Abstract: People with Parkinson's disease often show deficits in dexterity, which, in turn, can lead to limitations in performing activities of daily life. Previous studies have suggested that training in playing the piano may improve or prevent a decline in dexterity in this population. In this pilot study, we tested three participants on a six-week, custom, piano-based training protocol, and quantified dexterity before and after the intervention using a sensor-enabled version of the nine-hole peg test, the box and block test, a test of finger synergies using unidimensional force sensors, and the Quantitative Digitography test using a digital piano, as well as selected relevant items from the motor parts of the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) quality of life questionnaire. The participants showed improved dexterity following the training program in several of the measures used. This pilot study proposes measures that can track changes in dexterity as a result of practice in people with Parkinson's disease and describes a potential protocol that needs to be tested in a larger cohort.

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.

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.

Abstract: BACKGROUND: Auditory cues are known to alter movement kinematics in healthy people as well as in people with neurological conditions (e.g., Parkinson's disease or stroke). Pacing movement to rhythmical constraints is known to change both the spatial and temporal features of movement. However, the effect of complexity of pacing on the spatial and temporal kinematic properties is still poorly understood. The current study investigated spatial and temporal aspects of movement (path and speed, respectively) and their integration while subjects followed simple isochronous or complex non-isochronous rhythmical constraints. Spatiotemporal decoupling was expected under the latter constraint. METHODS: Ten subjects performed point-to-point hand movements towards visual targets on the surface of a hemisphere, while following continuous auditory cues of different pace and meter. The spatial and temporal properties of movement were compared to geodesic paths and unimodal bell-shaped speed profiles, respectively. Multiple two-way RM-ANOVAs (pace [1-2 Hz] x meter [duple-triple]) were performed on the different kinematic variables calculated to assess hand deviations from the model data (p< or = 0.05). RESULTS: As expected, increasing pace resulted in straighter hand paths and smoother speed profiles. Meter, however, affected only the path (shorter and straighter under triple) without significantly changing speed. Such an effect was observed at the slow pace only. CONCLUSIONS: Under simple rhythmic cues, an increase in pace causes spontaneous adjustments in spatial features (straighter hand paths) while preserving temporal ones (maximally-smoothed hand speeds). Complex rhythmical cues in contrast perturb spatiotemporal coupling and challenge movement control. These results may have important practical implications in motor rehabilitation.

Abstract: BACKGROUND: This study investigated the force-time relationship during the push-off stage of a rapid voluntary step in young and older healthy adults, to study the assumption that when balance is lost a quick step may preserve stability. The ability to achieve peak propulsive force within a short time is critical for the performance of such a quick powerful step. We hypothesized that older adults would achieve peak force and power in significantly longer times compared to young people, particularly during the push-off preparatory phase. METHODS: Fifteen young and 15 older volunteers performed rapid forward steps while standing on a force platform. Absolute anteroposterior and body weight normalized vertical forces during the push-off in the preparation and swing phases were used to determine time to peak and peak force, and step power. Two-way analyses of variance ('Group' [young-older] by 'Phase' [preparation-swing]) were used to assess our hypothesis (P </= 0.05). FINDINGS: Older people exerted lower peak forces (anteroposterior and vertical) than young adults, but not necessarily lower peak power. More significantly, they showed a longer time to peak force, particularly in the vertical direction during the preparation phase. INTERPRETATIONS: Older adults generate propulsive forces slowly and reach lower magnitudes, mainly during step preparation. The time to achieve a peak force and power, rather than its actual magnitude, may account for failures in quickly performing a preventive action. Such delay may be associated with the inability to react and recruit muscles quickly. Thus, training elderly to step fast in response to relevant cues may be beneficial in the prevention of falls.

Abstract: BACKGROUND: Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before. METHODS: Cervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON). The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile. RESULTS: Together, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 +/- 88 degrees /s and CON: 348 +/- 92 degrees /s, p < 0.01). Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low-back pain. Associations were found between reduced peak speed and self-rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor. CONCLUSIONS: Peak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.

Abstract: The article characterizes hand paths and speed profiles for movements performed in a nonplanar, 2-dimensional workspace (a hemisphere of constant curvature). The authors assessed endpoint kinematics (i.e., paths and speeds) under the minimum-jerk model assumptions and calculated minimal amplitude paths (geodesics) and the corresponding speed profiles. The authors also calculated hand speeds using the 2/3 power law. They then compared modeled results with the empirical observations. In all, 10 participants moved their hands forward and backward from a common starting position toward 3 targets located within a hemispheric workspace of small or large curvature. Comparisons of modeled observed differences using 2-way RM-ANOVAs showed that movement direction had no clear influence on hand kinetics (p < .05). Workspace curvature affected the hand paths, which seldom followed geodesic lines. Constraining the paths to different curvatures did not affect the hand speed profiles. Minimum-jerk speed profiles closely matched the observations and were superior to those predicted by 2/3 power law (p < .001). The authors conclude that speed and path cannot be unambiguously linked under the minimum-jerk assumption when individuals move the hand in a nonplanar 2-dimensional workspace. In such a case, the hands do not follow geodesic paths, but they preserve the speed profile, regardless of the geometric features of the workspace.

