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Author |
Wilf, M.; Korakin, A.; Bahat, Y.; Koren, O.; Galor, N.; Dagan, O.; Wright, W.G.; Friedman, J.; Plotnik, M. |
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Title |
Using virtual reality-based neurocognitive testing and eye tracking to study naturalistic cognitive-motor performance |
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Journal Article |
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Year |
2024 |
Publication |
Neuropsychologia |
Abbreviated Journal |
Neuropsychologia |
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Volume |
194 |
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Pages |
108744 |
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Keywords |
Humans; Aged; *Eye-Tracking Technology; Cognition; Executive Function; *Virtual Reality; Aging; Color trails test; Fall risk; Hand kinematics; Pupil; Virtual reality |
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Abstract |
Natural human behavior arises from continuous interactions between the cognitive and motor domains. However, assessments of cognitive abilities are typically conducted using pen and paper tests, i.e., in isolation from “real life” cognitive-motor behavior and in artificial contexts. In the current study, we aimed to assess cognitive-motor task performance in a more naturalistic setting while recording multiple motor and eye tracking signals. Specifically, we aimed to (i) delineate the contribution of cognitive and motor components to overall task performance and (ii) probe for a link between cognitive-motor performance and pupil size. To that end, we used a virtual reality (VR) adaptation of a well-established neurocognitive test for executive functions, the 'Color Trails Test' (CTT). The VR-CTT involves performing 3D reaching movements to follow a trail of numbered targets. To tease apart the cognitive and motor components of task performance, we included two additional conditions: a condition where participants only used their eyes to perform the CTT task (using an eye tracking device), incurring reduced motor demands, and a condition where participants manually tracked visually-cued targets without numbers on them, incurring reduced cognitive demands. Our results from a group of 30 older adults (>65) showed that reducing cognitive demands shortened completion times more extensively than reducing motor demands. Conditions with higher cognitive demands had longer target search time, as well as decreased movement execution velocity and head-hand coordination. We found larger pupil sizes in the more cognitively demanding conditions, and an inverse correlation between pupil size and completion times across individuals in all task conditions. Lastly, we found a possible link between VR-CTT performance measures and clinical signatures of participants (fallers versus non-fallers). In summary, performance and pupil parameters were mainly dependent on task cognitive load, while maintaining systematic interindividual differences. We suggest that this paradigm opens the possibility for more detailed profiling of individual cognitive-motor performance capabilities in older adults and other at-risk populations. |
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Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel; Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. Electronic address: Meir.Plotnik@sheba.health.gov.il |
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0028-3932 |
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PMID:38072162 |
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123 |
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Lackritz, H.; Parmet, Y.; Frenkel-Toledo, S.; Banina, M.C.; Soroker, N.; Solomon, J.M.; Liebermann, D.G.; Levin, M.F.; Berman, S. |
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Title |
Effect of post-stroke spasticity on voluntary movement of the upper limb |
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Journal Article |
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Year |
2021 |
Publication |
Journal of Neuroengineering and Rehabilitation |
Abbreviated Journal |
J Neuroeng Rehabil |
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18 |
Issue |
1 |
Pages |
81 |
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Keywords |
Gaussian mixture model; Hellinger's distance; Hemiparesis; Kinematics; Kullback-Liebler divergence; Spasticity; Stochastic model; Stroke |
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Abstract |
BACKGROUND: Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. METHODS: Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the 'distance' between pathological and normal movement, (a) the bidirectional Kullback-Liebler divergence (BKLD) and (b) Hellinger's distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. RESULTS: Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. CONCLUSIONS: The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints. |
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The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. sigalbe@bgu.ac.il |
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1743-0003 |
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PMID:33985543 |
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108 |
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Krasovsky, T.; Weiss, P.L.; Zuckerman, O.; Bar, A.; Keren-Capelovitch, T.; Friedman, J. |
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Title |
DataSpoon: Validation of an Instrumented Spoon for Assessment of Self-Feeding |
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Journal Article |
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2020 |
Publication |
Sensors (Basel, Switzerland) |
Abbreviated Journal |
Sensors (Basel) |
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20 |
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7 |
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Keywords |
