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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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Friedman, J., Brown, S., & Finkbeiner, M. (2013). Linking cognitive and reaching trajectories via intermittent movement control. Journal of Mathematical Psychology, 57(3-4), 140–151.
Abstract: Theories of decision-making have traditionally been constrained by reaction time data. A limitation of reaction time data, particularly for studying the temporal dynamics of cognitive processing, is that they index only the endpoint of the decision making process. Recently, physical reaching trajectories have been used as proxies for underlying mental trajectories through decision space. We suggest that this approach has been oversimplified: while it is possible for the motor control system to access the current state of the evidence accumulation process, this access is intermittent. Instead, we demonstrate how a model of arm movements that assumes intermittent, not continuous, access to the decision process is sufficient to describe the effects of stimulus quality and viewing time in curved reaching movements.
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Mindy F. Levin, Osnat Snir, Dario G. Liebermann, Harold Weingarden, & Patrice L. Weiss. (2012). Virtual Reality Versus Conventional Treatment of Reaching Ability in Chronic Stroke: Clinical Feasibility Study. Neurology and Therapy, 1(3), 1–15.
Abstract: Introduction
The objective of this study was to evaluate the potential of exercises performed in a 2D video-capture virtual reality (VR) training environment to improve upper limb motor ability in stroke patients compared to those performed in conventional therapy.
Methods
A small sample randomized control trial, in an outpatient rehabilitation center with 12 patients with chronic stroke, aged 33–80 years, who were randomly allocated to video-capture VR therapy and conventional therapy groups. All patients participated in four clinical evaluation sessions (pre-test 1, pre-test 2, post-test, follow-up) and nine 45-minute intervention sessions over a 3-week period. Main outcomes assessed were Body Structure and Function (impairment: Fugl–Meyer Assessment [FMA]; Composite Spasticity Index [CSI]; Reaching Performance Scale for Stroke), Activity (Box and Blocks; Wolf Motor Function Test [WMFT]), and Participation (Motor Activity Log) levels of the International Classification of Functioning.
Results
Improvements occurred in both groups, but more patients in the VR group improved upper limb clinical impairment (FMA, CSI) and activity scores (WMFT) and improvements occurred earlier. Patients in the VR group also reported satisfaction with the novel treatment.
Conclusions
The modest advantage of VR over conventional training supports further investigation of the effect of video-capture VR or VR combined with conventional therapy in larger-scale randomized, more intense controlled studies.
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Kapur, S., Friedman, J., Zatsiorsky, V. M., & Latash, M. L. (2010). Finger interaction in a three-dimensional pressing task. Experimental Brain Research, 203(1), 101–118.
Abstract: Accurate control of forces produced by the fingers is essential for performing object manipulation. This study examines the indices of finger interaction when accurate time profiles of force are produced in different directions, while using one of the fingers or all four fingers of the hand. We hypothesized that patterns of unintended force production among shear force components may involve features not observed in the earlier studies of vertical force production. In particular, we expected to see unintended forces generated by non-task fingers not in the
direction on the instructed force but in the opposite direction as well as substantial force production in directions orthogonal to the instructed direction. We also tested a hypothesis that multi-finger synergies, quantified using the framework of the uncontrolled manifold hypothesis, will help reduce across-trials variance of both total force magnitude and direction. Young, healthy subjects were required to produce accurate ramps of force in five different directions by
pressing on force sensors with the fingers of the right (dominant) hand. The index finger induced the smallest unintended forces in non-task fingers. The little finger showed the smallest unintended forces when it was a non-task finger. Task fingers showed substantial force production in directions orthogonal to the intended force direction. During four-finger tasks, individual force vectors typically pointed off the task direction, with these deviations nearly
perfectly matched to produce a resultant force in the task direction. Multi-finger synergy indices reflected strong co-variation in the space of finger modes (commands to fingers) that reduced variability of the total force magnitude and direction across trials. The synergy indices increased in magnitude over the first 30% of the trial time and then stayed at a nearly constant level. The synergy index for stabilization of total force magnitude was higher for shear force components as compared to the downward pressing force component. The results suggest complex interactions between enslaving and synergic force adjustments, possibly reflecting the experience with everyday prehensile tasks. For the first time, the data document multi-finger synergies stabilizing both shear force magnitude and force vector direction. These synergies may play a major role in
stabilizing the hand action during object manipulation.
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Flash, T., Richardson, M. E., Handzel, A. A., & Liebermann, D. G. (2003). Computational Models and Geometric Approaches in Arm Trajectory Control Studies. In M. L. Latash, & M. F. Levin (Eds.), Progress in Motor Control III: From Basic Science to Applications. Champaign, Il: Human Kinetics.
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