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Kanzler CM, Armand T, Simovic L, Sylvester R, Domnik N, Eilfort AM, Rohner C, Gassert R, Gonzenbach R, Lambercy O. Influence of virtual reality and task complexity on digital health metrics assessing upper limb function. J Neuroeng Rehabil 2024; 21:125. [PMID: 39068424 PMCID: PMC11282591 DOI: 10.1186/s12984-024-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Technology-based assessments using 2D virtual reality (VR) environments and goal-directed instrumented tasks can deliver digital health metrics describing upper limb sensorimotor function that are expected to provide sensitive endpoints for clinical studies. Open questions remain about the influence of the VR environment and task complexity on such metrics and their clinimetric properties. METHODS We aim to investigate the influence of VR and task complexity on the clinimetric properties of digital health metrics describing upper limb function. We relied on the Virtual Peg Insertion Test (VPIT), a haptic VR-based assessment with a virtual manipulation task. To evaluate the influence of VR and task complexity, we designed two novel tasks derived from the VPIT, the VPIT-2H (VR environment with reduced task complexity) and the PPIT (physical task with reduced task complexity). These were administered in an observational longitudinal study with 27 able-bodied participants and 31 participants with multiple sclerosis (pwMS, VPIT and PPIT only) and the value of kinematic and kinetic metrics, their clinimetric properties, and the usability of the assessment tasks were compared. RESULTS Intra-participant variability strongly increased with increasing task complexity (coefficient of variation + 56%) and was higher in the VR compared to the physical environment (+ 27%). Surprisingly, this did not translate into significant differences in the metrics' measurement error and test-retest reliability across task conditions (p > 0.05). Responsiveness to longitudinal changes in pwMS was even significantly higher (effect size + 0.35, p < 0.05) for the VR task with high task complexity compared to the physical instrumented task with low task complexity. Increased inter-participant variability might have compensated for the increased intra-participant variability to maintain good clinimetric properties. No significant influence of task condition on concurrent validity was present in pwMS. Lastly, pwMS rated the PPIT with higher usability than the VPIT (System Usability Scale + 7.5, p < 0.05). CONCLUSION The metrics of both the VR haptic- and physical task-based instrumented assessments showed adequate clinimetric properties. The VR haptic-based assessment may be superior when longitudinally assessing pwMS due to its increased responsiveness. The physical instrumented task may be advantageous for regular clinical use due to its higher usability. These findings highlight that both assessments should be further validated for their ideal use-cases.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore.
| | - Tom Armand
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Leonardo Simovic
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Nadine Domnik
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Antonia M Eilfort
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Carola Rohner
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
| | | | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
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Bernal-Jiménez JJ, Polonio-López B, Sanz-García A, Martín-Conty JL, Lerín-Calvo A, Segura-Fragoso A, Martín-Rodríguez F, Cantero-Garlito PA, Corregidor-Sánchez AI, Mordillo-Mateos L. Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:337. [PMID: 38338223 PMCID: PMC10855329 DOI: 10.3390/healthcare12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.
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Affiliation(s)
- Juan J. Bernal-Jiménez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Alfredo Lerín-Calvo
- Neruon Neurobotic S.L., 28015 Madrid, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University La Salle, 28023 Madrid, Spain
| | - Antonio Segura-Fragoso
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
| | - Pablo A. Cantero-Garlito
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
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Seo HG, Yun SJ, Farrens A, Johnson C, Reinkensmeyer DJ. A Systematic Review of the Learning Dynamics of Proprioception Training: Specificity, Acquisition, Retention, and Transfer. Neurorehabil Neural Repair 2023; 37:744-757. [PMID: 37864458 PMCID: PMC10847967 DOI: 10.1177/15459683231207354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE We aimed to identify key aspects of the learning dynamics of proprioception training including: 1) specificity to the training type, 2) acquisition of proprioceptive skills, 3) retention of learning effects, and 4) transfer to different proprioceptive skills. METHODS We performed a systematic literature search using the database (MEDLINE, EMBASE, Cochrane Library, and PEDro). The inclusion criteria required adult participants who underwent any training program that could enhance proprioceptive function, and at least 1 quantitative assessment of proprioception before and after the intervention. We analyzed within-group changes to quantify the effectiveness of an intervention. RESULTS In total, 106 studies with 343 participant-outcome groups were included. Proprioception-specific training resulted in large effect sizes with a mean improvement of 23.4 to 42.6%, nonspecific training resulted in medium effect sizes with 12.3 to 22% improvement, and no training resulted in small effect sizes with 5.0 to 8.9% improvement. Single-session training exhibited significant proprioceptive improvement immediately (10 studies). For training interventions with a midway evaluation (4 studies), trained groups improved by approximately 70% of their final value at the midway point. Proprioceptive improvements were largely maintained at a delayed follow-up of at least 1 week (12 studies). Finally, improvements in 1 assessment were significantly correlated with improvements in another assessment (10 studies). CONCLUSIONS Proprioceptive learning appears to exhibit several features similar to motor learning, including specificity to the training type, 2 time constant learning curves, good retention, and improvements that are correlated between different assessments, suggesting a possible, common mechanism for the transfer of training.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Andria Farrens
