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	Author	Levin, M.F.; Berman, S.; Weiss, N.; Parmet, Y.; Banina, M.C.; Frenkel-Toledo, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G.
	Title	ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range			Type
	Year	2023	Publication	Scientific Reports	Abbreviated Journal	Sci Rep
	Volume	13	Issue	1	Pages	22934
	Keywords	Humans; Elbow; Transcranial Direct Current Stimulation; Muscle Spasticity/therapy/complications; Upper Extremity; Elbow Joint; Stroke/complications; Stroke Rehabilitation/methods
	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.
	Address	Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel. dlieberm@tauex.tau.ac.il
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language	English	Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	2045-2322	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:38129527; PMCID:PMC10739929			Approved	no
	Call Number				Serial	121
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	Author	Salzer, Y.; Friedman, J.
	Title	Reaching trajectories unravel modality-dependent temporal dynamics of the automatic process in the Simon task: a model-based approach			Type	Journal Article
	Year	2020	Publication	Psychological Research	Abbreviated Journal	Psychol Res
	Volume	84	Issue	6	Pages	1700-1713
	Keywords
	Abstract	The Simon effect represents a phenomenon in which the location of the stimuli affects the speed and accuracy of the response, despite being irrelevant for the task demands. This is believed to be due to an automatic activation of a response corresponding to the location of the stimuli, which conflicts with the controlled decision process based on relevant stimuli features. Previously, differences in the nature of the Simon effect (i.e., the pattern of change of the effect across the distribution of response times) between visual and somatosensory stimuli were reported. We hypothesize that the temporal dynamics of visual and somatosensory automatic and controlled processes vary, thus driving the reported behavioral differences. While most studies have used response times to study the underlying mechanisms involved, in this study we had participants reach out to touch the targets and recorded their arm movements using a motion capture system. Importantly, the participants started their movements before a final decision was made. In this way, we could analyze the movements to gain insights into the competition between the automatic and controlled processes. We used this technique to describe the results in terms of a model assuming automatic activation due to location-based evidence, followed by inhibition. We found that for the somatosensory Simon effect, the decay of the automatic process is significantly slower than for the visual Simon effect, suggesting quantitative differences in this automatic process between the visual and somatosensory modalities.
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language	English	Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	0340-0727	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:30980236			Approved	no
	Call Number				Serial	97
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	Author	Prushansky, T.; Kaplan-Gadasi, L.; Friedman, J.
	Title	The relationship between thoracic posture and ultrasound echo intensity of muscles spanning this region in healthy men and women			Type	Journal Article
	Year	2023	Publication	Physiotherapy Theory and Practice	Abbreviated Journal	Physiother Theory Pract
	Volume	39	Issue	6	Pages	1257-1265
	Keywords	Ultrasound imaging; muscle echogenicity; posture; thoracic kyphosis
	Abstract	PURPOSE: Skeletal muscle echogenicity intensity (EI) is considered a measure of muscle quality, being associated with old age and pathologies. Whether EI variations can be identified in healthy adults, due to habitual shortened or elongated muscle position is unknown. Thus, this study aimed to assess the relationship between thoracic kyphosis angulation and EI scores of muscles spanning this region ((Lower Trapezius (LT), Rhomboid Major (RM), Erector Spine (ES)) in healthy young people and in addition to examine the relationship between the change in thoracic kyphosis angle from relaxed to upright position (â�� degrees ) and the EI of these muscles. METHODS: Thoracic kyphosis in relaxed and erect standing was measured using a digital inclinometer in 29 healthy adults (16 women, 13 men), aged 25-35 years. The thoracic kyphosis angles including the difference between relaxed and erect postures (â�� degrees ) were correlated to the EI scores of right and left LT, RM and ES. RESULTS: No significant differences in EI were found between the 3 muscles EI or between sides, hence they were pooled together to a total thoracic EI score (TTEI). Although the TTEI did not correlate with relaxed or erect thoracic kyphosis, it was significantly but negatively correlated with â�� degrees in the entire group: Pearson's correlation coefficient of r = -0.544; p = .01 and in men; r = -0.732; p = .01, failing to reach significance in women; r = -0.457. CONCLUSION: The negative association between the EI of the explored muscles and â�� degrees could imply a possible relationship between these muscles range of movement excursions and their composition.
	Address	Department of Physical Therapy, the Stanley Stayer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language	English	Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	0959-3985	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:35125048			Approved	no
	Call Number				Serial	116
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	Author	Lerner, O.; Friedman, J.; Frenkel-Toledo, S.
	Title	The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial			Type	Journal Article
	Year	2021	Publication	Journal of NeuroEngineering and Rehabilitation	Abbreviated Journal	J NeuroEngineering Rehabil
	Volume	18	Issue		Pages	103
	Keywords
	Abstract
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	1743-0003	ISBN		Medium
	Area		Expedition		Conference
	Notes				Approved	no
	Call Number				Serial	109
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	Author	Lackritz, H.; Parmet, Y.; Frenkel-Toledo, S.; Banina, M.C.; Soroker, N.; Solomon, J.M.; Liebermann, D.G.; Levin, M.F.; Berman, S.
	Title	Effect of post-stroke spasticity on voluntary movement of the upper limb			Type	Journal Article
	Year	2021	Publication	Journal of Neuroengineering and Rehabilitation	Abbreviated Journal	J Neuroeng Rehabil
	Volume	18	Issue	1	Pages	81
	Keywords	Gaussian mixture model; Hellinger's distance; Hemiparesis; Kinematics; Kullback-Liebler divergence; Spasticity; Stochastic model; Stroke
	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.
	Address	The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. sigalbe@bgu.ac.il
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language	English	Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	1743-0003	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:33985543			Approved	no
	Call Number				Serial	108
Permanent link to this record