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Scarlat KA, Tchoumi CA, Feldman AG, Levin MF. Referent control of side-to-side body-weight transfer during standing and stepping in adults. Neuroscience 2024:S0306-4522(24)00210-0. [PMID: 38762084 DOI: 10.1016/j.neuroscience.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
Research suggests that locomotion may be primarily caused by shifting stable body balance from one location in the environment to another with subsequent rhythmical muscle activation by the central pattern generator (CPG), constituting a multi-level control system. All levels interact with environmental forces affected by proprioceptive and vestibular reflexes as well as vision. A similar multi-level control schema is likely used to shift body balance laterally when the body weight is rhythmically transferred from side-to-side. In order to do so, the system shifts a specific body posture in space. This body posture is referred to as the threshold or referent body posture, R, at which all muscles involved can be at rest but are activated depending on the deflection of the actual body posture, Q, from R. This concept has previously been investigated for forward and backward locomotion. The purpose of the present study was to verify if it was also applicable to locomotor tasks in other directions such as sidestepping. We predicted that during sidestepping, the actual and referent posture can transiently match each other bringing the activity of multiple muscles to a minimum. The existence of such minima was demonstrated in healthy adults performing three locomotor tasks involving shifts of the body weight from side-to-side thus further supporting the validity of the multi-level control scheme of locomotion.
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Affiliation(s)
- Katharine A Scarlat
- Integrated Program in Neuroscience, McGill University, Montreal, Qc., Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Qc., Canada
| | - Carl A Tchoumi
- Integrated Program in Neuroscience, McGill University, Montreal, Qc., Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Qc., Canada
| | - Anatol G Feldman
- Department of Neuroscience, University of Montreal, Montreal, Qc., Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Qc., Canada.
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Qc., Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Qc., Canada
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Tomita Y, Mullick AA, Feldman AG, Levin MF. Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabil Neural Repair 2024; 38:176-186. [PMID: 38347695 DOI: 10.1177/15459683241231528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
BACKGROUND Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. METHODS We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. RESULTS Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. CONCLUSIONS Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Alt Murphy M, Pradhan S, Levin MF, Hancock NJ. Uptake of Technology for Neurorehabilitation in Clinical Practice: A Scoping Review. Phys Ther 2024; 104:pzad140. [PMID: 37856528 PMCID: PMC10851848 DOI: 10.1093/ptj/pzad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake. METHODS This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers. RESULTS Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake. CONCLUSION Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development. IMPACT This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
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Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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Anaby DR, Avery L, Palisano RJ, Levin MF, Khayargoli P, Hsieh YH, Gorter JW, Teplicky R. Environment-based approaches to improve participation of young people with physical disabilities during COVID-19. Dev Med Child Neurol 2023. [PMID: 38140720 DOI: 10.1111/dmcn.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
AIM To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID-19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. METHOD An interrupted time-series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8-week self-chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed-effects models were used. RESULTS The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0-3.2] and 3.2 points [95% CI: 2.4-3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. INTERPRETATION Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body-function level.
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Affiliation(s)
- Dana R Anaby
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Avery Information Services Ltd., Ontario, Canada
| | - Robert J Palisano
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Pranamika Khayargoli
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Yu-Hsin Hsieh
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
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Subramanian SK, Margolese G, Turolla A, Saposnik G, Levin MF. Responsiveness of the Reaching Performance Scale for Stroke. Arch Phys Med Rehabil 2023; 104:1588-1595. [PMID: 37178950 DOI: 10.1016/j.apmr.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective of the study was to estimate the internal and external responsiveness of the Reaching Performance Scale for Stroke (RPSS) in individuals with stroke. DESIGN Retrospective analysis of data from 4 randomized controlled trials. SETTING Recruitment locations spanning rehabilitation centers and hospitals in Canada, Italy, Argentina, Peru, and Thailand. PARTICIPANTS Data from 567 participants (acute to chronic stroke; N=567) were available. INTERVENTIONS All 4 studies involved training using virtual reality for upper limb rehabilitation. MAIN OUTCOME MEASURES RPSS and upper extremity Fugl-Meyer Assessment (FMA-UE) scores. Responsiveness was quantified for all data and across different stages of stroke. Internal responsiveness of the RPSS was quantified as effect-sizes calculated using post and preintervention change data. External responsiveness was quantified using orthogonal regressions between FMA-UE and RPSS scores. The area under the Receiver Operating Characteristic curve (AUC) was quantified based on the ability of RPSS scores to detect change above FMA-UE minimal clinically important different values across different stages of stroke. RESULTS The RPSS had high internal responsiveness overall and across the acute or subacute and chronic stages of stroke. For external responsiveness, orthogonal regression analyses indicated that change in FMA-UE scores had positive moderate correlations with both RPSS Close and Far Target scores for all data and across the acute or subacute and chronic stages of stroke (0.6 CONCLUSIONS In addition to being reliable and valid, the RPSS is also responsive. Along with the FMA-UE, using RPSS scores can help present a more comprehensive picture of motor compensations to characterize poststroke upper limb motor improvement.
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Affiliation(s)
- Sandeep K Subramanian
- Departments of Physical Therapy, Physician Assistant Studies and Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Gita Margolese
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Unit, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
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El-Hage MR, Wendling A, Levin MF, Feldman AG. Identifying Referent Control Variables Underlying Goal-Directed Arm Movements. Motor Control 2023; 27:782-799. [PMID: 37225175 DOI: 10.1123/mc.2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 05/26/2023]
Abstract
The referent control theory (RCT) for action and perception is an advanced formulation of the equilibrium-point hypothesis. The RCT suggests that rather than directly specifying the desired motor outcome, the nervous system controls action and perception indirectly by setting the values of parameters of physical and physiological laws. This is done independently of values of kinematic and kinetic variables including electromyographic patterns describing the motor outcome. One such parameter-the threshold muscle length, λ, at which motoneurons of a given muscle begin to be recruited, has been identified experimentally. In RCT, a similar parameter, the referent arm position, R, has been defined for multiple arm muscles as the threshold arm position at which arm muscles can be quiescent but activated depending on the deflection of the actual arm position, Q, from R. Changes in R result in reciprocal changes in the activity of opposing muscle groups. We advanced the explanatory power of RCT by combining the usual biomechanical descriptions of motor actions with the identification of the timing of R underlying arm movements made with reversals in three directions and to three different extents. We found that in all movements, periods of minimization of the activity of multiple muscles could be identified at ∼61%-86% of the reaching extent in each direction. These electromyographic minimization periods reflect the spatial coordinates at which the R and Q overlap during the production of movements with reversals. The findings support the concept of the production of arm movement by shifting R.
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Affiliation(s)
- Marie-Reine El-Hage
- Department of Neuroscience, University of Montreal, Montreal, QC,Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, QC,Canada
| | - Alexandra Wendling
- Department of Neuroscience, University of Montreal, Montreal, QC,Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, QC,Canada
| | - Mindy F Levin
- Center for Interdisciplinary Research in Rehabilitation, Montreal, QC,Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC,Canada
| | - Anatol G Feldman
- Department of Neuroscience, University of Montreal, Montreal, QC,Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, QC,Canada
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Rajda CM, Feldman AG, Boudrias MH, Archambault PS, Berman S, Wein T, Levin MF. The use of enhanced intrinsic feedback for motor learning in stroke survivors: Clinical trial protocol. Contemp Clin Trials 2023:107236. [PMID: 37230167 DOI: 10.1016/j.cct.2023.107236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Stroke can lead to lasting sensorimotor deficits of the upper limb (UL) persisting into the chronic phase despite intensive rehabilitation. A major impairment of reaching after stroke is a decreased range of active elbow extension, which in turn leads to the use of compensatory movements. Retraining movement patterns relies on cognition and motor learning principles. Implicit learning may lead to better outcomes than explicit learning. Error augmentation (EA) is a feedback modality based on implicit learning resulting in improved precision and speed of UL reaching movements in people with stroke. However, accompanying changes in UL joint movement patterns have not been investigated. The objective of this study is to determine the capacity for implicit motor learning in people with chronic stroke and how this capacity is affected by post-stroke cognitive impairments. METHODS Fifty-two subjects who have chronic stroke will practice reaching movements 3×/wk. for 9 wk. in a virtual reality environment. Participants will be randomly allocated to 1 of 2 groups to train with or without EA feedback. Outcome measures (pre-, post- and follow-up) will be: endpoint precision, speed, smoothness, and straightness and joint (UL and trunk) kinematics during a functional reaching task. The degree of cognitive impairment, lesion profile, and integrity of descending white matter tracts will be related to training outcomes. CONCLUSIONS The results will inform us which patients can best benefit from training programs that rely on motor learning and utilize enhanced feedback. TRIAL STATUS Ethical approval for this study was finalized in May 2022. Recruitment and data collection is actively in progress and is planned to finish in 2026. Data analysis and evaluation will occur subsequently, and the final results will be published.