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Christopher Johnson
- Department of Biomedical Engineering, University of California at Irvine, California, USA
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
- Department of Biomedical Engineering, University of California at Irvine, California, USA
- Department of Anatomy and Neurobiology, University of California at Irvine, California, USA
- Department of Physical Medicine and Rehabilitation, University of California at Irvine, California, USA
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4
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Siviy C, Baker LM, Quinlivan BT, Porciuncula F, Swaminathan K, Awad LN, Walsh CJ. Opportunities and challenges in the development of exoskeletons for locomotor assistance. Nat Biomed Eng 2023; 7:456-472. [PMID: 36550303 PMCID: PMC11536595 DOI: 10.1038/s41551-022-00984-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
Exoskeletons can augment the performance of unimpaired users and restore movement in individuals with gait impairments. Knowledge of how users interact with wearable devices and of the physiology of locomotion have informed the design of rigid and soft exoskeletons that can specifically target a single joint or a single activity. In this Review, we highlight the main advances of the past two decades in exoskeleton technology and in the development of lower-extremity exoskeletons for locomotor assistance, discuss research needs for such wearable robots and the clinical requirements for exoskeleton-assisted gait rehabilitation, and outline the main clinical challenges and opportunities for exoskeleton technology.
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Affiliation(s)
- Christopher Siviy
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Lauren M Baker
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Brendan T Quinlivan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Franchino Porciuncula
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Krithika Swaminathan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Louis N Awad
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Conor J Walsh
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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Wenk N, Penalver-Andres J, Buetler KA, Nef T, Müri RM, Marchal-Crespo L. Effect of immersive visualization technologies on cognitive load, motivation, usability, and embodiment. VIRTUAL REALITY 2023; 27:307-331. [PMID: 36915633 PMCID: PMC9998603 DOI: 10.1007/s10055-021-00565-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/22/2021] [Indexed: 05/09/2023]
Abstract
Virtual reality (VR) is a promising tool to promote motor (re)learning in healthy users and brain-injured patients. However, in current VR-based motor training, movements of the users performed in a three-dimensional space are usually visualized on computer screens, televisions, or projection systems, which lack depth cues (2D screen), and thus, display information using only monocular depth cues. The reduced depth cues and the visuospatial transformation from the movements performed in a three-dimensional space to their two-dimensional indirect visualization on the 2D screen may add cognitive load, reducing VR usability, especially in users suffering from cognitive impairments. These 2D screens might further reduce the learning outcomes if they limit users' motivation and embodiment, factors previously associated with better motor performance. The goal of this study was to evaluate the potential benefits of more immersive technologies using head-mounted displays (HMDs). As a first step towards potential clinical implementation, we ran an experiment with 20 healthy participants who simultaneously performed a 3D motor reaching and a cognitive counting task using: (1) (immersive) VR (IVR) HMD, (2) augmented reality (AR) HMD, and (3) computer screen (2D screen). In a previous analysis, we reported improved movement quality when movements were visualized with IVR than with a 2D screen. Here, we present results from the analysis of questionnaires to evaluate whether the visualization technology impacted users' cognitive load, motivation, technology usability, and embodiment. Reports on cognitive load did not differ across visualization technologies. However, IVR was more motivating and usable than AR and the 2D screen. Both IVR and AR rea ched higher embodiment level than the 2D screen. Our results support our previous finding that IVR HMDs seem to be more suitable than the common 2D screens employed in VR-based therapy when training 3D movements. For AR, it is still unknown whether the absence of benefit over the 2D screen is due to the visualization technology per se or to technical limitations specific to the device.
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Affiliation(s)
- N. Wenk
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - J. Penalver-Andres
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - K. A. Buetler
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - T. Nef
- Gerontechnology & Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - R. M. Müri
- Gerontechnology & Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - L. Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, The Netherlands
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Young BM, Yadav R, Rana S, Kim WS, Liu C, Batth R, Sakthi S, Farahmand E, Han S, Patel D, Luo J, Ramsey C, Feldman M, Cardoso-Ferreira I, Holl C, Nguyen T, Brinkman L, Su M, Chang TY, Cramer SC. Wrist Proprioception in Adults with and without Subacute Stroke. Brain Sci 2022; 13:brainsci13010031. [PMID: 36672014 PMCID: PMC9856542 DOI: 10.3390/brainsci13010031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.
