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Author Wilf, M.; Korakin, A.; Bahat, Y.; Koren, O.; Galor, N.; Dagan, O.; Wright, W.G.; Friedman, J.; Plotnik, M. url  doi
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  Title Using virtual reality-based neurocognitive testing and eye tracking to study naturalistic cognitive-motor performance Type Journal Article
  Year 2024 Publication Neuropsychologia Abbreviated Journal Neuropsychologia  
  Volume 194 Issue (up) Pages 108744  
  Keywords Humans; Aged; *Eye-Tracking Technology; Cognition; Executive Function; *Virtual Reality; Aging; Color trails test; Fall risk; Hand kinematics; Pupil; Virtual reality  
  Abstract Natural human behavior arises from continuous interactions between the cognitive and motor domains. However, assessments of cognitive abilities are typically conducted using pen and paper tests, i.e., in isolation from “real life” cognitive-motor behavior and in artificial contexts. In the current study, we aimed to assess cognitive-motor task performance in a more naturalistic setting while recording multiple motor and eye tracking signals. Specifically, we aimed to (i) delineate the contribution of cognitive and motor components to overall task performance and (ii) probe for a link between cognitive-motor performance and pupil size. To that end, we used a virtual reality (VR) adaptation of a well-established neurocognitive test for executive functions, the 'Color Trails Test' (CTT). The VR-CTT involves performing 3D reaching movements to follow a trail of numbered targets. To tease apart the cognitive and motor components of task performance, we included two additional conditions: a condition where participants only used their eyes to perform the CTT task (using an eye tracking device), incurring reduced motor demands, and a condition where participants manually tracked visually-cued targets without numbers on them, incurring reduced cognitive demands. Our results from a group of 30 older adults (>65) showed that reducing cognitive demands shortened completion times more extensively than reducing motor demands. Conditions with higher cognitive demands had longer target search time, as well as decreased movement execution velocity and head-hand coordination. We found larger pupil sizes in the more cognitively demanding conditions, and an inverse correlation between pupil size and completion times across individuals in all task conditions. Lastly, we found a possible link between VR-CTT performance measures and clinical signatures of participants (fallers versus non-fallers). In summary, performance and pupil parameters were mainly dependent on task cognitive load, while maintaining systematic interindividual differences. We suggest that this paradigm opens the possibility for more detailed profiling of individual cognitive-motor performance capabilities in older adults and other at-risk populations.  
  Address Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel; Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. Electronic address: Meir.Plotnik@sheba.health.gov.il  
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  Series Volume Series Issue Edition  
  ISSN 0028-3932 ISBN Medium  
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  Notes PMID:38072162 Approved no  
  Call Number Serial 123  
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Author Frenkel-Toledo, S.; Levin, M.F.; Berman, S.; Liebermann, D.G.; Baniña, M.C.; Solomon, J.M.; Ofir-Geva, S.; Soroker, N. url  doi
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  Title Shared and distinct voxel-based lesion-symptom mappings for spasticity and impaired movement in the hemiparetic upper limb Type Journal Article
  Year 2022 Publication Scientific Reports Abbreviated Journal Sci Rep  
  Volume 12 Issue (up) 1 Pages  
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  ISSN 2045-2322 ISBN Medium  
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  Notes Approved no  
  Call Number Serial 113  
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Author Friedman, J.; Amiaz, A.; Korman, M. pdf  url
doi  openurl
  Title The online and offline effects of changing movement timing variability during training on a finger-opposition task Type Journal Article
  Year 2022 Publication Scientific Reports Abbreviated Journal Sci Rep  
  Volume 12 Issue (up) 1 Pages 13319  
  Keywords Fingers; Humans; *Learning; *Motor Skills; Movement; Psychomotor Performance; Upper Extremity  
  Abstract In motor learning tasks, there is mixed evidence for whether increased task-relevant variability in early learning stages leads to improved outcomes. One problem is that there may be a connection between skill level and motor variability, such that participants who initially have more variability may also perform worse on the task, so will have more room to improve. To avoid this confound, we experimentally manipulated the amount of movement timing variability (MTV) during training to test whether it improves performance. Based on previous studies showing that most of the improvement in finger-opposition tasks comes from optimizing the relative onset time of the finger movements, we used auditory cues (beeps) to guide the onset times of sequential movements during a training session, and then assessed motor performance after the intervention. Participants were assigned to three groups that either: (a) followed a prescribed random rhythm for their finger touches (Variable MTV), (b) followed a fixed rhythm (Fixed control MTV), or (c) produced the entire sequence following a single beep (Unsupervised control MTV). While the intervention was successful in increasing MTV during training for the Variable group, it did not lead to improved outcomes post-training compared to either control group, and the use of fixed timing led to significantly worse performance compared to the Unsupervised control group. These results suggest that manipulating MTV through auditory cues does not produce greater learning than unconstrained training in motor sequence tasks.  
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  ISSN 2045-2322 ISBN Medium  
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  Notes PMID:35922460; PMCID:PMC9349301 Approved no  
  Call Number Serial 115  
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Author Steinhart, S.; Weiss, P.L.; Friedman, J. pdf  url
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  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 (up) 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.  
  Address Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. jason@tau.ac.il  
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  Series Volume Series Issue Edition  
  ISSN 1743-0003 ISBN Medium  
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  Notes PMID:34930334; PMCID:PMC8690895 Approved no  
  Call Number Serial 118  
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Author Levin, M.F.; Berman, S.; Weiss, N.; Parmet, Y.; Banina, M.C.; Frenkel-Toledo, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. url  doi
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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 Type
  Year 2023 Publication Scientific Reports Abbreviated Journal Sci Rep  
  Volume 13 Issue (up) 1 Pages 22934  
  Keywords Humans; Elbow; *Transcranial Direct Current Stimulation; Muscle Spasticity/therapy/complications; Upper Extremity; *Elbow Joint; *Stroke/complications; *Stroke Rehabilitation/methods  
  Abstract 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.  
  Address 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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  Series Volume Series Issue Edition  
  ISSN 2045-2322 ISBN Medium  
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  Notes PMID:38129527; PMCID:PMC10739929 Approved no  
  Call Number Serial 121  
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