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Affiliation(s)
- C M Rajda
- Integrated Program in Neuroscience, McGill University, Room 302, Irving Ludmer Building, 1011 Pine Ave. W., Montreal, Quebec H3A 1A1, Canada; Feil-Oberfeld Research Site of the Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, Quebec H7V 1R2, Canada
| | - A G Feldman
- Department of Neuroscience, Université de Montréal, CP 6128, succ. Downtown, Montreal, Quebec H3C 3J7, Canada; Feil-Oberfeld Research Site of the Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, Quebec H7V 1R2, Canada
| | - M H Boudrias
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec H3G 1Y5, Canada; Feil-Oberfeld Research Site of the Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, Quebec H7V 1R2, Canada
| | - P S Archambault
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec H3G 1Y5, Canada; Feil-Oberfeld Research Site of the Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, Quebec H7V 1R2, Canada
| | - S Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva 84105, P.O.B 653, Israel
| | - T Wein
- McGill University Health Center, 1001 Décarie, Montreal, Quebec H4A 3J1, Canada; Department of Neurology, Montreal Neurological Institute, 3801 Rue University, Montreal, Quebec H3A 2B4, Canada
| | - M F Levin
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec H3G 1Y5, Canada; Feil-Oberfeld Research Site of the Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, Quebec H7V 1R2, Canada.
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Shoja O, Towhidkhah F, Hassanlouei H, Levin MF, Bahramian A, Nadeau S, Zhang L, Feldman AG. Correction to: Reaction of human walking to transient block of vision: analysis in the context of indirect, referent control of motor actions. Exp Brain Res 2023:10.1007/s00221-023-06642-5. [PMID: 37212860 DOI: 10.1007/s00221-023-06642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Otella Shoja
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Hamidollah Hassanlouei
- Department of Motor Behaviour, Faculty of Sport Science and Health, Shahid Beheshti University, Tehran, Iran
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Alireza Bahramian
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Sylvie Nadeau
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Faculté de Médecine-École de Réadaptation, Montreal, QC, Canada
| | - Lei Zhang
- Institute for Neural Computation, Ruhr University Bochum, Bochum, Germany
| | - Anatol G Feldman
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada.
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
- Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 Darlington, Montreal, QC, H3S 2J4, Canada.
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Shoja O, Towhidkhah F, Hassanlouei H, Levin MF, Bahramian A, Nadeau S, Zhang L, Feldman AG. Reaction of human walking to transient block of vision: analysis in the context of indirect, referent control of motor actions. Exp Brain Res 2023; 241:1353-1365. [PMID: 37010540 DOI: 10.1007/s00221-023-06593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
Human locomotion may result from monotonic shifts in the referent position, R, of the body in the environment. R is also the spatial threshold at which muscles can be quiescent but are activated depending on the deflection of the current body configuration Q from R. Shifts in R are presumably accomplished with the participation of proprioceptive and visual feedback and responsible for transferring stable body balance (equilibrium) from one place in the environment to another, resulting in rhythmic activity of multiple muscles by a central pattern generator (CPG). We tested predictions of this two-level control scheme. In particular, in response to a transient block of vision during locomotion, the system can temporarily slow shifts in R. As a result, the phase of rhythmical movements of all four limbs will be changed for some time, even though the rhythm and other characteristics of locomotion will be fully restored after perturbation, a phenomenon called long-lasting phase resetting. Another prediction of the control scheme is that the activity of multiple muscles of each leg can be minimized reciprocally at specific phases of the gait cycle both in the presence and absence of vision. Speed of locomotion is related to the rate of shifts in the referent body position in the environment. Results confirmed that human locomotion is likely guided by feedforward shifts in the referent body location, with subsequent changes in the activity of multiple muscles by the CPG. Neural structures responsible for shifts in the referent body configuration causing locomotion are suggested.
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Affiliation(s)
- Otella Shoja
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Hamidollah Hassanlouei
- Department of Motor Behaviour, Faculty of Sport Science and Health, Shahid Beheshti University, Tehran, Iran
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Alireza Bahramian
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Sylvie Nadeau
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Faculté de Médecine-École de Réadaptation, Montreal, QC, Canada
| | - Lei Zhang
- Institute for Neural Computation, Ruhr University Bochum, Bochum, Germany
| | - Anatol G Feldman
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada.
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
- Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 6300 Darlington, Montreal, QC, H3S 2J4, Canada.
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11
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Piscitelli D, Baniña MC, Lam TK, Chen JL, Levin MF. Psychometric Properties of a New Measure of Upper Limb Performance in Post-Stroke Individuals: Trunk-Based Index of Performance. Neurorehabil Neural Repair 2023; 37:66-75. [PMID: 36575955 PMCID: PMC9896540 DOI: 10.1177/15459683221143462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several measures of upper limb (UL) motor tasks have been developed to characterize recovery. However, UL performance and movement quality measures in isolation may not provide a true profile of functional recovery. OBJECTIVE To investigate the measurement properties of a new trunk-based Index of Performance (IPt) of the UL combining endpoint performance (accuracy and speed) and movement quality (trunk displacement) in stroke. METHODS Participants with stroke (n = 25, mean time since stroke: 18.7 ± 17.2 months) performed a reaching task over 3 evaluation sessions. The IPt was computed based on Fitts' Law that incorporated endpoint accuracy and speed corrected by the amount of trunk displacement. Test-retest reliability was analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. Standard error of measurement (SEM) and Minimal Detectable Change (MDC) were determined. Validity was investigated through the relationship between IPt, Fugl-Meyer Assessment (FMA-UE), and Action Research Arm Test (ARAT), as well as the ability of IPt to distinguish between levels of UL motor impairment severity. RESULTS Test-retest reliability was excellent (ICC = .908, 95% CI: 0.807-0.96). Bland-Altman did not show systematic differences. SEM and MDC95 were 14% and 39%, respectively. Construct validity was satisfactory. The IPt showed low-to-moderate relationships with FMA-UE (R2 ranged from .236 to .428) and ARAT (R2 ranged from .277 to .306). IPt scores distinguished between different levels of UL severity. CONCLUSIONS The IPt showed evidence of good reliability, and initial validity. The IPt may be a promising tool for research and clinical settings. Further research is warranted to investigate its validity with additional comparator instruments.
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Affiliation(s)
- Daniele Piscitelli
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Department of Kinesiology, University
of Connecticut, Storrs, CT, USA
| | - Melanie C. Baniña
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada
| | - Timothy K. Lam
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada
| | - Joyce L. Chen
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada,Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada
| | - Mindy F. Levin
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Mindy F. Levin, School of Physical and
Occupational Therapy, McGill University, 3654 Promenade Sir William Osler,
Montreal, QC H3G 1Y5, Canada.
