rotational chair testing (ρ = −0.72, p = 0.02 and ρ = −0.67, p = 0.04, respectively). These findings suggest that the reliance on vestibular information during standing balance control decreases with the severity of vestibular dysfunction. We conclude that particular gaze stabilization tests may be used to predict the effect of vestibular dysfunction on standing balance control.
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Affiliation(s)
- Joost van Kordelaar
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Jantsje H Pasma
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Massimo Cenciarini
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Christoph Maurer
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
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7
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Forbes PA, Chen A, Blouin JS. Sensorimotor control of standing balance. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:61-83. [DOI: 10.1016/b978-0-444-63916-5.00004-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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8
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Fernani DCGL, Prado MTA, da Silva TD, Massetti T, de Abreu LC, Magalhães FH, Dawes H, de Mello Monteiro CB. Evaluation of speed-accuracy trade-off in a computer task in individuals with cerebral palsy: a cross-sectional study. BMC Neurol 2017; 17:143. [PMID: 28750603 PMCID: PMC5530971 DOI: 10.1186/s12883-017-0920-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 07/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with Cerebral Palsy (CP) present with sensorimotor dysfunction which make the control and execution of movements difficult. This study aimed to verify the speed-accuracy trade-off in individuals with CP. METHODS Forty eight individuals with CP and 48 with typical development (TD) were evaluated (32 females and 64 males with a mean age of 15.02 ± 6.37 years: minimum 7 and maximum 30 years). Participants performed the "Fitts' Reciprocal Aiming Task v.1.0 (Horizontal)" on a computer with different sizes and distance targets, composed by progressive indices of difficulty (IDs): ID2, ID4a and ID4b. RESULTS There were no statistical differences between the groups in relation to the slope of the curve (b1) and dispersion of the movement time (r2). However, the intercept (b0) values presented significant differences (F(1.95) = 11.3; p = .001]), with greater movement time in the CP group compared to the TD group. It means that for individuals with CP, regardless of index difficulty, found the task more difficult than for TD participants. Considering CP and TD groups, speed-accuracy trade-off was found when using different indices of difficulty (ID2 and ID4). However, when the same index of difficulty was used with a larger target and longer distance (ID4a) or with a narrow target and shorter distance (ID4b), only individuals with CP had more difficulty performing the tasks involving smaller targets. Marginally significant inverse correlations were identified between the values of b1 and age (r = -0.119, p = .052) and between r2 and Gross Motor Function Classification System (r = -0.280, p = .054), which did not occur with the Manual Ability Classification System. CONCLUSION We conclude that the individuals with CP presented greater difficulty when the target was smaller and demanded more accuracy, and less difficulty when the task demanded speed. It is suggested that treatments should target tasks with accuracy demands, that could help in daily life tasks, since it is an element that is generally not considered by professionals during therapy. TRIAL REGISTRATION ClinicalTrials.gov, NCT03002285 , retrospectively registered on 20 Dec 2016.
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Affiliation(s)
- Deborah Cristina Gonçalves Luiz Fernani
- University of West Paulista, Presidente Prudente, SP, Brazil. .,Laboratory Design and Scientific Writing Department of Basic Sciences, ABC Faculty of Medicine, Av. Príncipe de Gales, 821, Vila Principe de Gales, Santo André, SP, 09060-650, Brazil.
| | - Maria Tereza Artero Prado
- University of West Paulista, Presidente Prudente, SP, Brazil.,Laboratory Design and Scientific Writing Department of Basic Sciences, ABC Faculty of Medicine, Av. Príncipe de Gales, 821, Vila Principe de Gales, Santo André, SP, 09060-650, Brazil
| | - Talita Dias da Silva
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Thais Massetti
- Post-graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratory Design and Scientific Writing Department of Basic Sciences, ABC Faculty of Medicine, Av. Príncipe de Gales, 821, Vila Principe de Gales, Santo André, SP, 09060-650, Brazil
| | | | - Helen Dawes
- Oxford Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, UK.,Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Carlos Bandeira de Mello Monteiro
- Laboratory Design and Scientific Writing Department of Basic Sciences, ABC Faculty of Medicine, Av. Príncipe de Gales, 821, Vila Principe de Gales, Santo André, SP, 09060-650, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil.,Post-graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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9
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Bank PJM, Dobbe LRM, Meskers CGM, de Groot JH, de Vlugt E. Manipulation of visual information affects control strategy during a visuomotor tracking task. Behav Brain Res 2017; 329:205-214. [PMID: 28501420 DOI: 10.1016/j.bbr.2017.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
Proper understanding of motor control requires insight into the extent and manner in which task performance and control strategy are influenced by various aspects of visual information. We therefore systematically manipulated the visual presentation (i.e., scaling factor and optical flow density) of a visuomotor tracking task without changing the task itself, and investigated the effect on performance, effort, motor control strategy (i.e., anticipatory or corrective steering) and underlying neuromechanical parameters (i.e., intrinsic muscle stiffness and damping, and proprioceptive and visual feedback). Twenty healthy participants controlled the left-right position of a virtual car (by means of wrist rotations in a haptic robot) to track a slightly curved virtual road (presented on a 60" LED screen), while small torque perturbations were applied to the wrist (1.25-20Hz multisine) for quantification of the neuromechanical parameters. This visuomotor tracking task was performed in conditions with low/medium/high scaling factor and low/high optical flow density. Task performance was high in all conditions (tracking accuracy 96.6%-100%); a higher scaling factor was associated with slightly better performance. As expected, participants did adapt their control strategy and the use of proprioceptive and visual feedback in response to changes in the visual presentation. These findings indicate that effects of visual representation on motor behavior should be taken into consideration in designing, interpreting and comparing experiments on motor control in health and disease. In future studies, these insights might be exploited to assess the sensory-motor adaptability in various clinical conditions.