Abstract: The present study examined the effect of continuous vision and its occlusion in timing of pre-landing actions during free falls. When vision is occluded, muscle activation is hypothesized to start relative to onset of the fall. However, when continuous vision is available onset of action is hypothesized to be relative to the moment of touchdown. Six subjects performed 6 randomized sets of 6 trials after becoming familiar with the task. The 36 trials were divided in 2 visual conditions (vision and blindfold) and 3 heights of fall (15, 45 and 75 cm). EMG activity was recorded from the gastrocnemius and rectus femoris muscles during the falls. The latency of onset (L(o)) and the lapse from EMG onset to touchdown (T(c)) were obtained from these muscles. Vertical forces were recorded to assess the effects of pre-landing activity on the impacts at collision with and without continuous vision. Peak amplitude (F(max)), time to peak (T(max)) and peak impulse normalized to momentum (I(norm)) were used as outcome measures. Within flight time ranges of approximately 50-400 ms, the results showed that L(o) and T(c) follow a similar linear trend whether continuous vision was available or occluded. However, the variability of T(c) for each of the muscles was larger in the vision occluded condition. Analyses of variance showed that the rectus femoris muscle started consistently earlier in no vision trials. Finally, impact forces were not different in vision or blindfold conditions, and thus, they were not affected by minor differences in the timing of muscles prior to landing. Thus, it appears that knowing the surroundings before falling may help to reduce the need for a continuous visual input. The relevance of such input cannot be ruled out for falls from high landing heights, but cognitive factors (e.g., attention to specific cues and anticipation of a fall) may play a dominant role in timing actions during short duration falls encountered daily.

Abstract: The recent development of information technologies has dramatically increased the tools available for facilitating motor rehabilitation. This review focuses on technologies which can be used to augment movement-related information both to patients as well as to their therapists. A brief outline of the motor system emphasizes the role of spinal motor neurons in the control of voluntary movement and rehabilitative efforts. Technologies which induce passive motion to stimulate spinal motor output as well as technologies that stimulate active voluntary movements are discussed. Finally, we review technologies and notational methods that can be used to quantify and assess the quality of movement for evaluating the efficacy of motor rehabilitation efforts. We conclude that stronger evidence is necessary to determine the applicability of the wide range of technologies now available to clinical rehabilitation efforts.

Abstract: This paper overviews the diverse information technologies that are used to provide athletes with relevant feedback. Examples taken from various sports are used to illustrate selected applications of technology-based feedback. Several feedback systems are discussed, including vision, audition and proprioception. Each technology described here is based on the assumption that feedback would eventually enhance skill acquisition and sport performance and, as such, its usefulness to athletes and coaches in training is critically evaluated.

Abstract: METHODS: There were 14 male soldiers who participated in this study examining the relationship of leg strength and power on landing performance. Subjects were separated into two groups. The first group (E, n = 7) were parachute training instructors and highly experienced in parachute jumping. The second group of subjects (N, n = 7) had no prior parachute training experience and were considered novice jumpers. All subjects were tested for one-repetition maximum (1 RM) squat strength and maximal jump power. Ground reaction forces (GRF) and the time to peak force (TPF) at landing were measured from jumps at four different heights (95 cm, 120 cm, 145 cm, and 170 cm). All jumps were performed from a customized jump platform onto a force plate. RESULTS: No differences were seen between E and N in either IRM squat strength or in MJP. In addition, no differences were seen between the groups for time to peak force at any jump height. However, significantly greater GRF were observed in E compared to N. Moderate to high correlations between maximal jump power and GRF (r values ranging from 0.62-0.93) were observed in E. Although maximal jump power and the TPF was significantly correlated (r = -0.89) at only 120 cm for E, it was interesting to note that the correlations between MJP and the time to peak force in E were all negative and that the correlations between these variables in N were all positive. CONCLUSIONS: These results suggest that experienced parachutists may use a different landing strategy than novice jumpers. This difference may be reflected by differences in GRF generated during impact and a more efficient utilization of muscle power during the impact phase of the landing.

Abstract: While a common view is that vision is essential to motor performance, some recent studies have shown that continuous visual guidance may not always be required within certain time constraints. This study investigated a landing-related task (self-released falls) to assess the extent to which visual information enhances the ability to reduce the impacts at touchdown. Six individuals performed six blocked trials from four height categories in semi-counterbalanced order (5-10, 20-25, 60-65, and 90-95 cm) in vision and no-vision conditions randomly assigned. A series of two-way ANOVA with repeated measures were carried out separately on each dependent variable collapsed over six trials. The results indicated that vision during the flight did not produce softer landings. Indeed, in analysing the first peak (PFP) a main effect for visual condition was revealed in that the mean amplitude was slightly higher when vision was available (F(1,5) = 6.57; p less than 0.05), thus implicating higher forces at impact. The results obtained when the time to the first peak (TFP) was applied showed no significant differences between conditions (F(1,5) less than 1). As expected, in all cases, the analyses yielded significant main effects for the height categories factor. It appears that during self-initiated falls in which the environmental cues are known before the event, visual guidance is not necessary in order to adopt a softer landing strategy.