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Author |
Levin, M.F.; Liebermann, D.G.; Parmet, Y.; Berman, S. |
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Title |
Compensatory Versus Noncompensatory Shoulder Movements Used for Reaching in Stroke |
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Journal Article |
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Year |
2015 |
Publication |
Neurorehabilitation and Neural Repair |
Abbreviated Journal |
Neurorehabil Neural Repair |
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Keywords |
adaptation; arm movement; compensation; kinematics; recovery; rehabilitation |
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Abstract |
BACKGROUND: The extent to which the upper-limb flexor synergy constrains or compensates for arm motor impairment during reaching is controversial. This synergy can be quantified with a minimal marker set describing movements of the arm-plane. OBJECTIVES: To determine whether and how (a) upper-limb flexor synergy in patients with chronic stroke contributes to reaching movements to different arm workspace locations and (b) reaching deficits can be characterized by arm-plane motion. METHODS: Sixteen post-stroke and 8 healthy control subjects made unrestrained reaching movements to targets located in ipsilateral, central, and contralateral arm workspaces. Arm-plane, arm, and trunk motion, and their temporal and spatial linkages were analyzed. RESULTS: Individuals with moderate/severe stroke used greater arm-plane movement and compensatory trunk movement compared to those with mild stroke and control subjects. Arm-plane and trunk movements were more temporally coupled in stroke compared with controls. Reaching accuracy was related to different segment and joint combinations for each target and group: arm-plane movement in controls and mild stroke subjects, and trunk and elbow movements in moderate/severe stroke subjects. Arm-plane movement increased with time since stroke and when combined with trunk rotation, discriminated between different subject groups for reaching the central and contralateral targets. Trunk movement and arm-plane angle during target reaches predicted the subject group. CONCLUSIONS: The upper-limb flexor synergy was used adaptively for reaching accuracy by patients with mild, but not moderate/severe stroke. The flexor synergy, as parameterized by the amount of arm-plane motion, can be used by clinicians to identify levels of motor recovery in patients with stroke. |
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1545-9683 |
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PMID:26510934 |
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79 |
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Raveh, E.; Portnoy, S.; Friedman, J. |
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Title |
Myoelectric Prosthesis Users Improve Performance Time and Accuracy Using Vibrotactile Feedback When Visual Feedback Is Disturbed |
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Journal Article |
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Year |
2018 |
Publication |
Archives of Physical Medicine and Rehabilitation |
Abbreviated Journal |
Arch Phys Med Rehabil |
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99 |
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11 |
Pages |
2263-2270 |
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Keywords |
Amputation; Prosthesis; Rehabilitation; Sensory feedback; Visual feedback |
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Abstract |
OBJECTIVE: To evaluate the effects of adding vibrotactile feedback (VTF) in myoelectric prosthesis users during performance of a functional task when visual feedback is disturbed. DESIGN: A repeated-measures design with a counter-balanced order of 3 conditions. SETTING: Laboratory setting. PARTICIPANTS: Transradial amputees using a myoelectric prosthesis with normal or corrected eyesight (N=12, median age 65+/-13y). Exclusion criteria were orthopedic or neurologic problems. INTERVENTIONS: All participants performed the modified Box and Blocks Test, grasping and manipulating 16 blocks over a partition using their myoelectric prosthesis. This was performed 3 times: in full light, in a dark room without VTF, and in a dark room with VTF. MAIN OUTCOME MEASURES: Performance time, that is, the time needed to transfer 1 block, and accuracy during performance, measured by number of empty grips, empty transitions with no block and block drops from the hand. RESULTS: Significant differences were found in all outcome measures when VTF was added, with improved performance time (4.2 vs 5.3s) and a reduced number of grasping errors (3.0 vs 6.5 empty grips, 1.5 vs 4 empty transitions, 2.0 vs 4.5 block drops). CONCLUSIONS: Adding VTF to myoelectric prosthesis users has positive effects on performance time and accuracy when visual feedback is disturbed. |
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0003-9993 |
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PMID:29935153 |
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96 |
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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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2019 |
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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 |
Merdler, T.; Liebermann, D.G.; Levin, M.F.; Berman, S. |
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Title |
Arm-plane representation of shoulder compensation during pointing movements in patients with stroke |
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Journal Article |
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2013 |
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Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology |
Abbreviated Journal |
J Electromyogr Kinesiol |
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23 |
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4 |
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938–947 |
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Kinematics; Arm movement; Rehabilitation |
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Improvements in functional motor activities are often accompanied by motor compensations to overcome persistent motor impairment in the upper limb. Kinematic analysis is used to objectively quantify movement patterns including common motor compensations such as excessive trunk displacement during reaching. However, a common motor compensation to assist reaching, shoulder abduction, is not adequately characterized by current motion analysis approaches. We apply the arm-plane representation that accounts for the co-variation between movements of the whole arm, and investigate its ability to identify and quantify compensatory arm movements in stroke subjects when making forward arm reaches. This method has not been previously applied to the analysis of motion deficits. Sixteen adults with right post-stroke hemiparesis and eight healthy age-matched controls reached in three target directions (14 trials/target; sampling rate: 100Hz). Arm-plane movement was validated against endpoint, joint, and trunk kinematics and compared between groups. In stroke subjects, arm-plane measures were correlated with arm impairment (Fugl-Meyer Assessment) and ability (Box and Blocks) scores and were more sensitive than clinical measures to detect mild motor impairment. Arm-plane motion analysis provides new information about motor compensations involving the co-variation of shoulder and elbow movements that may help to understand the underlying motor deficits in patients with stroke. |
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Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel |
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1050-6411 |
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PMID:23566477 |
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69 |
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Levin, M.F.; Berman, S.; Weiss, N.; Parmet, Y.; Banina, M.C.; Frenkel-Toledo, S.; Soroker, N.; Solomon, J.M.; Liebermann, D.G. |
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ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range |
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2023 |
Publication |
Scientific Reports |
Abbreviated Journal |
Sci Rep |
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13 |
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1 |
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22934 |
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Humans; Elbow; *Transcranial Direct Current Stimulation; Muscle Spasticity/therapy/complications; Upper Extremity; *Elbow Joint; *Stroke/complications; *Stroke Rehabilitation/methods |
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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. |
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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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2045-2322 |
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PMID:38129527; PMCID:PMC10739929 |
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121 |
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