| Records |
| Author |
Levin, M.F.; Berman, S.; Weiss, N.; Parmet, Y.; Banina, M.C.; Frenkel-Toledo, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. |
| 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 |
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| Year |
2023 |
Publication  |
Scientific Reports |
Abbreviated Journal |
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 |
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| Language |
English |
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Series Issue |
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Edition |
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| ISSN |
2045-2322 |
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| Notes |
PMID:38129527; PMCID:PMC10739929 |
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no |
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Serial |
121 |
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| Author |
Lowenthal-Raz, J.; Liebermann, D.G.; Friedman, J.; Soroker, N. |
| Title |
Kinematic descriptors of arm reaching movement are sensitive to hemisphere-specific immediate neuromodulatory effects of transcranial direct current stimulation post stroke |
Type |
Journal Article |
| Year |
2024 |
Publication |
Scientific Reports |
Abbreviated Journal |
Sci Rep |
| Volume |
14 |
Issue |
1 |
Pages |
11971 |
| Keywords |
Humans; *Transcranial Direct Current Stimulation/methods; Male; Female; Middle Aged; *Stroke/physiopathology/therapy; Biomechanical Phenomena; Aged; *Arm/physiopathology; *Movement/physiology; *Stroke Rehabilitation/methods; Single-Blind Method; Cross-Over Studies |
| Abstract |
Transcranial direct current stimulation (tDCS) exerts beneficial effects on motor recovery after stroke, presumably by enhancement of adaptive neural plasticity. However, patients with extensive damage may experience null or deleterious effects with the predominant application mode of anodal (excitatory) stimulation of the damaged hemisphere. In such cases, excitatory stimulation of the non-damaged hemisphere might be considered. Here we asked whether tDCS exerts a measurable effect on movement quality of the hemiparetic upper limb, following just a single treatment session. Such effect may inform on the hemisphere that should be excited. Using a single-blinded crossover experimental design, stroke patients and healthy control subjects were assessed before and after anodal, cathodal and sham tDCS, each provided during a single session of reaching training (repeated point-to-point hand movement on an electronic tablet). Group comparisons of endpoint kinematics at baseline-number of peaks in the speed profile (NoP; smoothness), hand-path deviations from the straight line (SLD; accuracy) and movement time (MT; speed)-disclosed greater NoP, larger SLD and longer MT in the stroke group. NoP and MT revealed an advantage for anodal compared to sham stimulation of the lesioned hemisphere. NoP and MT improvements under anodal stimulation of the non-lesioned hemisphere correlated positively with the severity of hemiparesis. Damage to specific cortical regions and white-matter tracts was associated with lower kinematic gains from tDCS. The study shows that simple descriptors of movement kinematics of the hemiparetic upper limb are sensitive enough to demonstrate gain from neuromodulation by tDCS, following just a single session of reaching training. Moreover, the results show that tDCS-related gain is affected by the severity of baseline motor impairment, and by lesion topography. |
| Address |
Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. nachum@soroker.online |
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English |
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2045-2322 |
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| Notes |
PMID:38796610; PMCID:PMC11127956 |
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no |
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Serial |
125 |
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| Author |
Markstrom, J.L.; Liebermann, D.G.; Schelin, L.; Hager, C.K. |
| Title |
Atypical Lower Limb Mechanics During Weight Acceptance of Stair Descent at Different Time Frames After Anterior Cruciate Ligament Reconstruction |
Type |
Journal Article |
| Year |
2022 |
Publication |
The American Journal of Sports Medicine |
Abbreviated Journal |
Am J Sports Med |
| Volume |
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Issue |
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Pages |
1-9 |
| Keywords |
Acl; biomechanics; functional data analysis; motion analysis; stepping down |
| Abstract |
BACKGROUND: An anterior cruciate ligament (ACL) rupture may result in poor sensorimotor knee control and, consequentially, adapted movement strategies to help maintain knee stability. Whether patients display atypical lower limb mechanics during weight acceptance of stair descent at different time frames after ACL reconstruction (ACLR) is unknown. PURPOSE: To compare the presence of atypical lower limb mechanics during the weight acceptance phase of stair descent among athletes at early, middle, and late time frames after unilateral ACLR. