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Melzer, I., Krasovsky, T., Oddsson, L. I. E., & Liebermann, D. G. (2010). Age-related differences in lower-limb force-time relation during the push-off in rapid voluntary stepping. Clin Biomech (Bristol, Avon), 25(10), 989–994.
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.
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Harel Arzi, Tal Krasovsky, Moshe Pritsch, & Dario G. Liebermann. (2014). Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients. Journal of Shoulder and Elbow Surgery, 23(7), 982–992.
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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Berman, S., Liebermann, D. G., & McIntyre, J. (2014). Constrained Motion Control on a Hemispherical Surface – Path Planning. J Neurophysiol, 111(5), 954–968.
Abstract: Surface-constrained motion, i.e., motion constraint by a rigid surface, is commonly found in daily activities. The current work investigates the choice of hand paths constrained to a concave hemispherical surface. To gain insight regarding the paths and their relationship with task dynamics, we simulated various control policies. The simulations demonstrated that following a geodesic path is advantageous not only in terms of path length, but also in terms of motor planning and sensitivity to motor command errors. These stem from the fact that the applied forces lie in a single plane (that of the geodesic path itself). To test whether human subjects indeed follow the geodesic, and to see how such motion compares to other paths, we recorded movements in a virtual haptic-visual environment from eleven healthy subjects. The task was comprised of point-to-point motion between targets at two elevations (30 degrees and 60 degrees ). Three typical choices of paths were observed from a frontal plane projection of the paths: circular arcs, straight lines, and arcs close to the geodesic path for each elevation. Based on the measured hand paths, we applied k-means blind separation to divide the subjects into three groups and compared performance indicators. The analysis confirmed that subjects who followed paths closest to the geodesic produced faster and smoother movements, compared to the others. The 'better' performance reflects the dynamical advantages of following the geodesic path, as shown by the simulations, and may also reflect invariant features of the control policies used to produce such a surface-constrained motion.
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Merdler, T., Liebermann, D. G., Levin, M. F., & Berman, S. (2013). Arm-plane representation of shoulder compensation during pointing movements in patients with stroke. J Electromyogr Kinesiol, 23(4), 938–947.
Abstract: Improvements in functional motor activities are often accompanied by motor compensations to overcome persistent motor impairment in the upper limb. Kinematic analysis is used to objectively quantify movement patterns including common motor compensations such as excessive trunk displacement during reaching. However, a common motor compensation to assist reaching, shoulder abduction, is not adequately characterized by current motion analysis approaches. We apply the arm-plane representation that accounts for the co-variation between movements of the whole arm, and investigate its ability to identify and quantify compensatory arm movements in stroke subjects when making forward arm reaches. This method has not been previously applied to the analysis of motion deficits. Sixteen adults with right post-stroke hemiparesis and eight healthy age-matched controls reached in three target directions (14 trials/target; sampling rate: 100Hz). Arm-plane movement was validated against endpoint, joint, and trunk kinematics and compared between groups. In stroke subjects, arm-plane measures were correlated with arm impairment (Fugl-Meyer Assessment) and ability (Box and Blocks) scores and were more sensitive than clinical measures to detect mild motor impairment. Arm-plane motion analysis provides new information about motor compensations involving the co-variation of shoulder and elbow movements that may help to understand the underlying motor deficits in patients with stroke.
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Liebermann, D. G., Berman, S., Weiss, P. L. T., & Levin, M. F. (2012). Kinematics of reaching movements in a 2-d virtual environment in adults with and without stroke. IEEE Trans Neural Syst Rehabil Eng, 20(6), 778–787.
Abstract: Virtual reality environments are increasingly being used for upper limb rehabilitation in poststroke patients. Our goal was to determine if arm reaching movements made in a 2-D video-capture virtual reality environment are similar to those made in a comparable physical environment. We compared arm and trunk kinematics for reaches made with the right, dominant arm to three targets (14 trials per target) in both environments by 16 adults with right poststroke hemiparesis and by eight healthy age-matched controls. Movement kinematics were recorded with a three-camera optoelectronic system at 100 samples/s. Reaching movements made by both control and stroke subjects were affected by viewing the targets in the video-capture 2-D virtual environment. Movements were slower, shorter, less straight, less accurate and involved smaller ranges of shoulder and elbow joint excursions for target reaches in the virtual environment compared to the physical environment in all subjects. Thus, there was a decrease in the overall movement quality for movements made in the 2-D virtual environment. This suggests that 2-D video-capture virtual reality environments should be used with caution when the goal of the rehabilitation program is to improve the quality of movement patterns of the upper limb.
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