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12
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Schwartz E, Guidry K, Lee A, Dinh D, Levin MF, Demers M. Clinical Motor Coordination Tests in Adult Neurology: A Scoping Review. Physiother Can 2022; 74:387-395. [PMID: 37324609 PMCID: PMC10262719 DOI: 10.3138/ptc-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/22/2021] [Indexed: 08/26/2023]
Abstract
Purpose: This scoping review aimed to identify which clinical tests are used to assess upper limb, lower limb, and trunk motor coordination, and their metric and measurement properties for adult neurological populations. Method: MEDLINE (1946-) and EMBASE (1996-) databases were searched using keywords such as movement quality, motor performance, motor coordination, assessment, and psychometrics. Data regarding the body part assessed, neurological condition, psychometric properties, and scored metrics of spatial and/or temporal coordination were independently extracted by two reviewers. Alternate versions of some tests such as the Finger-to-Nose Test were included. Results: Fifty-one included articles yielded 2 tests measuring spatial coordination, 7 tests measuring temporal coordination, and 10 tests measuring both. Scoring metrics and measurement properties differed between tests, with a majority of tests having good-to-excellent measurement properties. Conclusions: The metrics of motor coordination scored by current tests vary. Since tests do not assess functional task performance, the onus falls on clinicians to infer the connection between coordination impairments and functional deficits. Clinical practice would benefit from the development of a battery of tests that assesses the metrics of coordination related to functional performance.
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Affiliation(s)
- Elka Schwartz
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Kathryn Guidry
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Amanda Lee
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Danny Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Marika Demers
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
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13
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Schuch CP, Lam TK, Levin MF, Cramer SC, Swartz RH, Thiel A, Chen JL. A comparison of lesion-overlap approaches to quantify corticospinal tract involvement in chronic stroke. J Neurosci Methods 2022; 376:109612. [PMID: 35487314 DOI: 10.1016/j.jneumeth.2022.109612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Clarissa Pedrini Schuch
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, M5S 2W6, Canada
| | - Timothy K Lam
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, H3G 1Y5, Canada; Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, QC, H7V 1R2, Canada
| | - Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles; and California Rehabilitation Institute; Los Angeles, CA, 90095-1769, United States of America
| | - Richard H Swartz
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Joyce L Chen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, M5S 2W6, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada.
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14
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Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. VR-based rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Post-Stroke Upper Extremity Function Recovery: A Randomized Controlled Trial (Preprint). JMIR Serious Games 2022; 10:e37506. [PMID: 36166289 PMCID: PMC9555337 DOI: 10.2196/37506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alejandro Hernandez
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | | | - Philippe S Archambault
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Mindy F Levin
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Dahlia Kairy
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
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15
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Abstract
While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning.Implications for RehabilitationKinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task.The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system.Learning can be enhanced by varied practice with feedback about key movement elements.Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Marika Demers
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- USA Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Feldman AG, Levin MF, Garofolini A, Piscitelli D, Zhang L. Central pattern generator and human locomotion in the context of referent control of motor actions. Clin Neurophysiol 2021; 132:2870-2889. [PMID: 34628342 DOI: 10.1016/j.clinph.2021.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/13/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
Unperturbed human locomotion presumably results from feedforward shifts in stable body equilibrium in the environment, thus avoiding falling and subsequent catching considered in alternative theories of locomotion. Such shifts are achieved by relocation of the referent body configuration at which multiple muscle recruitment begins. Rather than being directly specified by a central pattern generator, multiple muscles are activated depending on the extent to which the body is deflected from the referent, threshold body configuration, as confirmed in previous studies. Based on the referent control theory of action and perception, solutions to classical problems in motor control are offered, including the previously unresolved problem of the integration of central and reflex influences on motoneurons and the problem of how posture and movement are related. The speed of locomotion depends on the rate of shifts in the referent body configuration. The transition from walking to running results from increasing the rate of referent shifts. It is emphasised that there is a certain hierarchy between reciprocal and co-activation of agonist and antagonist muscles during locomotion and other motor actions, which is also essential for the understanding of how locomotor speed is regulated. The analysis opens a new avenue in neurophysiological approaches to human locomotion with clinical implications.
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Affiliation(s)
- Anatol G Feldman
- Department of Neuroscience, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
| | - Lei Zhang
- Institut für Neuroinformatik, Ruhr-Universität Bochum, Universitätsstraße 150, 44801 Bochum, Germany
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18
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Mullick AA, Baniña MC, Tomita Y, Fung J, Levin MF. Obstacle Avoidance and Dual-Tasking During Reaching While Standing in Patients With Mild Chronic Stroke. Neurorehabil Neural Repair 2021; 35:915-928. [PMID: 34455852 DOI: 10.1177/15459683211023190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Poststroke individuals use their paretic arms less often than expected in daily life situations, even when motor recovery is scored highly in clinical tests. Real-world environments are often unpredictable and require the ability to multitask and make decisions about rapid and accurate arm movement adjustments. Objective. To identify whether and to what extent cognitive-motor deficits in well-recovered individuals with stroke affect the ability to rapidly adapt reaching movements in changing cognitive and environmental conditions. Methods. Thirteen individuals with mild stroke and 11 healthy controls performed an obstacle avoidance task in a virtual environment while standing. Subjects reached for a virtual juice bottle with their hemiparetic arm as quickly as possible under single- and dual-task conditions. In the single-task condition, a sliding glass door partially obstructed the reaching path of the paretic arm. A successful trial was counted when the subject touched the bottle without the hand colliding with the door. In the dual-task condition, subjects repeated the same task while performing an auditory-verbal working memory task. Results. Individuals with stroke had significantly lower success rates than controls in avoiding the moving door in single-task (stroke: 51.8 ± 21.2%, control: 70.6 ± 12.7%; P = .018) and dual-task conditions (stroke: 40.0 ± 27.6%, control: 65.3 ± 20.0%; P = .015). Endpoint speed was lower in stroke subjects for successful trials in both conditions. Obstacle avoidance deficits were exacerbated by increased cognitive demands in both groups. Individuals reporting greater confidence using their hemiparetic arm had higher success rates. Conclusion. Clinically well-recovered individuals with stroke may have persistent deficits performing a complex reaching task.
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Affiliation(s)
- Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Yosuke Tomita
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada.,Department of Physical Therapy, Faculty of Health Care, 47735Takasaki University of Health and Welfare, Takasaki, Japan
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil/Oberfeld Research Centre, Jewish Rehabilitation Hospital Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation and CISSS-Laval, QC, Canada
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19
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Khanafer S, Sveistrup H, Levin MF, Cressman EK. Age-related changes in upper limb coordination in a complex reaching task. Exp Brain Res 2021; 239:2285-2294. [PMID: 34081178 DOI: 10.1007/s00221-021-06143-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
When reaching to targets within arm's reach, intentional trunk motion must be neutralized by compensatory motion of the upper limb (UL). Advanced age has been associated with deterioration in the coordination of multi-joint UL movements. In the current study, we looked to determine if older adults also have difficulties modifying their UL movements (i.e., coordination between the shoulder and elbow joints), during a complex reaching task when trunk motion is manipulated. Two groups of healthy participants were recruited: 18 young (mean age = 24.28 ± 2.89 years old) and 18 older (mean age = 72.11 ± 2.39 years old) adults. Participants reached to a target with their eyes closed, while simultaneously moving the trunk forward. In 40% of trials, the trunk motion was unexpectedly blocked. Participants performed the task with both their dominant and non-dominant arms, and at a preferred and fast speed. All participants were able to coordinate motion at the elbow and shoulder joints in a similar manner and modify this coordination in accordance with motion at the trunk, regardless of the hand used or speed of movement. Specifically, in reaches that involved forward trunk motion (free-trunk trials), all participants demonstrated increased elbow flexion (i.e., less elbow extension) compared to blocked-trunk trials. In contrast, when trunk motion was blocked (blocked-trunk trials), all reaching movements were accompanied by increased shoulder horizontal adduction. While coordination of UL joints was similar across older and young adults, the extent of changes at the elbow and shoulder was smaller and less consistent in older adults compared to young participants, especially when trunk motion was involved. These results suggest that older adults can coordinate their UL movements based on task requirements, but that their performance is not as consistent as young adults.
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Affiliation(s)
- Sajida Khanafer
- School of Human Kinetics, University of Ottawa, 125 University, Ottawa, ON, K1N 6N5, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Erin K Cressman
- School of Human Kinetics, University of Ottawa, 125 University, Ottawa, ON, K1N 6N5, Canada.
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20
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Lackritz H, Parmet Y, Frenkel-Toledo S, Baniña MC, Soroker N, Solomon JM, Liebermann DG, Levin MF, Berman S. Effect of post-stroke spasticity on voluntary movement of the upper limb. J Neuroeng Rehabil 2021; 18:81. [PMID: 33985543 PMCID: PMC8117272 DOI: 10.1186/s12984-021-00876-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.
