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Author |
Levin, M.F.; Banina, M.C.; Frenkel-Toledo, S.; Berman, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. |
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Title |
Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial |
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Journal Article |
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Year |
2018 |
Publication |
Trials |
Abbreviated Journal |
Trials |
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Volume |
19 |
Issue |
1 |
Pages |
7 |
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Keywords |
Neurorehabilitation; Spasticity; Spatial threshold; Stroke; tDCS |
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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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Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel |
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1745-6215 |
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PMID:29301545 |
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87 |
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Prushansky, T.; Kaplan-Gadasi, L.; Friedman, J. |
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Title |
The relationship between thoracic posture and ultrasound echo intensity of muscles spanning this region in healthy men and women |
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Journal Article |
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Year |
2023 |
Publication |
Physiotherapy Theory and Practice |
Abbreviated Journal |
Physiother Theory Pract |
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39 |
Issue |
6 |
Pages |
1257-1265 |
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Keywords |
Ultrasound imaging; muscle echogenicity; posture; thoracic kyphosis |
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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 (� 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 (� 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 � 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 � degrees could imply a possible relationship between these muscles range of movement excursions and their composition. |
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Department of Physical Therapy, the Stanley Stayer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel |
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0959-3985 |
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PMID:35125048 |
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116 |
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Liebermann, D.G.; Krasovsky, T.; Berman, S. |
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Title |
Planning maximally smooth hand movements constrained to nonplanar workspaces |
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Journal Article |
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2008 |
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Journal of Motor Behavior |
Abbreviated Journal |
J Mot Behav |
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40 |
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6 |
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516-531 |
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Keywords |
Adaptation, Physiological; Adult; Algorithms; Female; Hand/*physiology; Humans; *Intention; Kinesthesis/*physiology; Male; Models, Statistical; Movement/*physiology; Psychomotor Performance/*physiology; Reference Values; Writing |
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The article characterizes hand paths and speed profiles for movements performed in a nonplanar, 2-dimensional workspace (a hemisphere of constant curvature). The authors assessed endpoint kinematics (i.e., paths and speeds) under the minimum-jerk model assumptions and calculated minimal amplitude paths (geodesics) and the corresponding speed profiles. The authors also calculated hand speeds using the 2/3 power law. They then compared modeled results with the empirical observations. In all, 10 participants moved their hands forward and backward from a common starting position toward 3 targets located within a hemispheric workspace of small or large curvature. Comparisons of modeled observed differences using 2-way RM-ANOVAs showed that movement direction had no clear influence on hand kinetics (p < .05). Workspace curvature affected the hand paths, which seldom followed geodesic lines. Constraining the paths to different curvatures did not affect the hand speed profiles. Minimum-jerk speed profiles closely matched the observations and were superior to those predicted by 2/3 power law (p < .001). The authors conclude that speed and path cannot be unambiguously linked under the minimum-jerk assumption when individuals move the hand in a nonplanar 2-dimensional workspace. In such a case, the hands do not follow geodesic paths, but they preserve the speed profile, regardless of the geometric features of the workspace. |
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Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel. dlieberm@post.tau.ac.il |
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0022-2895 |
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PMID:18980905 |
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33 |
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Liebermann, D.G.; Defrin, R. |
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Characteristics of the nociceptive withdrawal response elicited under aware and unaware conditions |
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Journal Article |
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2009 |
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Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology |
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J Electromyogr Kinesiol |
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19 |
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2 |
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e114-22 |
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Adult; Arm/*physiopathology; Attention; *Awareness; Cues; Female; Humans; Male; Movement; *Muscle Contraction; Muscle, Skeletal/*physiopathology; Pain/*physiopathology; *Reflex; *Startle Reaction |
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BACKGROUND: Nociceptive withdrawal reflexes (NWR) are subject to supraspinal modulation. Therefore, awareness about a noxious stimulation may affect its characteristics. The goal of this study was to investigate the effect of different degrees of awareness on the NWR. METHOD: Eight subjects performed back and forth hand movements from a common starting point towards four visual targets during which NWR was evoked when subjects were either unaware or aware of a noxious stimulation (unaware-NWR and aware-NWR). For the comparison between the NWR under both conditions, onset latencies and kinematic variables were computed respectively from the recorded Biceps Brachii EMG and from the spatial coordinates of hand reflective markers. RESULTS: The onset latency of unaware-NWR (mean+/-SD 73.9+/-13 ms) was significantly shorter than that of the aware-NWR (91.1+/-27 ms, p<0.05). The total duration of the muscular activation was shorter in unaware-NWR than in aware-NWR. The slopes of the tangential velocity-time curves were steeper for unaware-NWR than for aware-NWR (p=0.057). CONCLUSIONS: The results suggest that supraspinal regulation of NWR under different degrees of awareness involves the re-parameterization of selected spatiotemporal aspects of a pre-structured motor response. |
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Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel |
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1050-6411 |
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PMID:18063387 |
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34 |
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Zacks, O.; Friedman, J. |
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Analogies can speed up the motor learning process |
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Journal Article |
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2020 |
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Scientific Reports |
Abbreviated Journal |
Sci Rep |
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10 |
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1 |
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6932 |
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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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Dept. of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel |
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2045-2322 |
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PMID:32332826; PMCID:PMC7181737 |
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Penn State @ write.to.jason @ |
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105 |
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