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Raveh, E., Portnoy, S., & Friedman, J. (2018). Adding vibrotactile feedback to a myoelectric-controlled hand improves performance when online visual feedback is disturbed. Hum Mov Sci, 58, 32–40.
Abstract: We investigated whether adding vibrotactile feedback to a myoelectric-controlled hand, when visual feedback is disturbed, can improve performance during a functional test. For this purpose, able-bodied subjects, activating a myoelectric-controlled hand attached to their right hand performed the modified Box & Blocks test, grasping and manipulating wooden blocks over a partition. This was performed in 3 conditions, using a repeated-measures design: in full light, in a dark room where visual feedback was disturbed and no auditory feedback – one time with the addition of tactile feedback provided during object grasping and manipulation, and one time without any tactile feedback. The average time needed to transfer one block was measured, and an infrared camera was used to give information on the number of grasping errors during performance of the test. Our results show that when vibrotactile feedback was provided, performance time was reduced significantly, compared with when no vibrotactile feedback was available. Furthermore, the accuracy of grasping and manipulation was improved, reflected by significantly fewer errors during test performance. In conclusion, adding vibrotactile feedback to a myoelectric-controlled hand has positive effects on functional performance when visual feedback is disturbed. This may have applications to current myoelectric-controlled hands, as adding tactile feedback may help prosthesis users to improve their functional ability during daily life activities in different environments, particularly when limited visual feedback is available or desirable.
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Levin, M. F., Banina, M. C., Frenkel-Toledo, S., Berman, S., Soroker, N., Solomon, J. M., et al. (2018). Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial. Trials, 19(1), 7.
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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Ezrati, O., Friedman, J., & Dar, R. (2019). Attenuation of access to internal states in high obsessive-compulsive individuals might increase susceptibility to false feedback: Evidence from a visuo-motor hand-reaching task. Journal of Behavior Therapy and Experimental Psychiatry, 65, 101445.
Abstract: Background and objectives
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Hence, they seek and rely on proxies, or discernible substitutes for these internal states. In previous studies, participants with high OC tendencies and OCD patients, compared to controls, showed increased reliance on external proxies and were more influenced by false feedback when judging their internal states. This study is the first to examine the effects of false feedback on performance of hand movements in participants with high and low OC tendencies.
Method
Thirty-four participants with high OC tendencies and 34 participants with low OC tendencies were asked to perform accurate hand reaches without visual feedback in two separate sessions of a computerized hand-reaching task: once after valid feedback training of their hand location and once with false-rotated feedback. We assessed the accuracy and directional adaptation of participants' reaches.
Results
As predicted, high OC participants evidenced a larger decrease in their hand positioning accuracy after training with false feedback compared to low OC participants.
Limitations
The generalization of our findings to OCD requires replication with a clinical sample.
Conclusions
These results suggest that in addition to self-perceptions, motor performance of OC individuals is prone to be overly influenced by false feedback, possibly due to attenuated access to proprioceptive cues. These findings may be particularly relevant to understanding the distorted sense of agency in OCD.
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Harel Arzi, Tal Krasovsky, Moshe Pritsch, & Dario G. Liebermann. (2014). Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients. Journal of Shoulder and Elbow Surgery, 23(7), 982–992.
Abstract: Background
Open surgery to correct shoulder instability is deemed to facilitate recovery of static and dynamic motor functions. Postoperative assessments focus primarily on static outcomes (e.g., repositioning accuracy). We introduce kinematic measures of arm smoothness to assess shoulder patients after open surgery and compare them with nonoperated patients. Performance among both groups of patients was hypothesized to differ. Postsurgery patients were expected to match healthy controls.
Methods
All participants performed pointing movements with the affected/dominant arm fully extended at fast, preferred, and slow speeds (36 trials per subject). Kinematic data were collected (100 Hz, 3 seconds), and mixed-design analyses of variance (group, speed) were performed with movement time, movement amplitude, acceleration time, and model-observed similarities as dependent variables. Nonparametric tests were performed for number of velocity peaks.
Results
Nonoperated and postsurgery patients showed similarities at preferred and faster movement speeds but not at slower speed. Postsurgery patients were closer to maximally smoothed motion and differed from healthy controls mainly during slow arm movements (closer to maximal smoothness, larger movement amplitude, shorter movement time, and lower number of peaks; i.e., less movement fragmentation).
Conclusions
Arm kinematic analyses suggest that open surgery stabilizes the shoulder but does not necessarily restore normal movement quality. Patients with recurrent anterior shoulder instability (RASI) seem to implement a “safe” but nonadaptive mode of action whereby preplanned stereotypical movements may be executed without depending on feedback. Rehabilitation of RASI patients should focus on restoring feedback-based movement control. Clinical assessment of RASI patients should include higher order kinematic descriptors.
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Banina, M. C., Molad, R., Solomon, J. S., Berman, S., Soroker, N., Frenkel-Toledo, S., et al. (2020). Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system. Disabil Rehabil Assist Technol, , 1–7.
Abstract: 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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