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Liebermann, D. G., & Goodman, D. (1991). Effects of visual guidance on the reduction of impacts during landings. Ergonomics, 34(11), 1399–1406.
Abstract: While a common view is that vision is essential to motor performance, some recent studies have shown that continuous visual guidance may not always be required within certain time constraints. This study investigated a landing-related task (self-released falls) to assess the extent to which visual information enhances the ability to reduce the impacts at touchdown. Six individuals performed six blocked trials from four height categories in semi-counterbalanced order (5-10, 20-25, 60-65, and 90-95 cm) in vision and no-vision conditions randomly assigned. A series of two-way ANOVA with repeated measures were carried out separately on each dependent variable collapsed over six trials. The results indicated that vision during the flight did not produce softer landings. Indeed, in analysing the first peak (PFP) a main effect for visual condition was revealed in that the mean amplitude was slightly higher when vision was available (F(1,5) = 6.57; p less than 0.05), thus implicating higher forces at impact. The results obtained when the time to the first peak (TFP) was applied showed no significant differences between conditions (F(1,5) less than 1). As expected, in all cases, the analyses yielded significant main effects for the height categories factor. It appears that during self-initiated falls in which the environmental cues are known before the event, visual guidance is not necessary in order to adopt a softer landing strategy.
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Banina, M. C., Molad, R., Solomon, J. S., Berman, S., Soroker, N., Frenkel-Toledo, S., et al. (2020). Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system. Disabil Rehabil Assist Technol, , 1–7.
Abstract: Purpose: Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment.Methods: Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 approximately 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres.Results: Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity.Conclusion: The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application.Implications for rehabilitationVR rehabilitation systems can be used to deliver intensive exercise programmes.VR rehabilitation systems need to be designed with measurable progressions through difficulty levels.
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Liebermann, D. G., Levin, M. F., McIntyre, J., Weiss, P. L., & Berman, S. (2010). Arm path fragmentation and spatiotemporal features of hand reaching in healthy subjects and stroke patients. Conf Proc IEEE Eng Med Biol Soc, 2010, 5242–5245.
Abstract: Arm motion in healthy humans is characterized by smooth and relatively short paths. The current study focused on 3D reaching in stroke patients. Sixteen right-hemiparetic stroke patients and 8 healthy adults performed 42 reaching movements towards 3 visual targets located at an extended arm distance. Performance was assessed in terms of spatial and temporal features of the movement; i.e., hand path, arm posture and smoothness. Differences between groups and within subjects were hypothesized for spatial and temporal aspects of reaching under the assumption that both are independent. As expected, upper limb motion of patients was characterized by longer and jerkier hand paths and slower speeds. Assessment of the number of sub-movements within each movement did not clearly discriminate between groups. Principal component analyses revealed specific clusters of either spatial or temporal measures, which accounted for a large proportion of the variance in patients but not in healthy controls. These findings support the notion of a separation between spatial and temporal features of movement. Stroke patients may fail to integrate the two aspects when executing reaching movements towards visual targets.
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Raveh, E., Friedman, J., & Portnoy, S. (2018). Evaluation of the effects of adding vibrotactile feedback to myoelectric prosthesis users on performance and visual attention in a dual-task paradigm. Clin Rehabil, 99(11), 2263–2270.
Abstract: Objective: To evaluate the effects of adding vibrotactile feedback to myoelectric prosthesis users on the performance time and visual attention in a dual-task paradigm.
Design: A repeated-measures design with a counterbalanced order of two conditions.
Setting: Laboratory setting.
Subjects: Transradial amputees using a myoelectric prosthesis with normal or corrected eyesight (N=12, median age=65 ± 13 years). Exclusion criteria were orthopedic or neurologic problems.
Interventions: Subjects performed grasping tasks with their prosthesis, while controlling a virtual car on a road with their intact hand. The dual task was performed twice: with and without vibrotactile feedback.
Main measures: Performance time of each of the grasping tasks and gaze behavior, measured by the number of times the subjects shifted their gaze toward their hand, the relative time they applied their attention to the screen, and percentage of error in the secondary task.
Results: The mean performance time was significantly shorter (P=0.024) when using vibrotactile feedback (93.2 ± 9.6 seconds) compared with the performance time measured when vibrotactile feedback was not available (107.8 ± 20.3seconds). No significant differences were found between the two conditions in the number of times the gaze shifted from the screen to the hand, in the time the subjects applied their attention to the screen, and in the time the virtual car was off-road, as a percentage of the total game time
(51.4 ± 15.7 and 50.2 ± 19.5, respectively).
Conclusion: Adding vibrotactile feedback improved performance time during grasping in a dual-task paradigm. Prosthesis users may use vibrotactile feedback to perform better during daily tasks, when multiple cognitive demands are present.
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Liebermann, D. G., Buchman, A. S., & Franks, I. M. (2006). Enhancement of motor rehabilitation through the use of information technologies. Clin Biomech (Bristol, Avon), 21(1), 8–20.
Abstract: The recent development of information technologies has dramatically increased the tools available for facilitating motor rehabilitation. This review focuses on technologies which can be used to augment movement-related information both to patients as well as to their therapists. A brief outline of the motor system emphasizes the role of spinal motor neurons in the control of voluntary movement and rehabilitative efforts. Technologies which induce passive motion to stimulate spinal motor output as well as technologies that stimulate active voluntary movements are discussed. Finally, we review technologies and notational methods that can be used to quantify and assess the quality of movement for evaluating the efficacy of motor rehabilitation efforts. We conclude that stronger evidence is necessary to determine the applicability of the wide range of technologies now available to clinical rehabilitation efforts.
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