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Affiliation(s)
- Paulina J M Bank
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Lucas R M Dobbe
- Faculty of Mechanical, Maritime and Materials Engineering, Section of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Research Institute MOVE, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Jurriaan H de Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Erwin de Vlugt
- Faculty of Mechanical, Maritime and Materials Engineering, Section of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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Golkar MA, Sobhani Tehrani E, Kearney RE. Linear Parameter Varying Identification of Dynamic Joint Stiffness during Time-Varying Voluntary Contractions. Front Comput Neurosci 2017; 11:35. [PMID: 28579954 PMCID: PMC5437117 DOI: 10.3389/fncom.2017.00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
Dynamic joint stiffness is a dynamic, nonlinear relationship between the position of a joint and the torque acting about it, which can be used to describe the biomechanics of the joint and associated limb(s). This paper models and quantifies changes in ankle dynamic stiffness and its individual elements, intrinsic and reflex stiffness, in healthy human subjects during isometric, time-varying (TV) contractions of the ankle plantarflexor muscles. A subspace, linear parameter varying, parallel-cascade (LPV-PC) algorithm was used to identify the model from measured input position perturbations and output torque data using voluntary torque as the LPV scheduling variable (SV). Monte-Carlo simulations demonstrated that the algorithm is accurate, precise, and robust to colored measurement noise. The algorithm was then used to examine stiffness changes associated with TV isometric contractions. The SV was estimated from the Soleus EMG using a Hammerstein model of EMG-torque dynamics identified from unperturbed trials. The LPV-PC algorithm identified (i) a non-parametric LPV impulse response function (LPV IRF) for intrinsic stiffness and (ii) a LPV-Hammerstein model for reflex stiffness consisting of a LPV static nonlinearity followed by a time-invariant state-space model of reflex dynamics. The results demonstrated that: (a) intrinsic stiffness, in particular ankle elasticity, increased significantly and monotonically with activation level; (b) the gain of the reflex pathway increased from rest to around 10-20% of subject's MVC and then declined; and (c) the reflex dynamics were second order. These findings suggest that in healthy human ankle, reflex stiffness contributes most at low muscle contraction levels, whereas, intrinsic contributions monotonically increase with activation level.
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Affiliation(s)
- Mahsa A Golkar
- Department of Biomedical Engineering, McGill UniversityMontréal, QC, Canada
| | | | - Robert E Kearney
- Department of Biomedical Engineering, McGill UniversityMontréal, QC, Canada
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11
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von Walden F, Jalaleddini K, Evertsson B, Friberg J, Valero-Cuevas FJ, Pontén E. Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff. Front Comput Neurosci 2017; 11:30. [PMID: 28487645 PMCID: PMC5403928 DOI: 10.3389/fncom.2017.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/07/2017] [Indexed: 11/26/2022] Open
Abstract
Children with cerebral palsy (CP) often develop reduced passive range of motion with age. The determining factor underlying this process is believed to be progressive development of contracture in skeletal muscle that likely changes the biomechanics of the joints. Consequently, to identify the underlying mechanisms, we modeled the mechanical characteristics of the forearm flexors acting across the wrist joint. We investigated skeletal muscle strength (Grippit®) and passive stiffness and viscosity of the forearm flexors in 15 typically developing (TD) children (10 boys/5 girls, mean age 12 years, range 8–18 yrs) and nine children with CP Nine children (6 boys/3 girls, mean age 11 ± 3 years (yrs), range 7–15 yrs) using the NeuroFlexor® apparatus. The muscle stiffness we estimate and report is the instantaneous mechanical response of the tissue that is independent of reflex activity. Furthermore, we assessed cross-sectional area of the flexor carpi radialis (FCR) muscle using ultrasound. Age and body weight did not differ significantly between the two groups. Children with CP had a significantly weaker (−65%, p < 0.01) grip and had smaller cross-sectional area (−43%, p < 0.01) of the FCR muscle. Passive stiffness of the forearm muscles in children with CP was increased 2-fold (p < 0.05) whereas viscosity did not differ significantly between CP and TD children. FCR cross-sectional area correlated to age (R2 = 0.58, p < 0.01), body weight (R2 = 0.92, p < 0.0001) and grip strength (R2 = 0.82, p < 0.0001) in TD children but only to grip strength (R2 = 0.60, p < 0.05) in children with CP. We conclude that children with CP have weaker, thinner, and stiffer forearm flexors as compared to typically developing children.
