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Levin, M. F., Banina, M. C., Frenkel-Toledo, S., Berman, S., Soroker, N., Solomon, J. M., et al. (2018). Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial. Trials, 19(1), 7.
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.
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Krasovsky, T., Weiss, P. L., Zuckerman, O., Bar, A., Keren-Capelovitch, T., & Friedman, J. (2020). DataSpoon: Validation of an Instrumented Spoon for Assessment of Self-Feeding. Sensors (Basel), 20(7).
Abstract: Clinically feasible assessment of self-feeding is important for adults and children with motor impairments such as stroke or cerebral palsy. However, no validated assessment tool for self-feeding kinematics exists. This work presents an initial validation of an instrumented spoon (DataSpoon) developed as an evaluation tool for self-feeding kinematics. Ten young, healthy adults (three male; age 27.2 +/- 6.6 years) used DataSpoon at three movement speeds (slow, comfortable, fast) and with three different grips: “natural”, power and rotated power grip. Movement kinematics were recorded concurrently using DataSpoon and a magnetic motion capture system (trakSTAR). Eating events were automatically identified for both systems and kinematic measures were extracted from yaw, pitch and roll (YPR) data as well as from acceleration and tangential velocity profiles. Two-way, mixed model Intraclass correlation coefficients (ICC) and 95% limits of agreement (LOA) were computed to determine agreement between the systems for each kinematic variable. Most variables demonstrated fair to excellent agreement. Agreement for measures of duration, pitch and roll exceeded 0.8 (excellent agreement) for >80% of speed and grip conditions, whereas lower agreement (ICC < 0.46) was measured for tangential velocity and acceleration. A bias of 0.01-0.07 s (95% LOA [-0.54, 0.53] to [-0.63, 0.48]) was calculated for measures of duration. DataSpoon enables automatic detection of self-feeding using simple, affordable movement sensors. Using movement kinematics, variables associated with self-feeding can be identified and aid clinical reasoning for adults and children with motor impairments.
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Friedman, J., & Korman, M. (2019). Observation of an expert model induces a skilled movement coordination pattern in a single session of intermittent practice. Sci Rep, 9(1), 4609.
Abstract: We tested how observation of a skilled pattern of planar movements can assist in the learning of a new motor skill, which otherwise requires rigorous long-term practice to achieve fast and smooth performance. Sixty participants performed a sequence of planar hand movements on pre-test, acquisition, post-test and 24 h post-training blocks, under 1 of 4 conditions: an observation group (OG), a slowed observation group (SOG), a random motion control group (RMCG) and a double physical training control group (DPTCG). The OG and SOG observed an expert model's right hand performing the study task intermittently throughout acquisition, RMCG observed random dots movement instead of a model. Participants in the DPTCG received extra physical practice trials instead of the visually observed trials. Kinematic analysis revealed that only in conditions with observation of an expert model there was an instant robust improvement in motor planning of the task. This step-wise improvement was not only persistent in post-training retests but was also apparently implicit and subject to further incremental improvements in movement strategy over the period of 24 hours. The rapid change in motor strategy was accompanied by a transient within-session increase in spatial error for the observation groups, but this went away by 24 h post-training. We suggest that observation of hand movements of an expert model coaligned with self-produced movements during training can significantly condense the time-course of ecologically relevant drawing/writing skill mastery.
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Zacks, O., & Friedman, J. (2020). Analogies can speed up the motor learning process. Sci Rep, 10(1), 6932.
Abstract: Analogies have been shown to improve motor learning in various tasks and settings. In this study we tested whether applying analogies can shorten the motor learning process and induce insight and skill improvement in tasks that usually demand many hours of practice. Kinematic measures were used to quantify participant's skill and learning dynamics. For this purpose, we used a drawing task, in which subjects drew lines to connect dots, and a mirror game, in which subjects tracked a moving stimulus. After establishing a baseline, subjects were given an analogy, explicit instructions or no further instruction. We compared their improvement in skill (quantified by coarticulation or smoothness), accuracy and movement duration. Subjects in the analogy and explicit groups improved their coarticulation in the target task, while significant differences were found in the mirror game only at a slow movement frequency between analogy and controls.We conclude that a verbal analogy can be a useful tool for rapidly changing motor kinematics and movement strategy in some circumstances, although in the tasks selected it did not produce better performance in most measurements than explicit guidance. Furthermore, we observed that different movement facets may improve independently from others, and may be selectively affected by verbal instructions. These results suggest an important role for the type of instruction in motor learning.
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Frenkel-Toledo, S., Levin, M. F., Berman, S., Liebermann, D. G., Baniña, M. C., Solomon, J. M., et al. (2022). Shared and distinct voxel-based lesion-symptom mappings for spasticity and impaired movement in the hemiparetic upper limb. Sci Rep, 12(1).
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