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Author Levin, M.F.; Banina, M.C.; Frenkel-Toledo, S.; Berman, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. url  doi
openurl 
  Title Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial Type Journal Article
  Year 2018 Publication Trials Abbreviated Journal (down) Trials  
  Volume 19 Issue 1 Pages 7  
  Keywords Neurorehabilitation; Spasticity; Spatial threshold; Stroke; tDCS  
  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.  
  Address Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1745-6215 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:29301545 Approved no  
  Call Number Serial 87  
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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
openurl 
  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 (down) Sci Rep  
  Volume 12 Issue 1 Pages  
  Keywords  
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  Corporate Author Thesis  
  Publisher Place of Publication Editor  
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  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 2045-2322 ISBN Medium  
  Area Expedition Conference  
  Notes Approved no  
  Call Number Serial 113  
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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
openurl 
  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 (down) Sci Rep  
  Volume 13 Issue 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  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 2045-2322 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:38129527; PMCID:PMC10739929 Approved no  
  Call Number Serial 121  
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Author Grip, H.; Tengman, E.; Liebermann, D.G.; Hager, C.K. url  doi
openurl 
  Title Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury Type Journal Article
  Year 2019 Publication PloS one Abbreviated Journal (down) PLoS One  
  Volume 14 Issue 10 Pages e0224261  
  Keywords  
  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.  
  Address Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden  
  Corporate Author Thesis  
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  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1932-6203 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:31671111 Approved no  
  Call Number Serial 102  
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Author Biess, A.; Flash, T.; Liebermann, D.G. url  openurl
  Title Riemannian geometric approach to human arm dynamics, movement optimization, and invariance Type Journal Article
  Year 2011 Publication Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics Abbreviated Journal (down) Phys Rev E Stat Nonlin Soft Matter Phys  
  Volume 83 Issue 3 Pt 1 Pages 031927  
  Keywords Arm/*physiology; Biomechanics; Computer Simulation; Humans; Kinetics; Male; Models, Biological; Models, Statistical; Models, Theoretical; *Movement; Psychomotor Performance/*physiology; Range of Motion, Articular/physiology; Reaction Time/physiology; Space Perception/*physiology; Torque  
  Abstract We present a generally covariant formulation of human arm dynamics and optimization principles in Riemannian configuration space. We extend the one-parameter family of mean-squared-derivative (MSD) cost functionals from Euclidean to Riemannian space, and we show that they are mathematically identical to the corresponding dynamic costs when formulated in a Riemannian space equipped with the kinetic energy metric. In particular, we derive the equivalence of the minimum-jerk and minimum-torque change models in this metric space. Solutions of the one-parameter family of MSD variational problems in Riemannian space are given by (reparameterized) geodesic paths, which correspond to movements with least muscular effort. Finally, movement invariants are derived from symmetries of the Riemannian manifold. We argue that the geometrical structure imposed on the arm's configuration space may provide insights into the emerging properties of the movements generated by the motor system.  
  Address Bernstein Center for Computational Neuroscience, DE-37073 Gottingen, Germany. armin@nld.ds.mpg.de  
  Corporate Author Thesis  
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  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1539-3755 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:21517543 Approved no  
  Call Number Serial 29  
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