concurrent validity; feasibility; kinematics; outcome assessment; rehabilitation |
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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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Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel |
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1424-8220 |
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PMID:32283624; PMCID:PMC7180859 |
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104 |
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Kaufman-Cohen, Y.; Portnoy, S.; Levanon, Y.; Friedman, J. |
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Title |
Does Object Height Affect the Dart Throwing Motion Angle during Seated Activities of Daily Living? |
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Journal Article |
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Year |
2019 |
Publication |
Journal of Motor Behavior |
Abbreviated Journal |
J Mot Behav |
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1-10 |
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dart throwing motion (DTM); heights; kinematics; seated activities of daily living (ADL); upper extremity; wrist rehabilitation |
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Complex wrist motions are needed to complete various daily activities. Analyzing the multidimensional motion of the wrist is crucial for understanding our functional movement. Several studies have shown that numerous activities of daily livings (ADLs) are performed using an oblique plane of wrist motion from radial-extension to ulnar-flexion, named the Dart Throwing Motion (DTM) plane. To the best of our knowledge, the DTM plane angle performed during ADLs has not been compared between different heights (e.g. table, shoulder and head height), as is common when performing day-to-day tasks. In this study, we compared DTM plane angles when performing different ADLs at three different heights and examined the relationship between DTM plane angles and limb position. We found that height had a significant effect on the DTM plane angles – the mean DTM plane angle was greater at the lower level compared to the mid and higher levels. A significant effect of shoulder orientation on mean DTM plane angles was shown in the sagittal and coronal planes. Our findings support the importance of training daily tasks at different heights during rehabilitation following wrist injuries, in order to explore a large range of DTM angles, to accommodate needs of common ADLs. |
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0022-2895 |
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PMID:31359843 |
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100 |
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Author |
Davidowitz, I.; Parmet, Y.; Frenkel-Toledo, S.; Banina, M.C.; Soroker, N.; Solomon, J.M.; Liebermann, D.G.; Levin, M.F.; Berman, S. |
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Title |
Relationship Between Spasticity and Upper-Limb Movement Disorders in Individuals With Subacute Stroke Using Stochastic Spatiotemporal Modeling |
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Journal Article |
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2019 |
Publication |
Neurorehabilitation and Neural Repair |
Abbreviated Journal |
Neurorehabil Neural Repair |
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33 |
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2 |
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141-152 |
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Gaussian mixture model; Kullback-Liebler divergence; spasticity; stroke; upper-limb kinematics |
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BACKGROUND: Spasticity is common in patients with stroke, yet current quantification methods are insufficient for determining the relationship between spasticity and voluntary movement deficits. This is partly a result of the effects of spasticity on spatiotemporal characteristics of movement and the variability of voluntary movement. These can be captured by Gaussian mixture models (GMMs). OBJECTIVES: To determine the influence of spasticity on upper-limb voluntary motion, as assessed by the bidirectional Kullback-Liebler divergence (BKLD) between motion GMMs. METHODS: A total of 16 individuals with subacute stroke and 13 healthy aged-equivalent controls reached to grasp 4 targets (near-center, contralateral, far-center, and ipsilateral). Two-dimensional GMMs (angle and time) were estimated for elbow extension motion. BKLD was computed for each individual and target, within the control group and between the control and stroke groups. Movement time, final elbow angle, average elbow velocity, and velocity smoothness were computed. RESULTS: Between-group BKLDs were much larger than within control-group BKLDs. Between-group BKLDs for the near-center target were lower than those for the far-center and contralateral targets, but similar to that for the ipsilateral target. For those with stroke, the final angle was lower for the near-center target, and the average velocity was higher. Velocity smoothness was lower for the near-center than for the ipsilateral target. Elbow flexor and extensor passive muscle resistance (Modified Ashworth Scale) strongly explained BKLD values. CONCLUSIONS: Results support the view that individuals with poststroke spasticity have a velocity-dependent reduction in active elbow joint range and that BKLD can be used as an objective measure of the effects of spasticity on reaching kinematics. |
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1 Ben-Gurion University of the Negev, Beer-Sheva, Israel |
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1545-9683 |
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PMID:30744528 |
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93 |
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