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Prushansky, T., Kaplan-Gadasi, L., & Friedman, J. (2023). The relationship between thoracic posture and ultrasound echo intensity of muscles spanning this region in healthy men and women. Physiother Theory Pract, 39(6), 1257–1265.
Abstract: PURPOSE: Skeletal muscle echogenicity intensity (EI) is considered a measure of muscle quality, being associated with old age and pathologies. Whether EI variations can be identified in healthy adults, due to habitual shortened or elongated muscle position is unknown. Thus, this study aimed to assess the relationship between thoracic kyphosis angulation and EI scores of muscles spanning this region ((Lower Trapezius (LT), Rhomboid Major (RM), Erector Spine (ES)) in healthy young people and in addition to examine the relationship between the change in thoracic kyphosis angle from relaxed to upright position (� degrees ) and the EI of these muscles. METHODS: Thoracic kyphosis in relaxed and erect standing was measured using a digital inclinometer in 29 healthy adults (16 women, 13 men), aged 25-35 years. The thoracic kyphosis angles including the difference between relaxed and erect postures (� degrees ) were correlated to the EI scores of right and left LT, RM and ES. RESULTS: No significant differences in EI were found between the 3 muscles EI or between sides, hence they were pooled together to a total thoracic EI score (TTEI). Although the TTEI did not correlate with relaxed or erect thoracic kyphosis, it was significantly but negatively correlated with � degrees in the entire group: Pearson's correlation coefficient of r = -0.544; p = .01 and in men; r = -0.732; p = .01, failing to reach significance in women; r = -0.457. CONCLUSION: The negative association between the EI of the explored muscles and � degrees could imply a possible relationship between these muscles range of movement excursions and their composition.
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Steinhart, S., Weiss, P. L., & Friedman, J. (2021). Proximal and distal movement patterns during a graphomotor task in typically developing children and children with handwriting problems. J Neuroeng Rehabil, 18(1), 178.
Abstract: BACKGROUND: Therapists specializing in handwriting difficulties in children often address motor problems including both proximal and distal movements in the upper extremity. Kinematic measures can be used to investigate various aspects of handwriting. This study examined differences in movement patterns in proximal and distal joints of the upper extremity during graphomotor tasks between typically developing children with and without handwriting problems. Additionally, it explored relationships between movement patterns, speed, and legibility of writing. METHODS: Forty-one children, aged 7-11 years, were assessed with the Aleph Aleph Ktav Yad Hebrew Handwriting assessment and the Beery Test of Visual Motor Integration and, based on their scores, were divided into a research group (with handwriting difficulties) and a control group (without handwriting difficulties). Upper extremity joint movement patterns were analyzed with a motion capture system. Differences in the quality of shapes traced and copied on a graphics tablet positioned horizontally and vertically were compared. Between-group differences and relationships with speed and legibility were analyzed. RESULTS: In both groups, there was greater movement in the distal compared to the proximal joints, greater movement when performing the task in a horizontal compared to a vertical plane, and greater movement when tracing than copying. Joint movements in the arm executed scaled-down versions of the shapes being drawn. While the amount of joint displacement was similar between groups, children in the research group showed greater dissimilarity between the drawn shape and the shape produced by the proximal joints. Finally, the drawing measure on the tablet was a significant predictor of legibility, speed of writing, visual motor integration and motor coordination, whereas the dissimilarity measure of joint movement was a significant predictor of speed of writing and motor coordination. CONCLUSIONS: This study provides support for the role of the distal upper extremity joints in the writing process and some guidance to assist clinicians in devising treatment strategies for movement-related handwriting problems. While we observed differences in proximal joint movements between the children with and without handwriting difficulties, the extent to which they are responsible for the differences in drawing quality remains to be determined. Further studies should use a similar methodology to examine additional tasks such as drawing shapes of varying sizes.
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Krasovsky, T., Keren-Capelovitch, T., Friedman, J., & Weiss, P. L. (2021). Self-feeding kinematics in an ecological setting: typically developing children and children with cerebral palsy. IEEE Trans Neural Syst Rehabil Eng, 29, 1462–1469.
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.
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Bezalel, G., Nachoum Arad, G., Plotnik, M., & Friedman, J. (2021). Voluntary step execution in patients with knee osteoarthritis: Symptomatic vs. non-symptomatic legs. Gait Posture, 83, 60–66.
Abstract: BACKGROUND: Individuals with osteoarthritis fall at a greater rate than the general population, likely as a result of weakness, pain, movement limitations, and a decline in balance. Due to the high prevalence of osteoarthritis in the population, understanding the mechanisms leading to greater fall risk is an important issue to better understand. RESEARCH QUESTION: What is the influence of unilateral knee osteoarthritis on the characteristics of performing a voluntary step (i.e., similar to that performed to avoid a fall after a perturbation), compared to healthy age-matched controls? METHODS: Case-control study performed in a Health maintenance organization physical therapy clinic. The research group consisted of a referred sample of 21 patients with unilateral knee osteoarthritis. The control group consisted of 22 age-matched healthy individuals. All participants were over 65 years of age. Participants were excluded if they had a surgical procedure to back or lower limb within one year before testing, oncological or neurological disease or a deficit in tactile sense. Movements were performed with and without dual tasking. MEASUREMENTS: Duration of the initiation phase (cue to step initiation), preparatory phase (step initiation to foot off) and swing phase (foot off to foot contact). RESULTS: In the preparatory phase and swing phase, the osteoarthritis group moved more slowly than the control group, and these differences were larger for forward compared to backward movements. Dual-tasking slowed responses in the pre-movement initiation stage across groups. SIGNIFICANCE: The differences in basic parameters, and the slower movements in the osteoarthritis group, are consistent with known features of osteoarthritis, being a disease commonly regarded as primarily “mechanical”, and are likely to increase fall risk. These response deficits suggest we should take advantage of advanced rehabilitation techniques, including cognitive loading, to help prevent falls in older adults with osteoarthritis.
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Zacks, O., & Friedman, J. (2020). Analogies can speed up the motor learning process. Sci Rep, 10(1), 6932.
Abstract: Analogies have been shown to improve motor learning in various tasks and settings. In this study we tested whether applying analogies can shorten the motor learning process and induce insight and skill improvement in tasks that usually demand many hours of practice. Kinematic measures were used to quantify participant's skill and learning dynamics. For this purpose, we used a drawing task, in which subjects drew lines to connect dots, and a mirror game, in which subjects tracked a moving stimulus. After establishing a baseline, subjects were given an analogy, explicit instructions or no further instruction. We compared their improvement in skill (quantified by coarticulation or smoothness), accuracy and movement duration. Subjects in the analogy and explicit groups improved their coarticulation in the target task, while significant differences were found in the mirror game only at a slow movement frequency between analogy and controls.We conclude that a verbal analogy can be a useful tool for rapidly changing motor kinematics and movement strategy in some circumstances, although in the tasks selected it did not produce better performance in most measurements than explicit guidance. Furthermore, we observed that different movement facets may improve independently from others, and may be selectively affected by verbal instructions. These results suggest an important role for the type of instruction in motor learning.
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