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Affiliation(s)
- Ferdinand von Walden
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden
| | - Kian Jalaleddini
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos Angeles, CA, USA
| | - Björn Evertsson
- Department of Neurology, Karolinska Hospital HuddingeStockholm, Sweden.,Karolinska InstituteStockholm, Sweden
| | - Johanna Friberg
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden.,Karolinska InstituteStockholm, Sweden
| | - Francisco J Valero-Cuevas
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern CaliforniaLos Angeles, CA, USA
| | - Eva Pontén
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden.,Department of Pediatric orthopedic Surgery, Astrid Lindgren's Children HospitalStockholm, Sweden
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Jalaleddini K, Golkar MA, Kearney RE. Measurement of Dynamic Joint Stiffness from Multiple Short Data Segments. IEEE Trans Neural Syst Rehabil Eng 2017; 25:925-934. [PMID: 28278472 DOI: 10.1109/tnsre.2017.2659749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents our new method, Short Segment-Structural Decomposition SubSpace (SS-SDSS), for the estimation of dynamic joint stiffness from short data segments. The main application is for data sets that are only piecewise stationary. Our approach is to: 1) derive a data-driven, mathematical model for dynamic stiffness for short data segments; 2) bin the non-stationary data into a number of short, stationary data segments; and 3) estimate the model parameters from subsets of segments with the same properties. This method extends our previous state-spacework by recognizing that initial conditions have important effects for short data segments; consequently, initial conditions are incorporated into the stiffness model and estimated for each segment. A simulation study that faithfully replicated experimental conditions delineated the range of experimental conditions for which the method can successfully identify stiffness. An experimental study on the ankle of a healthy subject during a torque matching tasks demonstrated the successful estimation of dynamic stiffness in a slow, time-varying experiment. Together, the simulation and experimental studies demonstrate that the SS-SDSS method is a valuable tool to measure stiffness in functionally important tasks.
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Jalaleddini K, Tehrani ES, Kearney RE. A Subspace Approach to the Structural Decomposition and Identification of Ankle Joint Dynamic Stiffness. IEEE Trans Biomed Eng 2016; 64:1357-1368. [PMID: 28113221 DOI: 10.1109/tbme.2016.2604293] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this paper is to present a structural decomposition subspace (SDSS) method for decomposition of the joint torque to intrinsic, reflexive, and voluntary torques and identification of joint dynamic stiffness. METHODS First, it formulates a novel state-space representation for the joint dynamic stiffness modeled by a parallel-cascade structure with a concise parameter set that provides a direct link between the state-space representation matrices and the parallel-cascade parameters. Second, it presents a subspace method for the identification of the new state-space model that involves two steps: 1) the decomposition of the intrinsic and reflex pathways and 2) the identification of an impulse response model of the intrinsic pathway and a Hammerstein model of the reflex pathway. RESULTS Extensive simulation studies demonstrate that SDSS has significant performance advantages over some other methods. Thus, SDSS was more robust under high noise conditions, converging where others failed; it was more accurate, giving estimates with lower bias and random errors. The method also worked well in practice and yielded high-quality estimates of intrinsic and reflex stiffnesses when applied to experimental data at three muscle activation levels. CONCLUSION The simulation and experimental results demonstrate that SDSS accurately decomposes the intrinsic and reflex torques and provides accurate estimates of physiologically meaningful parameters. SIGNIFICANCE SDSS will be a valuable tool for studying joint stiffness under functionally important conditions. It has important clinical implications for the diagnosis, assessment, objective quantification, and monitoring of neuromuscular diseases that change the muscle tone.
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