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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. |
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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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Year |
2023 |
Publication |
Scientific Reports |
Abbreviated Journal |
Sci Rep |
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Volume |
13 |
Issue |
1 |
Pages |
22934 |
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Keywords  |
Humans; Elbow; *Transcranial Direct Current Stimulation; Muscle Spasticity/therapy/complications; Upper Extremity; *Elbow Joint; *Stroke/complications; *Stroke Rehabilitation/methods |
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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. |
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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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Author |
Merdler, T.; Liebermann, D.G.; Levin, M.F.; Berman, S. |
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Title |
Arm-plane representation of shoulder compensation during pointing movements in patients with stroke |
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Year |
2013 |
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Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology |
Abbreviated Journal |
J Electromyogr Kinesiol |
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23 |
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4 |
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938–947 |
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Keywords |
Kinematics; Arm movement; Rehabilitation |
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Abstract |
Improvements in functional motor activities are often accompanied by motor compensations to overcome persistent motor impairment in the upper limb. Kinematic analysis is used to objectively quantify movement patterns including common motor compensations such as excessive trunk displacement during reaching. However, a common motor compensation to assist reaching, shoulder abduction, is not adequately characterized by current motion analysis approaches. We apply the arm-plane representation that accounts for the co-variation between movements of the whole arm, and investigate its ability to identify and quantify compensatory arm movements in stroke subjects when making forward arm reaches. This method has not been previously applied to the analysis of motion deficits. Sixteen adults with right post-stroke hemiparesis and eight healthy age-matched controls reached in three target directions (14 trials/target; sampling rate: 100Hz). Arm-plane movement was validated against endpoint, joint, and trunk kinematics and compared between groups. In stroke subjects, arm-plane measures were correlated with arm impairment (Fugl-Meyer Assessment) and ability (Box and Blocks) scores and were more sensitive than clinical measures to detect mild motor impairment. Arm-plane motion analysis provides new information about motor compensations involving the co-variation of shoulder and elbow movements that may help to understand the underlying motor deficits in patients with stroke. |
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Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel |
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1050-6411 |
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PMID:23566477 |
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69 |
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Friedman, J.; Korman, M. |
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Offline Optimization of the Relative Timing of Movements in a Sequence Is Blocked by Retroactive Behavioral Interference |
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2016 |
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Frontiers in Human Neuroscience |
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Front. Hum. Neurosci. |
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10 |
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623 |
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Keywords |
learning; interference; consolidation; finger movements; kinematics |
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Acquisition of motor skills often involves the concatenation of single movements into sequences. Along the course of learning, sequential performance becomes progressively faster and smoother, presumably by optimization of both motor planning and motor execution. Following its encoding during training, “how-to” memory undergoes consolidation, reflecting transformations in performance and its neurobiological underpinnings over time. This offline post-training memory process is characterized by two phenomena: reduced sensitivity to interference and the emergence of delayed, typically overnight, gains in performance. Here, using a training protocol that effectively induces motor sequence memory consolidation, we tested temporal and kinematic parameters of performance within (online) and between (offline) sessions, and their sensitivity to retroactive interference. One group learned a given finger-to-thumb opposition sequence (FOS), and showed robust delayed (consolidation) gains in the number of correct sequences performed at 24 h. A second group learned an additional (interference) FOS shortly after the first and did not show delayed gains. Reduction of touch times and inter-movement intervals significantly contributed to the overall offline improvement of performance overnight. However, only the offline inter-movement interval shortening was selectively blocked by the interference experience. Velocity and amplitude, comprising movement time, also significantly changed across the consolidation period but were interference-insensitive. Moreover, they paradoxically canceled out each other. Current results suggest that shifts in the representation of the trained sequence are subserved by multiple processes: from distinct changes in kinematic characteristics of individual finger movements to high-level, temporal reorganization of the movements as a unit. Each of these processes has a distinct time course and a specific susceptibility to retroactive interference. This multiple-component view may bridge the gap in understanding the link between the behavioral changes, which define online and offline learning, and the biological mechanisms that support those changes. |
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1662-5161 |
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83 |
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Portnoy, S.; Rosenberg, L.; Alazraki, T.; Elyakim, E.; Friedman, J. |
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Differences in Muscle Activity Patterns and Graphical Product Quality in Children Copying and Tracing Activities on Horizontal or Vertical Surfaces |
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2015 |
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Journal of Electromyography and Kinesiology |
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Journal of Electromyography and Kinesiology |
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25 |
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3 |
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540�547 |
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Motor equivalence; Electromyography; Tablet; Occupational Therapy; Muscle fatigue; Motor control |
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The observation that a given task, e.g. producing a signature, looks similar when created by different motor commands and different muscles groups is known as motor equivalence. Relatively little data exists regarding the characteristics of motor equivalence in children. In this study, we compared the level of performance when performing a tracing task and copying figures in two common postures: while sitting at a desk and while standing in front of a wall, among preschool children. In addition, we compared muscle activity patterns in both postures. Specifically, we compared the movements of 35 five- to six-year old children, recording the same movements of copying figures and path tracing on an electronic tablet in both a horizontal orientation, while sitting, and a vertical orientation, while standing. Different muscle activation patterns were observed between the postures, however no significant difference in the performance level was found, providing evidence of motor equivalence at this young age. The study presents a straightforward method of assessing motor equivalence that can be extended to other stages of development as well as motor disorders. |
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1050-6411 |
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77 |
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Author |
Zopf, R.; Friedman, J.; Williams, M.A. |
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The plausibility of visual information for hand ownership modulates multisensory synchrony perception |
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2015 |
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Experimental Brain Research |
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233 |
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8 |
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2311-2321 |
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Multisensory perception; Temporal synchrony perception; Virtual hand; Body representations; Body ownership; Sensory predictions |
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We are frequently changing the position of our bodies and body parts within complex environments. How does the brain keep track of one’s own body? Current models of body ownership state that visual body ownership cues such as viewed object form and orientation are combined with multisensory information to correctly identify one’s own body, estimate its current location and evoke an experience of body ownership. Within this framework, it may be possible that the brain relies on a separate perceptual analysis of body ownership cues (e.g. form, orientation, multisensory synchrony). Alternatively, these cues may interact in earlier stages of perceptual processing—visually derived body form and orientation cues may, for example, directly modulate temporal synchrony perception. The aim of the present study was to distinguish between these two alternatives. We employed a virtual hand set-up and psychophysical methods. In a two-interval force-choice task, participants were asked to detect temporal delays between executed index finger movements and observed movements. We found that body-specifying cues interact in perceptual processing. Specifically, we show that plausible visual information (both form and orientation) for one’s own body led to significantly better detection performance for small multisensory asynchronies compared to implausible visual information. We suggest that this perceptual modulation when visual information plausible for one’s own body is present is a consequence of body-specific sensory predictions. |
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Springer Berlin Heidelberg |
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0014-4819 |
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78 |
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