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Affiliation(s)
- Hadar Lackritz
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Silvi Frenkel-Toledo
- Faculty of Health Sciences, Department of Physical Therapy, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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21
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Norouzi-Gheidari N, Archambault PS, Monte-Silva K, Kairy D, Sveistrup H, Trivino M, Levin MF, Milot MH. Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation. J Neuroeng Rehabil 2021; 18:61. [PMID: 33853614 PMCID: PMC8045249 DOI: 10.1186/s12984-021-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Background Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We designed the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility and the preliminary efficacy of the SUPER intervention in individuals with moderate/severe stroke. Methods Stroke participants (n = 28) received a 4-week intervention (3 × per week), tailored to their functional level. The functional integrity of the corticospinal tract was assessed using the Predict Recovery Potential algorithm, involving measurements of motor evoked potentials and manual muscle testing. Those with low potential for hand recovery (shoulder group; n = 18) received a robotic-rehabilitation intervention focusing on elbow and shoulder movements only. Those with a good potential for hand recovery (hand group; n = 10) received EMG-triggered NMES, in addition to robot therapy. The primary outcomes were the Fugl-Meyer UE assessment and the ABILHAND assessment. Secondary outcomes included the Motor Activity Log and the Stroke Impact Scale. Results Eighteen participants (64%), in either the hand or the shoulder group, showed changes in the Fugl-Meyer UE or in the ABILHAND assessment superior to the minimal clinically important difference. Conclusions This indicates that our personalized approach is feasible and may be beneficial in improving UE function in individuals with moderate to severe impairments due to stroke. Trial registration ClinicalTrials.gov NCT03903770. Registered 4 April 2019. Registered retrospectively. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00851-1.
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Affiliation(s)
- Nahid Norouzi-Gheidari
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Interdisciplinary Research Center in Rehabilitation, Montreal, Canada
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada. .,Interdisciplinary Research Center in Rehabilitation, Montreal, Canada.
| | - Katia Monte-Silva
- Physical Therapy Department, Universidade Federal de Pernambuco, Recife, Brazil
| | - Dahlia Kairy
- Interdisciplinary Research Center in Rehabilitation, Montreal, Canada.,School of Rehabilitation, University of Montreal, Montreal, Canada
| | - Heidi Sveistrup
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Michael Trivino
- Interdisciplinary Research Center in Rehabilitation, Montreal, Canada.,Centre Intégré de santé et services sociaux de Laval, Laval, Canada
| | - Mindy F Levin
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Interdisciplinary Research Center in Rehabilitation, Montreal, Canada
| | - Marie-Hélène Milot
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada.,Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
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22
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Subramanian SK, Baniña MC, Turolla A, Levin MF. Reaching performance scale for stroke - Test-retest reliability, measurement error, concurrent and discriminant validity. PM R 2021; 14:337-347. [PMID: 33675151 DOI: 10.1002/pmrj.12584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Post-stroke upper limb motor improvement can be better quantified by describing movement patterns characterizing movement quality and use of compensations. Movement patterns can be described using both kinematic and clinical outcomes. One clinical outcome that assesses movement quality and compensations used for reaching a Close (18 points) and Far target (18 points) is the Reaching Performance Scale for Stroke (RPSS). OBJECTIVE To estimate the pilot test-retest reliability and validity (concurrent, discriminant) of the RPSS in individuals with chronic stroke. DESIGN Retrospective data analysis. SETTING Research laboratory. PARTICIPANTS Seventy-two individuals with upper limb hemiparesis ≥6 months prior to participation. INTERVENTION Not applicable. MAIN OUTCOME MEASURE RPSS Close and Far Target scores. Intraclass correlation coefficients (ICCs) helped assess pilot test-retest reliability on a subset of 14 participants. Concurrent validity was assessed for individual RPSS items with corresponding kinematic outcomes (trunk displacement, shoulder flexion, shoulder horizontal adduction, elbow extension, trajectory straightness) using Pearson correlations. We also ran multiple regression analyses with the RPSS total scores and used kinematic outcomes as the criterion standard. Logistic regression analyses estimated discriminant validity. We divided participants into two groups based on the Fugl-Meyer Assessment (FMA) scores (mild: ≥50/66; moderate-to-severe: ≤49/66). RESULTS Test-retest reliability was excellent for Close (ICC = 0.98, 95% confidence interval [CI] 0.94-0.99) and Far targets (ICC = 0.98, 95% CI 0.95-0.99). Individual RPSS items for both targets were mildly to moderately correlated with corresponding kinematic values. A combination of trajectory straightness, elbow extension, and trunk displacement explained the majority of the variance in RPSS scores (47%) for both targets. The RPSS scores discriminated between individuals with mild and moderate-to-severe motor impairment for both Close (ExpB = 3.33, P < .001; 95% CI 1.70-6.52) and Far targets (ExpB = 2.59, P < .001, 95% CI 1.65-4.07). Cutoff points for transition between groups were 15.5 (Close target) and 14 (Far target). CONCLUSION The RPSS is a valid clinical measure with excellent pilot results of test-retest reliability for assessing movement patterns and compensations used for reaching.
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Affiliation(s)
- Sandeep K Subramanian
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.,Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Melanie C Baniña
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, Ospedale San Camillo IRCCS, Venice, Italy
| | - Mindy F Levin
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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23
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Abstract
Background Motor performance is a complex process controlled in task-specific spatial frames of reference (FRs). Movements can be made within the framework of the body (egocentric FR) or external space (exocentric FR). People with stroke have impaired reaching, which may be related to deficits in movement production in different FRs. Objective To characterize rapid motor responses to changes in the number of degrees of freedom for movements made in different FRs and their relationship with sensorimotor and cognitive impairment in individuals with mild chronic stroke. Methods Healthy and poststroke individuals moved their hand along the contralateral forearm (egocentric task) and between targets in the peripersonal space (exocentric task) without vision while flexing the trunk. Trunk movement was blocked in randomized trials. Results For the egocentric task, controls produced the same endpoint trajectories in both conditions (free- and blocked-trunk) by preserving similar shoulder-elbow interjoint coordination (IJC). However, endpoint trajectories were dissimilar because of altered IJC in stroke. For the exocentric task, controls produced the same endpoint trajectories when the trunk was free or blocked by rapidly changing the IJC, whereas this was not the case in stroke. Deficits in exocentric movement after stroke were related to cognitive but not sensorimotor impairment. Conclusions Individuals with mild stroke have deficits rapidly responding to changing conditions for complex reaching tasks. This may be related to cognitive deficits and limitations in the regulation of tonic stretch reflex thresholds. Such deficits should be considered in rehabilitation programs encouraging the reintegration of the affected arm into activities of daily living.
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Affiliation(s)
- Fariba Hasanbarani
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montréal, QC, Canada
| | - Marc Aureli Pique Batalla
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montréal, QC, Canada.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Limburg, Netherlands
| | - Anatol G Feldman
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montréal, QC, Canada.,Department of Neuroscience, University of Montréal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montréal, QC, Canada
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24
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Molad R, Alouche SR, Demers M, Levin MF. Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients. Neurorehabil Neural Repair 2021; 35:194-203. [PMID: 33410389 DOI: 10.1177/1545968320981943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A comprehensive scale assessing motor coordination of multiple body segments was developed using a 3-phase content validation process. The Comprehensive Coordination Scale (CCS) evaluates motor coordination defined as the ability to produce context-dependent movements of multiple effectors in both spatial and temporal domains. The scale assesses motor coordination in individuals with neurological injuries at 2 levels of movement description: the motor performance level describes end point movements (ie, hand, foot), and the movement quality level describes limb joints/trunk movements contributing to end point movement. OBJECTIVE To determine measurement properties of the scale in people with chronic stroke. METHODS Standardized approaches determined the internal consistency (factor loadings), intrarater and interrater reliability (interclass correlation coefficient), measurement error (SEM; minimal detectable change [MDC]), construct validity, and interpretability (ie, ceiling and floor effects) of the CCS. RESULTS Data from 30 patients with chronic stroke were used for the analysis. The internal consistency of the scale was high (0.94), and the scale consisted of separate factors characterizing end point motor performance and movement quality. Intrarater (intraclass correlation coefficient [ICC] = 0.97-0.97) and interrater (ICC=0.76-0.98) reliability of the whole scale and subscales were good to excellent. The CCS had an SEM of 1.80 points (total score = 69 points) and an MDC95 of 4.98 points. The CCS total score was related to Fugl-Meyer Assessment total and motor scores and had no ceiling or floor effects. CONCLUSIONS The CCS scale has strong measurement properties and may be a useful measure of spatial and temporal coordination deficits in chronic stroke survivors.