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Affiliation(s)
- Brittany M. Young
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rishika Yadav
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivam Rana
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Won-Seok Kim
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, Republic of Korea
| | - Camellia Liu
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rajan Batth
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivani Sakthi
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Eden Farahmand
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Simon Han
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Darshan Patel
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Jason Luo
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Ramsey
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Marc Feldman
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Isabel Cardoso-Ferreira
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Holl
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tiffany Nguyen
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Lorie Brinkman
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Michael Su
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tracy Y. Chang
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Steven C. Cramer
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Correspondence:
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Wenk N, Buetler KA, Penalver-Andres J, Müri RM, Marchal-Crespo L. Naturalistic visualization of reaching movements using head-mounted displays improves movement quality compared to conventional computer screens and proves high usability. J Neuroeng Rehabil 2022; 19:137. [PMID: 36494668 PMCID: PMC9733395 DOI: 10.1186/s12984-022-01101-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar-with immersive VR (IVR)-or the user's real body-with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. METHODS We compared movement quality, cognitive load, motivation, and system usability in twenty elderly participants (>59 years old) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants' self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. RESULTS Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. CONCLUSIONS HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants' motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.*.
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Affiliation(s)
- Nicolas Wenk
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | - Karin A Buetler
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | - Joaquin Penalver-Andres
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
| | - René M Müri
- Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland.
- Department of Cognitive Robotics, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
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Moore RT, Piitz MA, Singh N, Dukelow SP, Cluff T. Assessing Impairments in Visuomotor Adaptation After Stroke. Neurorehabil Neural Repair 2022; 36:415-425. [PMID: 35616370 PMCID: PMC9198391 DOI: 10.1177/15459683221095166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Motor impairment in the arms is common after stroke and many individuals participate in therapy to improve function. It is assumed that individuals with stroke can adapt and improve their movements using feedback that arises from movement or is provided by a therapist. Here we investigated visuomotor adaptation in individuals with sub-acute and chronic stroke. Objective: We examined the impact of the stroke-affected arm (dominant or non-dominant), time post-stroke, and relationships with clinical measures of motor impairment and functional independence. Methods: Participants performed reaching movements with their arm supported in a robotic exoskeleton. We rotated the relationship between the motion of the participant’s hand and a feedback cursor displayed in their workspace. Outcome measures included the amount that participants adapted their arm movements and the number of trials they required to adapt. Results: Participants with stroke (n = 36) adapted less and required more trials to adapt than controls (n = 29). Stroke affecting the dominant arm impaired the amount of adaptation more than stroke affecting the non-dominant arm. Overall, 53% of participants with stroke were impaired in one or more measures of visuomotor adaptation. Initial adaptation was weakly correlated with time post-stroke, and the amount of adaptation correlated moderately with clinical measures of motor impairment and functional independence. Conclusion: Our findings reveal impairments in visuomotor adaptation that are associated with motor impairment and function after stroke. Longitudinal studies are needed to understand the relationship between adaptation and recovery attained in a therapy setting.
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Affiliation(s)
- Robert T Moore
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mark A Piitz
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Tyler Cluff
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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9
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Özen Ö, Buetler KA, Marchal-Crespo L. Towards functional robotic training: motor learning of dynamic tasks is enhanced by haptic rendering but hampered by arm weight support. J Neuroeng Rehabil 2022; 19:19. [PMID: 35152897 PMCID: PMC8842890 DOI: 10.1186/s12984-022-00993-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/19/2022] [Indexed: 01/19/2023] Open
Abstract
Background Current robot-aided training allows for high-intensity training but might hamper the transfer of learned skills to real daily tasks. Many of these tasks, e.g., carrying a cup of coffee, require manipulating objects with complex dynamics. Thus, the absence of somatosensory information regarding the interaction with virtual objects during robot-aided training might be limiting the potential benefits of robotic training on motor (re)learning. We hypothesize that providing somatosensory information through the haptic rendering of virtual environments might enhance motor learning and skill transfer. Furthermore, the inclusion of haptic rendering might increase the task realism, enhancing participants’ agency and motivation. Providing arm weight support during training might also enhance learning by limiting participants’ fatigue. Methods We conducted a study with 40 healthy participants to evaluate how haptic rendering and arm weight support affect motor learning and skill transfer of a dynamic task. The task consisted of inverting a virtual pendulum whose dynamics were haptically rendered on an exoskeleton robot designed for upper limb neurorehabilitation. Participants trained with or without haptic rendering and with or without weight support. Participants’ task performance, movement strategy, effort, motivation, and agency were evaluated during baseline, short- and long-term retention. We also evaluated if the skills acquired during training transferred to a similar task with a shorter pendulum. Results We found that haptic rendering significantly increases participants’ movement variability during training and the ability to synchronize their movements with the pendulum, which is correlated with better performance. Weight support also enhances participants’ movement variability during training and reduces participants’ physical effort. Importantly, we found that training with haptic rendering enhances motor learning and skill transfer, while training with weight support hampers learning compared to training without weight support. We did not observe any significant differences between training modalities regarding agency and motivation during training and retention tests. Conclusion Haptic rendering is a promising tool to boost robot-aided motor learning and skill transfer to tasks with similar dynamics. However, further work is needed to find how to simultaneously provide robotic assistance and haptic rendering without hampering motor learning, especially in brain-injured patients. Trial registrationhttps://clinicaltrials.gov/show/NCT04759976 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00993-w.
