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Friedman, J., Raveh, E., Weiss, T., Itkin, S., Niv, D., Hani, M., et al. (2019). Applying Incongruent Visual-Tactile Stimuli during Object Transfer with Vibro-Tactile Feedback (Vol. 147).
Abstract: The application of incongruent sensory signals that involves disrupted tactile feedback is rarely explored, specifically with the presence of vibrotactile feedback (VTF). This protocol aims to test the effect of VTF on the response to incongruent visual-tactile stimuli. The tactile feedback is acquired by grasping a block and moving it across a partition. The visual feedback is a real-time virtual presentation of the moving block, acquired using a motion capture system. The congruent feedback is the reliable presentation of the movement of the block, so that the subject feels that the block is grasped and see it move along with the path of the hand. The incongruent feedback appears as the movement of the block diverts from the actual movement path, so that it seems to drop from the hand when it is actually still held by the subject, thereby contradicting the tactile feedback. Twenty subjects (age 30.2 +/- 16.3) repeated 16 block transfers, while their hand was hidden. These were repeated with VTF and without VTF (total of 32 block transfers). Incongruent stimuli were presented randomly twice within the 16 repetitions in each condition (with and without VTF). Each subject was asked to rate the difficulty level of performing the task with and without the VTF. There were no statistically significant differences in the length of the hand paths and durations between transfers recorded with congruent and incongruent visual-tactile signals – with and without the VTF. The perceived difficulty level of performing the task with the VTF significantly correlated with the normalized path length of the block with VTF (r = 0.675, p = 0.002). This setup is used to quantify the additive or reductive value of VTF during motor function that involves incongruent visual-tactile stimuli. Possible applications are prosthetics design, smart sport-wear, or any other garments that incorporate VTF.
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Grip, H., Tengman, E., Liebermann, D. G., & Hager, C. K. (2019). Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury. PLoS One, 14(10), e0224261.
Abstract: The purpose was to evaluate the dynamic knee control during a drop jump test following injury of the anterior cruciate ligament injury (ACL) using finite helical axes. Persons injured 17-28 years ago, treated with either physiotherapy (ACLPT, n = 23) or reconstruction and physiotherapy (ACLR, n = 28) and asymptomatic controls (CTRL, n = 22) performed a drop jump test, while kinematics were registered by motion capture. We analysed the Preparation phase (from maximal knee extension during flight until 50 ms post-touchdown) followed by an Action phase (until maximal knee flexion post-touchdown). Range of knee motion (RoM), and the length of each phase (Duration) were computed. The finite knee helical axis was analysed for momentary intervals of ~15 degrees of knee motion by its intersection (DeltaAP position) and inclination (DeltaAP Inclination) with the knee's Anterior-Posterior (AP) axis. Static knee laxity (KT100) and self-reported knee function (Lysholm score) were also assessed. The results showed that both phases were shorter for the ACL groups compared to controls (CTRL-ACLR: Duration 35+/-8 ms, p = 0.000, CTRL-ACLPT: 33+/-9 ms, p = 0.000) and involved less knee flexion (CTRL-ACLR: RoM 6.6+/-1.9 degrees , p = 0.002, CTRL-ACLR: 7.5 +/-2.0 degrees , p = 0.001). Low RoM and Duration correlated significantly with worse knee function according to Lysholm and higher knee laxity according to KT-1000. Three finite helical axes were analysed. The DeltaAP position for the first axis was most anterior in ACLPT compared to ACLR (DeltaAP position -1, ACLPT-ACLR: 13+/-3 mm, p = 0.004), with correlations to KT-1000 (rho 0.316, p = 0.008), while the DeltaAP inclination for the third axis was smaller in the ACLPT group compared to controls (DeltaAP inclination -3 ACLPT-CTRL: -13+/-5 degrees , p = 0.004) and showed a significant side difference in ACL injured groups during Action (Injured-Non-injured: 8+/-2.7 degrees , p = 0.006). Small DeltaAP inclination -3 correlated with low Lysholm (rho 0.391, p = 0.002) and high KT-1000 (rho -0.450, p = 0.001). Conclusions Compensatory movement strategies seem to be used to protect the injured knee during landing. A decreased DeltaAP inclination in injured knees during Action suggests that the dynamic knee control may remain compromised even long after injury.
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Krasovsky, T., Weiss, P. L., Zuckerman, O., Bar, A., Keren-Capelovitch, T., & Friedman, J. (2020). DataSpoon: Validation of an Instrumented Spoon for Assessment of Self-Feeding. Sensors (Basel), 20(7).
Abstract: Clinically feasible assessment of self-feeding is important for adults and children with motor impairments such as stroke or cerebral palsy. However, no validated assessment tool for self-feeding kinematics exists. This work presents an initial validation of an instrumented spoon (DataSpoon) developed as an evaluation tool for self-feeding kinematics. Ten young, healthy adults (three male; age 27.2 +/- 6.6 years) used DataSpoon at three movement speeds (slow, comfortable, fast) and with three different grips: “natural”, power and rotated power grip. Movement kinematics were recorded concurrently using DataSpoon and a magnetic motion capture system (trakSTAR). Eating events were automatically identified for both systems and kinematic measures were extracted from yaw, pitch and roll (YPR) data as well as from acceleration and tangential velocity profiles. Two-way, mixed model Intraclass correlation coefficients (ICC) and 95% limits of agreement (LOA) were computed to determine agreement between the systems for each kinematic variable. Most variables demonstrated fair to excellent agreement. Agreement for measures of duration, pitch and roll exceeded 0.8 (excellent agreement) for >80% of speed and grip conditions, whereas lower agreement (ICC < 0.46) was measured for tangential velocity and acceleration. A bias of 0.01-0.07 s (95% LOA [-0.54, 0.53] to [-0.63, 0.48]) was calculated for measures of duration. DataSpoon enables automatic detection of self-feeding using simple, affordable movement sensors. Using movement kinematics, variables associated with self-feeding can be identified and aid clinical reasoning for adults and children with motor impairments.
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Zacks, O., & Friedman, J. (2020). Analogies can speed up the motor learning process. Sci Rep, 10(1), 6932.
Abstract: 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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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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