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Affiliation(s)
- Roni Molad
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada
| | - Sandra R Alouche
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada.,Universidade Cidade de São Paulo, Brazil
| | - Marika Demers
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada.,University of Southern California, Los Angeles, CA, USA
| | - Mindy F Levin
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada
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25
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Anaby D, Ryan M, Palisano RJ, Levin MF, Gorter JW, Avery L, Cormier I, Teplicky R, Coulter J, Hanes J. Participation during a Pandemic: Forging New Pathways. Phys Occup Ther Pediatr 2021; 41:115-119. [PMID: 33508997 DOI: 10.1080/01942638.2021.1875739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Mallory Ryan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Robert J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel Univeristy, Philadelphia, Pennsylvania, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Lisa Avery
- Avery Information Services Ltd, Orilla, ON, Canada
| | - Isabelle Cormier
- CRIR - Lethbridge-Layton-Mackay Rehabilitation Centre of the CIUSSS West-Central, Montreal, QC
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | | | - Julia Hanes
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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26
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Alouche SR, Molad R, Demers M, Levin MF. Development of a Comprehensive Outcome Measure for Motor Coordination; Step 1: Three-Phase Content Validity Process. Neurorehabil Neural Repair 2020; 35:185-193. [PMID: 33349134 DOI: 10.1177/1545968320981955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Motor coordination, the ability to produce context-dependent organized movements in spatial and temporal domains, is impaired after neurological injuries. Outcome measures assessing coordination mostly quantify endpoint performance variables (ie, temporal qualities of whole arm movement) but not movement quality (ie, trunk and arm joint displacements). OBJECTIVE To develop an outcome measure to assess coordination of multiple body segments at both endpoint trajectory and movement quality levels, based on observational kinematics, in adults with neurological injuries. METHODS A 3-phase study was used to develop the Comprehensive Coordination Scale (CCS): instrument development, Delphi process, and focus group meeting. The CCS was constructed from common tests used in clinical practice and research. Rating scales for different behavioral elements were developed to guide analysis. For content validation, 8 experts (ie, neurological clinicians/researchers) answered questionnaires about relevance, comprehension, and feasibility of each test and rating scale. A focus group conducted with 6 of 8 experts obtained consensus on rating scale and instruction wording, and identified gaps. Three additional experts reviewed the revised CCS content to obtain a final version. RESULTS Experts identified a gap regarding assessment of hand/finger coordination. The CCS final version is composed of 6 complementary tests of coordination: finger-to-nose, arm-trunk, finger, lower extremity, and 2- and 4-limb interlimb coordination. Constructs include spatial and temporal variables totaling 69 points. Higher scores indicate better performance. CONCLUSIONS The CCS may be an important, understandable and feasible outcome measure to assess spatial and temporal coordination. CCS measurement properties are presented in the companion article.
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Affiliation(s)
- Sandra R Alouche
- Universidade Cidade de São Paulo, Sao Paulo, Brazil.,McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Roni Molad
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Marika Demers
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,University of Southern California, Los Angeles, CA, USA
| | - Mindy F Levin
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
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27
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Baniña MC, Molad R, Solomon JM, Berman S, Soroker N, Frenkel-Toledo S, Liebermann DG, Levin MF. Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system. Disabil Rehabil Assist Technol 2020; 17:100-106. [DOI: 10.1080/17483107.2020.1765421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Melanie C. Baniña
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
| | - Roni Molad
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra’anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Dario G. Liebermann
- Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mindy F. Levin
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
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28
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Anaby D, Avery L, Gorter JW, Levin MF, Teplicky R, Turner L, Cormier I, Hanes J. Improving body functions through participation in community activities among young people with physical disabilities. Dev Med Child Neurol 2020; 62:640-646. [PMID: 31670397 DOI: 10.1111/dmcn.14382] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 12/14/2022]
Abstract
AIM To examine the impact of engagement in a self-chosen community-based activity on three relevant body functions (motor, cognitive, and affective) as well as on the performance of the selected activity. METHOD An individual-based interrupted time series design with multiple baselines was used. Seven young people (four males, three females) aged 15 to 25 years (median 18y; interquartile range 17-20y) with physical disabilities participated in an 8-week community activity of choice (e.g. swimming, playing piano). Change in three relevant body functions, underpinning the specific chosen activity, including motor (e.g. Functional Reach Test, Trunk Impairment Scale, dynamometers), cognitive and affective (Behavior Assessment System for Children), as well as activity performance (Canadian Occupational Performance Measure) were measured repeatedly, providing individual outcome trajectories. Linear and mixed-effects models were used. RESULTS Significant improvements in at least one aspect of motor function (6 out of 6), cognition (3 out of 3), affect (5 out of 7), and performance (7 out of 7) were observed. Specifically, the intervention had a moderate to large effect on hyperactivity (1.45, 95% confidence interval [CI] 1.0-1.9) with a smaller effect on anxiety (0.21, 95% CI 0.10-0.32) and inadequacy (0.21, 95% CI 0.02-0.39). Concurrently, a notable effect size for activity performance (4.61, 95% CI 0.76-8.46) was observed. Average change across motor outcomes was substantial (3.7 SDs from baseline), yet non-significant. INTERPERTATION Findings provide initial evidence of the benefits resulting from participation-based interventions, emphasizing the merit of meaningful 'real-life' young people-engaging therapy. WHAT THIS PAPER ADDS Participation-based interventions can impact body-function level outcomes. Significant improvements in the performance of chosen activities were observed. Significant improvements were also seen in cognitive and affective body functions. Improvements in motor-related outcomes were substantial but not statistically significant.