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 49 athletes with ACLR were classified into 3 groups according to time after ACLR-early (<6 months; n = 17), middle (6-18 months; n = 16), and late (>18 months; n = 16)-and compared with asymptomatic athletes (control; n = 18). Sagittal plane hip, knee, and ankle angles; angular velocities; moments; and powers were compared between the ACLR groups' injured and noninjured legs and the control group as well as between legs within groups using functional data analysis methods. RESULTS: All 3 ACLR groups showed greater knee flexion angles and moments than the control group for injured and noninjured legs. For the other outcomes, the early group had, compared with the control group, less hip power absorption, more knee power absorption, lower ankle plantarflexion angle, lower ankle dorsiflexion moment, and less ankle power absorption for the injured leg and more knee power absorption and higher vertical ground reaction force for the noninjured leg. In addition, the late group showed differences from the control group for the injured leg revealing more knee power absorption and lower ankle plantarflexion angle. Only the early group took a longer time than the control group to complete weight acceptance and demonstrated asymmetry for multiple outcomes. CONCLUSION: Athletes with different time frames after ACLR revealed atypically large knee angles and moments during weight acceptance of stair descent for both the injured and the noninjured legs. These findings may express a chronically adapted strategy to increase knee control. In contrast, atypical hip and ankle mechanics seem restricted to an early time frame after ACLR. CLINICAL RELEVANCE: Rehabilitation after ACLR should include early training in controlling weight acceptance. Including a control group is essential when evaluating movement patterns after ACLR because both legs may be affected. |
| Address |
Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden |
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English |
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0363-5465 |
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PMID:35604127 |
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no |
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Serial |
112 |
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| Author |
Carmeli E.; Liebermann, D.G. |
| Title |
The Function of the Aging Hand |
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Book Chapter |
| Year |
2007 |
Publication |
The Geriatric Rehabilitation Manual |
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Elsevier |
Place of Publication |
NY |
Editor |
T. L. Kauffman; M. Moran; J. Barr |
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no |
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Serial |
46 |
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| Author |
Biess, A.; Liebermann, D.G.; Flash, T. |
| Title |
A computational model for redundant human three-dimensional pointing movements: integration of independent spatial and temporal motor plans simplifies movement dynamics |
Type |
Journal Article |
| Year |
2007 |
Publication |
The Journal of Neuroscience : the Official Journal of the Society for Neuroscience |
Abbreviated Journal |
J Neurosci |
| Volume |
27 |
Issue |
48 |
Pages |
13045-13064 |
| Keywords |
Analysis of Variance; Arm/physiology; Biomechanics; *Computer Simulation; Humans; *Models, Biological; Movement/*physiology; *Nonlinear Dynamics; Posture/physiology; Psychomotor Performance/*physiology; Range of Motion, Articular/physiology; Reaction Time/physiology; Space Perception/*physiology; Time Factors; Torque |
| Abstract |
Few computational models have addressed the spatiotemporal features of unconstrained three-dimensional (3D) arm motion. Empirical observations made on hand paths, speed profiles, and arm postures during point-to-point movements led to the assumption that hand path and arm posture are independent of movement speed, suggesting that the geometric and temporal properties of movements are decoupled. In this study, we present a computational model of 3D movements for an arm with four degrees of freedom based on the assumption that optimization principles are separately applied at the geometric and temporal levels of control. Geometric properties (path and posture) are defined in terms of geodesic paths with respect to the kinetic energy metric in the Riemannian configuration space. Accordingly, a geodesic path can be generated with less muscular effort than on any other, nongeodesic path, because the sum of all configuration-speed-dependent torques vanishes. The temporal properties of the movement (speed) are determined in task space by minimizing the squared jerk along the selected end-effector path. The integration of both planning levels into a single spatiotemporal representation simplifies the control of arm dynamics along geodesic paths and results in movements with near minimal torque change and minimal peak value of kinetic energy. Thus, the application of Riemannian geometry allows for a reconciliation of computational models previously proposed for the description of arm movements. We suggest that geodesics are an emergent property of the motor system through the exploration of dynamical space. Our data validated the predictions for joint trajectories, hand paths, final postures, speed profiles, and driving torques. |
| Address |
Department of Mathematics, Weizmann Institute of Science, 76100 Rehovot, Israel. armin.biess@weizmann.ac.il |
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English |
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Edition |
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0270-6474 |
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| Notes |
PMID:18045899 |
Approved |
no |
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Serial |
35 |
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