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Author |
Harel Arzi; Tal Krasovsky; Moshe Pritsch; Dario G. Liebermann |
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Title |
Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients |
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Journal Article |
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Year |
2014 |
Publication |
Journal of Shoulder and Elbow Surgery |
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23 |
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7 |
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982–992 |
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Keywords |
Smoothness; kinesthesis; arm kinematics; shoulder instability; open surgery |
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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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74 |
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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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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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Friedman, J.; Korman, M. |
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Title |
Offline Optimization of the Relative Timing of Movements in a Sequence Is Blocked by Retroactive Behavioral Interference |
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2016 |
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Frontiers in Human Neuroscience |
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Front. Hum. Neurosci. |
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10 |
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623 |
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Keywords |
learning; interference; consolidation; finger movements; kinematics |
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Acquisition of motor skills often involves the concatenation of single movements into sequences. Along the course of learning, sequential performance becomes progressively faster and smoother, presumably by optimization of both motor planning and motor execution. Following its encoding during training, “how-to” memory undergoes consolidation, reflecting transformations in performance and its neurobiological underpinnings over time. This offline post-training memory process is characterized by two phenomena: reduced sensitivity to interference and the emergence of delayed, typically overnight, gains in performance. Here, using a training protocol that effectively induces motor sequence memory consolidation, we tested temporal and kinematic parameters of performance within (online) and between (offline) sessions, and their sensitivity to retroactive interference. One group learned a given finger-to-thumb opposition sequence (FOS), and showed robust delayed (consolidation) gains in the number of correct sequences performed at 24 h. A second group learned an additional (interference) FOS shortly after the first and did not show delayed gains. Reduction of touch times and inter-movement intervals significantly contributed to the overall offline improvement of performance overnight. However, only the offline inter-movement interval shortening was selectively blocked by the interference experience. Velocity and amplitude, comprising movement time, also significantly changed across the consolidation period but were interference-insensitive. Moreover, they paradoxically canceled out each other. Current results suggest that shifts in the representation of the trained sequence are subserved by multiple processes: from distinct changes in kinematic characteristics of individual finger movements to high-level, temporal reorganization of the movements as a unit. Each of these processes has a distinct time course and a specific susceptibility to retroactive interference. This multiple-component view may bridge the gap in understanding the link between the behavioral changes, which define online and offline learning, and the biological mechanisms that support those changes. |
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1662-5161 |
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83 |
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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 |
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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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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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Year |
2019 |
Publication |
Neurorehabilitation and Neural Repair |
Abbreviated Journal |
Neurorehabil Neural Repair |
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33 |
Issue |
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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