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Affiliation(s)
- Dana Anaby
- School of Physical and Occupation Therapy, McGill University, Montreal, QC, Canada.,CRIR - Lethbridge-Layton-Mackay Rehabilitation Centre of the CIUSSS West-Central Montreal, QC, Canada
| | - Lisa Avery
- Avery Information Services Ltd, Orilla, ON, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Mindy F Levin
- School of Physical and Occupation Therapy, McGill University, Montreal, QC, Canada
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Laura Turner
- Conestoga College of Applied Arts and Technology, Kitchener, ON, Canada
| | - Isabelle Cormier
- CRIR - Lethbridge-Layton-Mackay Rehabilitation Centre of the CIUSSS West-Central Montreal, QC, Canada
| | - Julia Hanes
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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29
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Abstract
Reaching from standing requires simultaneous adjustments of focal and postural task elements. We investigated the ability of people with stroke to stabilize the endpoint trajectory while maintaining balance during standing reaches. Nineteen stroke and 11 age-equivalent healthy subjects reached toward a target (n = 30 trials) located beyond arm length from standing. Endpoint and center-of-mass (COM) trajectories were analyzed using the uncontrolled manifold (UCM) approach, with segment angles as elemental variables. A synergy index (SI) represented the normalized difference between segment angle combinations, leading to endpoint or COM trajectory stabilization (VUCM) and lack of stabilization (in an orthogonal space; VORT). A higher SI reflects greater stability. In both groups, the endpoint SI (SIEND) decreased in parallel with endpoint velocity and returned close to baseline at the end of the movement. The range of SIEND was significantly greater in stroke (median: 0.87; QR:0.54) compared with healthy subjects (median: 0.58; QR: 0.33; P = 0.009). In both groups, the lowest SIEND occurred at the endpoint peak velocity, whereas the minimal SIEND of the stroke group (median: 0.51; QR:0.41) was lower than the healthy group (median: 0.25; QR: 0.50; P = 0.033). The COM SI (SICOM) remained stable in both groups (~0.8). The maintenance of a high SICOM despite a large reduction of SIEND in stroke subjects suggests that kinematic redundancy was effectively used to stabilize the COM position, but less so for endpoint position stabilization. Both focal and postural task elements should be considered when analyzing whole body reaching deficits in patients with stroke.NEW & NOTEWORTHY Reaching from standing requires simultaneous adjustments of endpoint and center-of-mass (COM) positions. We used uncontrolled manifold analysis to investigate the impact of stroke on the ability to use kinematic redundancy in this task. Our results showed that COM position was stabilized, whereas endpoint trajectory was more variable in stroke than healthy subjects. Enhancing the capacity to meet multiple task goals may be beneficial for motor recovery after stroke.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
| | - Nicolas A Turpin
- IRISSE (EA 4075), Department of Sport Sciences (STAPS), University of la Réunion; Tampon, France
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre of the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Anatol G Feldman
- Centre of the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada.,Département de Neurosciences, Université de Montréal, Montreal, Quebec, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre of the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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30
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Affiliation(s)
- Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
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31
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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] [What about the content of this article? (0)] [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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32
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Subramanian SK, Baniña MC, Sambasivan K, Haentjens K, Finestone HM, Sveistrup H, Levin MF. Motor-Equivalent Intersegmental Coordination Is Impaired in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:210-221. [PMID: 31976815 DOI: 10.1177/1545968319899912] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Kinematic abundance permits using different movement patterns for task completion. Individuals poststroke may take advantage of abundance by using compensatory trunk displacement to overcome upper limb (UL) movement deficits. However, movement adaptation in tasks requiring specific intersegment coordination may remain limited. Objective. We tested movement adaptation in both arms of individuals with chronic stroke (n = 16) and nondominant arms of controls (n = 12) using 2 no-vision reaching tasks involving trunk movement (40 trials/arm). Methods. In the "stationary hand task" (SHT), subjects maintained the hand motionless over a target while leaning the trunk forward. In the "reaching hand task" (RHT), subjects reached to the target while leaning forward. For both tasks, trunk movement was unexpectedly blocked in 40% of trials to assess the influence of trunk movement on adaptive arm positioning or reaching. UL sensorimotor impairment, activity, and sitting balance were assessed in the stroke group. The primary outcome measure for SHT was gain (g), defined as the extent to which trunk displacement contributing to hand motion was offset by appropriate changes in UL movements (g = 1: complete compensation) and endpoint deviation for RHT. Results. Individuals poststroke had lower gains and greater endpoint deviation using the more-affected compared with less-affected UL and controls. Those with less sensorimotor impairment, greater activity levels, and better sitting balance had higher gains and smaller endpoint deviations. Lower gains were associated with diminished UL adaptability. Conclusions. Tests of condition-specific adaptability of interjoint coordination may be used to measure UL adaptability and changes in adaptability with treatment.
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Affiliation(s)
- Sandeep K Subramanian
- Université de Montréal, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital site of the Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada
| | - Melanie C Baniña
- Jewish Rehabilitation Hospital site of the Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Krithika Sambasivan
- Jewish Rehabilitation Hospital site of the Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Katherine Haentjens
- Jewish Rehabilitation Hospital site of the Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Hillel M Finestone
- University of Ottawa, Ottawa, Ontario, Canada.,Élisabeth Bruyère Hospital, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mindy F Levin
- Jewish Rehabilitation Hospital site of the Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
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33
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Chan-Viquez D, Hasanbarani F, Zhang L, Anaby D, Turpin NA, Lamontagne A, Feldman AG, Levin MF. Development of vertical and forward jumping skills in typically developing children in the context of referent control of motor actions. Dev Psychobiol 2020; 62:711-722. [PMID: 31957019 DOI: 10.1002/dev.21949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/14/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
Abstract
The empirically based referent control theory of motor actions provides a new framework for understanding locomotor maturation. Mature movement patterns of referent control are characterized by periods of minimization of activity across multiple muscles (global electromyographic [EMG] minima) resulting from transient matching between actual and referent body configurations. We identified whether locomotor maturation in young children was associated with (a) development of referent control and (b) children's frequency of participation in everyday activities evaluated by parents. Kinematics and EMG activity were recorded from typically developing children (n = 15, 3-5 years) and young adults (n = 10, 18-25 years) while walking, vertical or forward jumping. Presence and location of global EMG minima in movement cycles, slopes of ankle vertical/sagittal displacements, and shoulder displacement ratios were evaluated. Children had fewer global EMG minima compared to adults during specific phases of vertical and forward jumps. Ankle displacement profiles for walking and jumping forward were related to each other in adults, whereas those for walking and vertical jumping were related in children. Higher frequency of participation was significantly correlated with more mature jumping patterns in children. A decrease in the number of global EMG minima and changes in ankle movement patterns could be indicators of locomotor immaturity in typically developing children.
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Affiliation(s)
- Daniela Chan-Viquez
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Fariba Hasanbarani
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Lei Zhang
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.,Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Nicolas A Turpin
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.,Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.,Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Davidowitz I, Parmet Y, Frenkel-Toledo S, Baniña MC, Soroker N, Solomon JM, Liebermann DG, Levin MF, Berman S. Relationship Between Spasticity and Upper-Limb Movement Disorders in Individuals With Subacute Stroke Using Stochastic Spatiotemporal Modeling. Neurorehabil Neural Repair 2019; 33:141-152. [PMID: 30744528 DOI: 10.1177/1545968319826050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spasticity is common in patients with stroke, yet current quantification methods are insufficient for determining the relationship between spasticity and voluntary movement deficits. This is partly a result of the effects of spasticity on spatiotemporal characteristics of movement and the variability of voluntary movement. These can be captured by Gaussian mixture models (GMMs). OBJECTIVES To determine the influence of spasticity on upper-limb voluntary motion, as assessed by the bidirectional Kullback-Liebler divergence (BKLD) between motion GMMs. METHODS A total of 16 individuals with subacute stroke and 13 healthy aged-equivalent controls reached to grasp 4 targets (near-center, contralateral, far-center, and ipsilateral). Two-dimensional GMMs (angle and time) were estimated for elbow extension motion. BKLD was computed for each individual and target, within the control group and between the control and stroke groups. Movement time, final elbow angle, average elbow velocity, and velocity smoothness were computed. RESULTS Between-group BKLDs were much larger than within control-group BKLDs. Between-group BKLDs for the near-center target were lower than those for the far-center and contralateral targets, but similar to that for the ipsilateral target. For those with stroke, the final angle was lower for the near-center target, and the average velocity was higher. Velocity smoothness was lower for the near-center than for the ipsilateral target. Elbow flexor and extensor passive muscle resistance (Modified Ashworth Scale) strongly explained BKLD values. CONCLUSIONS Results support the view that individuals with poststroke spasticity have a velocity-dependent reduction in active elbow joint range and that BKLD can be used as an objective measure of the effects of spasticity on reaching kinematics.
