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	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
	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
	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	2045-2322	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:38129527; PMCID:PMC10739929			Approved	no
	Call Number				Serial	121
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	Author	Lackritz, H.; Parmet, Y.; Frenkel-Toledo, S.; Banina, M.C.; Soroker, N.; Solomon, J.M.; Liebermann, D.G.; Levin, M.F.; Berman, S.
	Title	Effect of post-stroke spasticity on voluntary movement of the upper limb			Type	Journal Article
	Year	2021	Publication	Journal of Neuroengineering and Rehabilitation	Abbreviated Journal	J Neuroeng Rehabil
	Volume	18	Issue	1	Pages	81
	Keywords	Gaussian mixture model; Hellinger's distance; Hemiparesis; Kinematics; Kullback-Liebler divergence; Spasticity; Stochastic model; Stroke
	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.
	Address	The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. sigalbe@bgu.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	1743-0003	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:33985543			Approved	no
	Call Number				Serial	108
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	Author	Lerner, O.; Friedman, J.; Frenkel-Toledo, S.
	Title	The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial			Type	Journal Article
	Year	2021	Publication	Journal of NeuroEngineering and Rehabilitation	Abbreviated Journal	J NeuroEngineering Rehabil
	Volume	18	Issue		Pages	103
	Keywords
	Abstract
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	1743-0003	ISBN		Medium
	Area		Expedition		Conference
	Notes				Approved	no
	Call Number				Serial	109
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	Author	Krasovsky, T.; Keren-Capelovitch, T.; Friedman, J.; Weiss, P.L.
	Title	Self-feeding kinematics in an ecological setting: typically developing children and children with cerebral palsy			Type	Journal Article
	Year	2021	Publication	IEEE Transactions on Neural Systems and Rehabilitation Engineering : a Publication of the IEEE Engineering in Medicine and Biology Society	Abbreviated Journal	IEEE Trans Neural Syst Rehabil Eng
	Volume	29	Issue		Pages	1462-1469
	Keywords
	Abstract	Assessment of self-feeding kinematics is seldom performed in an ecological setting. In preparation for development of an instrumented spoon for measurement of self-feeding in children with cerebral palsy (CP), the current work aimed to evaluate upper extremity kinematics of self-feeding in young children with typical development (TD) and a small, age-matched group of children with CP in a familiar setting, while eating with a spoon. METHODS: Sixty-five TD participants and six children diagnosed with spastic CP, aged 3-9 years, fed themselves while feeding was measured using miniature three-dimensional motion capture sensors (trakStar). Kinematic variables associated with different phases of self-feeding cycle (movement time, curvature, time to peak velocity and smoothness) were compared across age-groups in the TD sample and between TD children and those with CP. RESULTS: Significant between-age group differences were identified in movement times, time to peak velocity and curvature. Children with CP demonstrated slower, less smooth self-feeding movements, potentially related to activity limitations. CONCLUSIONS: The identified kinematic variables form a basis for implementation of self-feeding performance assessment in children of different ages, including those with CP, which can be deployed via an instrumented spoon.
	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	1534-4320	ISBN		Medium
	Area		Expedition		Conference
	Notes	PMID:34280104			Approved	no
	Call Number				Serial	110
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	Author	Cantergi, D.; Awasthi, B.; Friedman, J.
	Title	Moving objects by imagination? Amount of finger movement and pendulum length determine success in the Chevreul pendulum illusion			Type	Journal Article
	Year	2021	Publication	Human Movement Science	Abbreviated Journal	Human Movement Science
	Volume	80	Issue		Pages	102879
	Keywords
	Abstract
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Summary Language		Original Title
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	0167-9457	ISBN		Medium
	Area		Expedition		Conference
	Notes				Approved	no
	Call Number				Serial	111
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