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Levin, M.F.; Berman, S.; Weiss, N.; Parmet, Y.; Banina, M.C.; Frenkel-Toledo, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. |
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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 |
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2023 |
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Scientific Reports |
Abbreviated Journal |
Sci Rep |
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13 |
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1 |
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22934 |
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Humans; Elbow; *Transcranial Direct Current Stimulation; Muscle Spasticity/therapy/complications; Upper Extremity; *Elbow Joint; *Stroke/complications; *Stroke Rehabilitation/methods |
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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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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 |
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2045-2322 |
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PMID:38129527; PMCID:PMC10739929 |
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121 |
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Markstrom, J.L.; Liebermann, D.G.; Schelin, L.; Hager, C.K. |
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Title |
Atypical Lower Limb Mechanics During Weight Acceptance of Stair Descent at Different Time Frames After Anterior Cruciate Ligament Reconstruction |
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2022 |
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The American Journal of Sports Medicine |
Abbreviated Journal |
Am J Sports Med |
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1-9 |
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Acl; biomechanics; functional data analysis; motion analysis; stepping down |
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BACKGROUND: An anterior cruciate ligament (ACL) rupture may result in poor sensorimotor knee control and, consequentially, adapted movement strategies to help maintain knee stability. Whether patients display atypical lower limb mechanics during weight acceptance of stair descent at different time frames after ACL reconstruction (ACLR) is unknown. PURPOSE: To compare the presence of atypical lower limb mechanics during the weight acceptance phase of stair descent among athletes at early, middle, and late time frames after unilateral ACLR. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 49 athletes with ACLR were classified into 3 groups according to time after ACLR-early (<6 months; n = 17), middle (6-18 months; n = 16), and late (>18 months; n = 16)-and compared with asymptomatic athletes (control; n = 18). Sagittal plane hip, knee, and ankle angles; angular velocities; moments; and powers were compared between the ACLR groups' injured and noninjured legs and the control group as well as between legs within groups using functional data analysis methods. RESULTS: All 3 ACLR groups showed greater knee flexion angles and moments than the control group for injured and noninjured legs. For the other outcomes, the early group had, compared with the control group, less hip power absorption, more knee power absorption, lower ankle plantarflexion angle, lower ankle dorsiflexion moment, and less ankle power absorption for the injured leg and more knee power absorption and higher vertical ground reaction force for the noninjured leg. In addition, the late group showed differences from the control group for the injured leg revealing more knee power absorption and lower ankle plantarflexion angle. Only the early group took a longer time than the control group to complete weight acceptance and demonstrated asymmetry for multiple outcomes. CONCLUSION: Athletes with different time frames after ACLR revealed atypically large knee angles and moments during weight acceptance of stair descent for both the injured and the noninjured legs. These findings may express a chronically adapted strategy to increase knee control. In contrast, atypical hip and ankle mechanics seem restricted to an early time frame after ACLR. CLINICAL RELEVANCE: Rehabilitation after ACLR should include early training in controlling weight acceptance. Including a control group is essential when evaluating movement patterns after ACLR because both legs may be affected. |
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Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden |
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0363-5465 |
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PMID:35604127 |
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112 |
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Mimouni-Bloch, A.; Shaklai, S.; Levin, M.; Ingber, M.; Karolitsky, T.; Grunbaum, S.; Friedman, J. |
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Developmental and acquired brain injury have opposite effects on finger coordination in children |
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2023 |
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Frontiers in Human Neuroscience |
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Front. Hum. Neurosci. |
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17 |
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1083304 |
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1662-5161 |
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119 |
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Prushansky, T.; Kaplan-Gadasi, L.; Friedman, J. |
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The relationship between thoracic posture and ultrasound echo intensity of muscles spanning this region in healthy men and women |
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2023 |
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Physiotherapy Theory and Practice |
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Physiother Theory Pract |
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39 |
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6 |
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1257-1265 |
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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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Salzer, Y.; Friedman, J. |
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Reaching trajectories unravel modality-dependent temporal dynamics of the automatic process in the Simon task: a model-based approach |
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2020 |
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Psychological Research |
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Psychol Res |
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84 |
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6 |
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1700-1713 |
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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. |
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0340-0727 |
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PMID:30980236 |
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97 |
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