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Affiliation(s)
| | - Yisrael Parmet
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Melanie C Baniña
- 4 McGill University, Montréal, Canada.,5 Center for Interdisciplinary Research in Rehabilitation (CRIR), Montréal, Canada
| | - Nachum Soroker
- 3 Loewenstein Hospital, Ra'anana, Israel.,6 Tel-Aviv University, Israel
| | | | | | - Mindy F Levin
- 2 Ariel University, Israel.,3 Loewenstein Hospital, Ra'anana, Israel
| | - Sigal Berman
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kwakkel G, van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2019; 33:951-958. [PMID: 31660781 DOI: 10.1177/1545968319886477] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - E E H van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J H Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - L E H van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - M F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - J W Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kwakkel G, Van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:783-791. [DOI: 10.1177/1747493019873519] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - EEH Van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - JH Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - CJ Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - LEH van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - MF Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - JW Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Levin MF, Hiengkaew V, Nilanont Y, Cheung D, Dai D, Shaw J, Bayley M, Saposnik G. Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke. Neurorehabil Neural Repair 2019; 33:432-441. [PMID: 31072222 DOI: 10.1177/1545968319847969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Understanding the relationship between movement quality (impairment) and performance (activity) in poststroke patients is important for rehabilitation intervention studies. This has led to an interest in kinematic characterization of upper limb motor impairment. Since instrumented motion analysis is not readily clinically available, observational kinematics may be a viable alternative. Objective. To determine if upper limb movement quality during a reach-to-grasp task identified by observation could be used to describe the relationship between motor impairments and the time to perform functional tasks. Methods. Cross-sectional, secondary analysis of baseline data from 141 participants with stroke, age 18 to 85 years, who participated in a multicenter randomized controlled trial. Clinical assessment of movement quality using the Reaching Performance Scale for Stroke (RPSS-Close and Far targets) and of performance (activity) from the Wolf Motor Function Test (WMFT-7 items) was assessed. The degree to which RPSS component scores explained scores on WMFT items was determined by multivariable regression. Results. Clinically significant decreases (>2 seconds) in performance time for some of the more complex WMFT tasks involving prehension were predicted from RPSS-Close and Far target components. Trunk compensatory movements did not predict either increases or decreases in performance time for the WMFT tasks evaluated. Overall, the strength of the regression models was low. Conclusions. In lieu of kinematic analysis, observational clinical movement analysis may be a valid and accessible method to determine relationships between motor impairment, compensations and upper limb function in poststroke patients. Specific relationships are unlikely to generalize to all tasks due to kinematic redundancy and task specificity.
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Affiliation(s)
- Mindy F Levin
- 1 McGill University and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | | | | | - Donna Cheung
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Dai
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Shaw
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- 5 Toronto Rehabilitation Institute and University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Monte-Silva K, Piscitelli D, Norouzi-Gheidari N, Batalla MAP, Archambault P, Levin MF. Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2019; 33:96-111. [DOI: 10.1177/1545968319826053] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness. Objective. To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains. Methods. Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6). Results. Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases. Conclusion. EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.
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Affiliation(s)
- Katia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Brazil
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
| | - Daniele Piscitelli
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Nahid Norouzi-Gheidari
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Marc Aureli Pique Batalla
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- Maastricht University, Maastricht, Netherlands
| | - Philippe Archambault
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Mindy F. Levin
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
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Demers M, Blanchette AK, Mullick AA, Shah A, Woo K, Solomon J, Levin MF. Facilitators and barriers to using neurological outcome measures in developed and developing countries. Physiother Res Int 2018; 24:e1756. [DOI: 10.1002/pri.1756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 07/30/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marika Demers
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - Andréanne K. Blanchette
- Department of Rehabilitation; Université Laval; Québec City Canada
- Institut de réadaptation en déficience physique de Québec; Center for Interdisciplinary Research in Rehabilitation and Social Integration; Québec City Québec Canada
| | - Aditi A. Mullick
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - Akash Shah
- Department of Physiotherapy, School of Allied Health Sciences; Manipal Academy of Higher Education; Manipal India
| | - Kathleen Woo
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - John Solomon
- Department of Physiotherapy, School of Allied Health Sciences; Manipal Academy of Higher Education; Manipal India
| | - Mindy F. Levin
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
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Abstract
Body orientation with respect to the direction of gravity changes when we lean forward from upright standing. We tested the hypothesis that during upright standing, the nervous system specifies the referent body orientation that defines spatial thresholds for activation of multiple muscles across the body. To intentionally lean the body forward, the system is postulated to transfer balance and stability to the leaned position by monotonically tilting the referent orientation, thus increasing the activation thresholds of ankle extensors and decreasing their activity. Consequently, the unbalanced gravitational torque would start to lean the body forward. With restretching, ankle extensors would be reactivated and generate increasing electromyographic (EMG) activity until the enhanced gravitational torque would be balanced at a new posture. As predicted, vestibular influences on motoneurons of ankle extensors evaluated by galvanic vestibular stimulation were smaller in the leaned compared with the upright position, despite higher tonic EMG activity. Defacilitation of vestibular influences was also observed during forward leaning when the EMG levels in the upright and leaned position were equalized by compensating the gravitational torque with a load. The vestibular system is involved in the active control of body orientation without directly specifying the motor outcome. Corticospinal influences originating from the primary motor cortex evaluated by transcranial magnetic stimulation remained similar at the two body postures. Thus, in contrast to the vestibular system, the corticospinal system maintains a similar descending facilitation of motoneurons of leg muscles at different body orientations. The study advances the understanding of how body orientation is controlled. NEW & NOTEWORTHY The brain changes the referent body orientation with respect to gravity to lean the body forward. Physiologically, this is achieved by shifts in spatial thresholds for activation of ankle muscles, which involves the vestibular system. Results advance the understanding of how the brain controls body orientation in the gravitational field. The study also extends previous evidence of empirical control of motor function, i.e., without the reliance on model-based computations and direct specification of motor outcome.
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Affiliation(s)
- Lei Zhang
- Department of Neuroscience, University of Montreal , Montreal, Quebec , Canada.,Institut de Réadaptation Gingras-Lindsay de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal, Quebec , Canada.,Jewish Rehabilitation Hospital, CRIR, Laval, Quebec , Canada
| | - Anatol G Feldman
- Department of Neuroscience, University of Montreal , Montreal, Quebec , Canada.,Institut de Réadaptation Gingras-Lindsay de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal, Quebec , Canada.,Jewish Rehabilitation Hospital, CRIR, Laval, Quebec , Canada
| | - Mindy F Levin
- Jewish Rehabilitation Hospital, CRIR, Laval, Quebec , Canada.,School of Physical and Occupational Therapy, McGill University , Montreal, Quebec , Canada
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Robert MT, Levin MF. Validation of reaching in a virtual environment in typically developing children and children with mild unilateral cerebral palsy. Dev Med Child Neurol 2018; 60:382-390. [PMID: 29427357 DOI: 10.1111/dmcn.13688] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
AIM To compare three reaching movements made in two planes between a low-cost, game-based virtual reality and a matched physical environment in typically developing children and children with cerebral palsy (CP). To determine if differences in kinematics are related to sensory deficits. METHOD An observational study in which 27 children (typically developing, n=17, mean age 13y, [SD] 2y 2mo, range 9y 3mo-17y 2mo; CP, n=10, mean age 13y 8mo, [SD] 1y 8mo, range 11y 1mo-17y 1mo, Manual Ability Classification System levels I-II) performed 15 trials of three gestures in each of a virtual reality and a matched physical environment. Upper-limb and trunk kinematics were recorded using an electromagnetic system (G4, Polhemus, six markers, 120Hz). RESULTS Compared to the physical environment, movements in virtual reality made by typically developing children were slower (p=0.002), and involved less trunk flexion (p=0.002) and rotation (p=0.026). Children with CP had more curved trajectories (p=0.005) and used less trunk flexion (p=0.003) and rotation (p=0.005). Elbow and shoulder kinematics differed from 2.8% to 155.4% between environments in both groups. Between groups, there were small, clinically insignificant differences with only the vertical gesture being longer in typically developing children. Children with CP who had greater tactile impairment used more trunk displacement. INTERPRETATION Clinicians and researchers need to be aware of differences in movement variables when setting goals or designing protocols for improving reaching in children with CP using low-cost, game-based virtual reality systems. WHAT THIS PAPER ADDS Upper-limb kinematics differed in each group when reaching in physical versus virtual environments. There were small differences in movements made by children with mild unilateral cerebral palsy (CP) compared to typically developing children. Differences in reaching kinematics should be considered when goal setting using virtual reality interventions for children with mild unilateral CP.
