| Records |
| 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. |
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The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. sigalbe@bgu.ac.il |
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1743-0003 |
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PMID:33985543 |
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108 |
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Lerner, O.; Friedman, J.; Frenkel-Toledo, S. |
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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 |
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103 |
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109 |
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Steinhart, S.; Weiss, P.L.; Friedman, J. |
| Title |
Proximal and distal movement patterns during a graphomotor task in typically developing children and children with handwriting problems |
Type |
Journal Article |
| Year |
2021 |
Publication |
Journal of Neuroengineering and Rehabilitation |
Abbreviated Journal |
J Neuroeng Rehabil |
| Volume |
18 |
Issue |
1 |
Pages |
178 |
| Keywords |
Arm; Biomechanical Phenomena; Child; *Handwriting; Humans; Motor Skills; *Movement; Upper Extremity; Distal joints; Handwriting; Motor control; Movement analysis; Proximal; Stability |
| Abstract |
BACKGROUND: Therapists specializing in handwriting difficulties in children often address motor problems including both proximal and distal movements in the upper extremity. Kinematic measures can be used to investigate various aspects of handwriting. This study examined differences in movement patterns in proximal and distal joints of the upper extremity during graphomotor tasks between typically developing children with and without handwriting problems. Additionally, it explored relationships between movement patterns, speed, and legibility of writing. METHODS: Forty-one children, aged 7-11 years, were assessed with the Aleph Aleph Ktav Yad Hebrew Handwriting assessment and the Beery Test of Visual Motor Integration and, based on their scores, were divided into a research group (with handwriting difficulties) and a control group (without handwriting difficulties). Upper extremity joint movement patterns were analyzed with a motion capture system. Differences in the quality of shapes traced and copied on a graphics tablet positioned horizontally and vertically were compared. Between-group differences and relationships with speed and legibility were analyzed. RESULTS: In both groups, there was greater movement in the distal compared to the proximal joints, greater movement when performing the task in a horizontal compared to a vertical plane, and greater movement when tracing than copying. Joint movements in the arm executed scaled-down versions of the shapes being drawn. While the amount of joint displacement was similar between groups, children in the research group showed greater dissimilarity between the drawn shape and the shape produced by the proximal joints. Finally, the drawing measure on the tablet was a significant predictor of legibility, speed of writing, visual motor integration and motor coordination, whereas the dissimilarity measure of joint movement was a significant predictor of speed of writing and motor coordination. CONCLUSIONS: This study provides support for the role of the distal upper extremity joints in the writing process and some guidance to assist clinicians in devising treatment strategies for movement-related handwriting problems. While we observed differences in proximal joint movements between the children with and without handwriting difficulties, the extent to which they are responsible for the differences in drawing quality remains to be determined. Further studies should use a similar methodology to examine additional tasks such as drawing shapes of varying sizes. |
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Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. jason@tau.ac.il |
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1743-0003 |
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PMID:34930334; PMCID:PMC8690895 |
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118 |
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Banina, M.C.; Molad, R.; Solomon, J.S.; Berman, S.; Soroker, N.; Frenkel-Toledo, S.; Liebermann, D.G.; Levin, M.F. |
| Title |
Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system |
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Journal Article |
| Year |
2020 |
Publication |
Disability and Rehabilitation. Assistive Technology |
Abbreviated Journal |
Disabil Rehabil Assist Technol |
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1-7 |
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Stroke; difficulty; exercise therapy; intensity; personalized exercise; upper limb; virtual reality |
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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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Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada |
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1748-3107 |
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PMID:32421460 |
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106 |
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Zacks, O.; Friedman, J. |
| Title |
Analogies can speed up the motor learning process |
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Journal Article |
| Year |
2020 |
Publication |
Scientific Reports |
Abbreviated Journal |
Sci Rep |
| Volume |
10 |
Issue |
1 |
Pages |
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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