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	Author	Frenkel-Toledo, S.; Yamanaka, J.; Friedman, J.; Feldman, A.G.; Levin, M.F.
	Title	Referent control of anticipatory grip force during reaching in stroke: an experimental and modeling study			Type	Journal Article
	Year	2019	Publication	Experimental Brain Research	Abbreviated Journal	Exp Brain Res
	Volume	237	Issue	7	Pages	1655-1672
	Keywords	Anticipatory grip force; Referent control; Stroke
	Abstract	To evaluate normal and impaired control of anticipatory grip force (GF) modulation, we compared GF production during horizontal arm movements in healthy and post-stroke subjects, and, based on a physiologically feasible dynamic model, determined referent control variables underlying the GF-arm motion coordination in each group. 63% of 13 healthy and 48% of 13 stroke subjects produced low sustained initial force (< 10 N) and increased GF prior to arm movement. Movement-related GF increases were higher during fast compared to self-paced arm extension movements only in the healthy group. Differences in the patterns of anticipatory GF increases before the arm movement onset between groups occurred during fast extension arm movement only. In the stroke group, longer delays between the onset of GF change and elbow motion were related to clinical upper limb deficits. Simulations showed that GFs could emerge from the difference between the actual and the referent hand aperture (Ra) specified by the CNS. Similarly, arm movement could result from changes in the referent elbow position (Re) and could be affected by the co-activation (C) command. A subgroup of stroke subjects, who increased GF before arm movement, could specify different patterns of the referent variables while reproducing the healthy typical pattern of GF-arm coordination. Stroke subjects, who increased GF after arm movement onset, also used different referent strategies than controls. Thus, altered anticipatory GF behavior in stroke subjects may be explained by deficits in referent control.
	Address
	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	0014-4819	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:30976821			Approved	no
	Call Number				Serial	98
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	Author	Banina, M.C.; Molad, R.; Solomon, J.S.; Berman, S.; Soroker, N.; Frenkel-Toledo, S.; Liebermann, D.G.; Levin, M.F.
	Title	Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system			Type	Journal Article
	Year	2020	Publication	Disability and Rehabilitation. Assistive Technology	Abbreviated Journal	Disabil Rehabil Assist Technol
	Volume		Issue		Pages	1-7
	Keywords	Stroke; difficulty; exercise therapy; intensity; personalized exercise; upper limb; virtual reality
	Abstract	Purpose: Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment.Methods: Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 approximately 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres.Results: Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity.Conclusion: The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application.Implications for rehabilitationVR rehabilitation systems can be used to deliver intensive exercise programmes.VR rehabilitation systems need to be designed with measurable progressions through difficulty levels.
	Address	Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
	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	1748-3107	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:32421460			Approved	no
	Call Number				Serial	106
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	Author	Liebermann, D.G.; Levin, M.F.; McIntyre, J.; Weiss, P.L.; Berman, S.
	Title	Arm path fragmentation and spatiotemporal features of hand reaching in healthy subjects and stroke patients			Type	Journal Article
	Year	2010	Publication	Conference Proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference	Abbreviated Journal	Conf Proc IEEE Eng Med Biol Soc
	Volume	2010	Issue		Pages	5242-5245
	Keywords	Aged; Aged, 80 and over; Analysis of Variance; Arm/physiology; Biomechanics/physiology; Female; Hand/physiology; Health; Humans; Male; Middle Aged; Movement/physiology; Posture/physiology; Principal Component Analysis; Stroke/*physiopathology; Time Factors
	Abstract	Arm motion in healthy humans is characterized by smooth and relatively short paths. The current study focused on 3D reaching in stroke patients. Sixteen right-hemiparetic stroke patients and 8 healthy adults performed 42 reaching movements towards 3 visual targets located at an extended arm distance. Performance was assessed in terms of spatial and temporal features of the movement; i.e., hand path, arm posture and smoothness. Differences between groups and within subjects were hypothesized for spatial and temporal aspects of reaching under the assumption that both are independent. As expected, upper limb motion of patients was characterized by longer and jerkier hand paths and slower speeds. Assessment of the number of sub-movements within each movement did not clearly discriminate between groups. Principal component analyses revealed specific clusters of either spatial or temporal measures, which accounted for a large proportion of the variance in patients but not in healthy controls. These findings support the notion of a separation between spatial and temporal features of movement. Stroke patients may fail to integrate the two aspects when executing reaching movements towards visual targets.
	Address	Physical Therapy Dept., Sackler Faculty of Medicine, Tel Aviv University, 69978 Israel. dlieberm@post.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	1557-170X	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:21096047			Approved	no
	Call Number				Serial	30
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