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Affiliation(s)
- Maxime T Robert
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Mindy F Levin
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Tomita Y, Mullick AA, Levin MF. Reduced Kinematic Redundancy and Motor Equivalence During Whole-Body Reaching in Individuals With Chronic Stroke. Neurorehabil Neural Repair 2018; 32:175-186. [DOI: 10.1177/1545968318760725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yosuke Tomita
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Aditi A. Mullick
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Mindy F. Levin
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Nguyen AV, Ong YLA, Luo CX, Thuraisingam T, Rubino M, Levin MF, Kaizer F, Archambault PS. Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers. Disabil Rehabil Assist Technol 2018. [DOI: 10.1080/17483107.2018.1447608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ai-Vi Nguyen
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Yau-Lok Austin Ong
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cindy Xin Luo
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Thiviya Thuraisingam
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Michael Rubino
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
| | - Franceen Kaizer
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
- Interdisciplinary Research Centre in Rehabilitation (CRIR), Montreal, Canada
| | - Philippe S. Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
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Demers M, Chan Chun Kong D, Levin MF. Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians. Disabil Rehabil Assist Technol 2018. [PMID: 29526122 DOI: 10.1080/17483107.2018.1449019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke. METHODS A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15-20 or 20-45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted. RESULTS Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events. CONCLUSIONS Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities. Implications for Rehabilitation • Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation. • Input from end-users (therapists and individuals with stroke) is critical for the development and implementation of a virtual reality intervention.
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Affiliation(s)
- Marika Demers
- a School of Physical and Occupational Therapy, McGill University , Montreal , Canada.,b Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada
| | - Daniel Chan Chun Kong
- a School of Physical and Occupational Therapy, McGill University , Montreal , Canada.,b Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada
| | - Mindy F Levin
- a School of Physical and Occupational Therapy, McGill University , Montreal , Canada.,b Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada
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Levac D, McCormick A, Levin MF, Brien M, Mills R, Miller E, Sveistrup H. Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study. Phys Occup Ther Pediatr 2018; 38:74-87. [PMID: 28375682 DOI: 10.1080/01942638.2017.1287810] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. METHODS Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. RESULTS There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. CONCLUSION Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.
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Affiliation(s)
- Danielle Levac
- a Department of Physical Therapy, Movement and Rehabilitation Sciences , Northeastern University , Boston , Massachusetts , USA
| | - Anna McCormick
- b Department of Pediatrics, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Mindy F Levin
- c School of Physical and Occupational Therapy , McGill University , Montreal , Quebec , Canada
| | - Marie Brien
- d Physiotherapy, Ottawa Children's Treatment Center , Ottawa , Ontario , Canada
| | - Richard Mills
- e School of Human Kinetics, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | - Elka Miller
- f Medical Imaging Department , Children's Hospital of Eastern Ontario , Ottawa , Ontario , Canada
| | - Heidi Sveistrup
- g Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
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Robert MT, Sambasivan K, Levin MF. Extrinsic feedback and upper limb motor skill learning in typically-developing children and children with cerebral palsy: Review. Restor Neurol Neurosci 2018; 35:171-184. [PMID: 28282845 DOI: 10.3233/rnn-160688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Improvment of upper limb motor skills occurs through motor learning that can be enhanced by providing extrinsic feedback. Different types and frequencies of feedback are discussed but specific guidelines for use of feedback for motor learning in typically-developing (TD) children and children with Cerebral Palsy (CP) are not available. OBJECTIVE Identify the most effective modalities and frequencies of feedback for improving upper limb motor skills in TD children and children with CP. METHODS Ovid MEDLINE, Cochrane, PEDro and PubMed-NCBI were searched from 1950 to December 2015 to identify English-language articles addressing the role of extrinsic feedback on upper limb motor learning in TD children and children with CP. Nine studies were selected with a total of 243 TD children and 102 children with CP. Study quality was evaluated using the Downs and Black scale and levels of evidence were determined with Sackett's quality ratings. RESULTS There was a lack of consistency in the modalities and frequencies of feedback delivery used to improve motor learning in TD children and in children with CP. Moreover, the complexity of the task to be learned influenced the degree of motor learning achieved. CONCLUSION A better understanding of the influence of feedback on motor learning is needed to optimize motor skill acquisition in children with CP.
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Affiliation(s)
- Maxime T Robert
- Integrated Program of Neuroscience, McGill University, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada
| | - Krithika Sambasivan
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Mindy F Levin
- Integrated Program of Neuroscience, McGill University, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Levin MF, Baniña MC, Frenkel-Toledo S, Berman S, Soroker N, Solomon JM, Liebermann DG. Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial. Trials 2018; 19:7. [PMID: 29301545 PMCID: PMC5755182 DOI: 10.1186/s13063-017-2377-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved (“active control zone”) after identification of a “spasticity zone”. Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. Methods This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two follow-up assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbow-flexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. Discussion This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries. Trial registration ClinicalTrials.gov, ID: NCT02725853. Initially registered on 12 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2377-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada. .,School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3S 1Y5, Canada.
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, School of Allied Health Sciences (SOAHS), Manipal University, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tomita Y, Rodrigues MRM, Levin MF. Upper Limb Coordination in Individuals With Stroke: Poorly Defined and Poorly Quantified. Neurorehabil Neural Repair 2017; 31:885-897. [DOI: 10.1177/1545968317739998] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. The identification of deficits in interjoint coordination is important in order to better focus upper limb rehabilitative treatment after stroke. The majority of standardized clinical measures characterize endpoint performance, such as accuracy, speed, and smoothness, based on the assumption that endpoint performance reflects interjoint coordination, without measuring the underlying temporal and spatial sequences of joint recruitment directly. However, this assumption is questioned since improvements of endpoint performance can be achieved through different degrees of restitution or compensation of upper limb motor impairments based on the available kinematic redundancy of the system. Confusion about adequate measurement may stem from a lack a definition of interjoint coordination during reaching. Methods and Results. We suggest an operational definition of interjoint coordination during reaching as a goal-oriented process in which joint degrees of freedom are organized in both spatial and temporal domains such that the endpoint reaches a desired location in a context-dependent manner. Conclusions. In this point-of-view article, we consider how current approaches to laboratory and clinical measures of coordination comply with our definition. We propose future study directions and specific research strategies to develop clinical measures of interjoint coordination with better construct and content validity than those currently in use.
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Affiliation(s)
- Yosuke Tomita
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Marcos R. M. Rodrigues
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Mindy F. Levin
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Turpin NA, Feldman AG, Levin MF. Stretch-reflex threshold modulation during active elbow movements in post-stroke survivors with spasticity. Clin Neurophysiol 2017; 128:1891-1897. [DOI: 10.1016/j.clinph.2017.07.411] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/24/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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Abstract
Previous motor learning studies based on adapting movements of the hemiparetic arm in stroke subjects have not accounted for spasticity occurring in specific joint ranges (spasticity zones), resulting in equivocal conclusions about learning capacity. We compared the ability of participants with stroke to rapidly adapt elbow extension movements to changing external load conditions outside and inside spasticity zones. Participants with stroke ( n = 12, aged 57.8 ± 9.6 yr) and healthy age-matched controls ( n = 8, 63.5 ± 9.1 yr) made rapid 40°-50° horizontal elbow extension movements from an initial (3°) to a final (6°) target. Sixteen blocks (6-10 trials/block) consisting of alternating loaded (30% maximal voluntary contraction) and nonloaded trials were made in one (controls) or two sessions (stroke; 1 wk apart). For the stroke group, the tonic stretch reflex threshold angle at which elbow flexors began to be activated during passive elbow extension was used to identify the beginning of the spasticity zone. The task was repeated in joint ranges that did or did not include the spasticity zone. Error correction strategies were identified by the angular positions before correction and compared between groups and sessions. Changes in load condition from no load to load and vice versa resulted in undershoot and overshoot errors, respectively. Stroke subjects corrected errors in 1-4 trials compared with 1-2 trials in controls. When movements did not include the spasticity zone, there was an immediate decrease in the number of trials needed to restore accuracy, suggesting that the capacity to learn may be preserved after stroke but masked by the presence of spasticity. NEW & NOTEWORTHY When arm movements were made outside, instead of inside, the range affected by spasticity, there was an immediate decrease in the number of trials needed to restore accuracy in response to a change in the external load. This suggests that motor learning processes may be preserved in patients with stroke but masked by the presence of spasticity in specific joint ranges. This has important implications for designing rehabilitation interventions predicated on motor learning principles.
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Affiliation(s)
- Sandeep K Subramanian
- Département de Neurosciences, Université de Montréal , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
| | - Anatol G Feldman
- Département de Neurosciences, Université de Montréal , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
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