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10
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Muller CO, Muthalib M, Mottet D, Perrey S, Dray G, Delorme M, Duflos C, Froger J, Xu B, Faity G, Pla S, Jean P, Laffont I, Bakhti KKA. Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomized controlled trial. Trials 2021; 22:747. [PMID: 34702317 PMCID: PMC8549202 DOI: 10.1186/s13063-021-05689-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. METHODS The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1 × 30 min session/day) and conventional therapy (3 × 30 min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2 mA, 20 min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2 mA, 30 s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block Test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index). Other/exploratory outcomes will include pain, fatigue, effort and performance, kinematics, and motor cortical region activation during functional motor tasks. DISCUSSION This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesize that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham. TRIAL REGISTRATION The ReArm project was approved by The French Research Ethics Committee, (Comité de Protection des Personnes-CPP SUD-EST II, N°ID-RCB: 2019-A00506-51, http://www.cppsudest2.fr/ ). The ReArm project was registered on ClinicalTrials.gov ( NCT04291573 , 2nd March 2020.
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Affiliation(s)
- Camille O Muller
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Makii Muthalib
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Silverline Research, Brisbane, Australia
| | - Denis Mottet
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Stéphane Perrey
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Gérard Dray
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Marion Delorme
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, CHU Nîmes, Le Grau du Roi, France
| | - Claire Duflos
- Clinical Research and Epidemiology unit, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Jérôme Froger
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, CHU Nîmes, Le Grau du Roi, France
| | - Binbin Xu
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Germain Faity
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Simon Pla
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Pierre Jean
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Isabelle Laffont
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Karima K A Bakhti
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France.
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France.
- Health Directorate, CHU Montpellier, Montpellier, France.
- Clinical Investigation Centre, CHU Montpellier, Montpellier, France - Inserm, CIC 1411, Montpellier, France.
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Basalp E, Wolf P, Marchal-Crespo L. Haptic Training: Which Types Facilitate (re)Learning of Which Motor Task and for Whom? Answers by a Review. IEEE TRANSACTIONS ON HAPTICS 2021; 14:722-739. [PMID: 34388095 DOI: 10.1109/toh.2021.3104518] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The use of robots has attracted researchers to design numerous haptic training methods to support motor learning. However, investigations of new methods yielded inconclusive results regarding their effectiveness to enhance learning due to the diversity of tasks, haptic designs, participants' skill level, and study protocols. In this review, we developed a taxonomy to identify generalizable findings out of publications on haptic training. In the taxonomy, we grouped the results of studies on healthy learners based on participants' skill level and tasks' characteristics. Our inspection of included studies revealed that: i) Performance-enhancing haptic methods were beneficial for novices, ii) Training with haptics was as effective as training with other feedback modalities, and iii) Performance-enhancing and performance-degrading haptic methods were useful for the learning of temporal and spatial aspects, respectively. We also observed that these findings are in line with results from robot-aided neurorehabilitation studies on patients. Our review suggests that haptic training can be effective to foster learning, especially when the information cannot be provided with other feedback modalities. We believe the findings from the taxonomy constitute a general guide, which can assist researchers when designing studies to investigate the effectiveness of haptics on learning different tasks.
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12
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Rose CG, Deshpande AD, Carducci J, Brown JD. The road forward for upper-extremity rehabilitation robotics. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021. [DOI: 10.1016/j.cobme.2021.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Grimm F, Kraugmann J, Naros G, Gharabaghi A. Clinical validation of kinematic assessments of post-stroke upper limb movements with a multi-joint arm exoskeleton. J Neuroeng Rehabil 2021; 18:92. [PMID: 34078400 PMCID: PMC8170809 DOI: 10.1186/s12984-021-00875-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The clinical evaluation of the upper limb of severely impaired stroke patient is challenging. Sensor-based assessments may allow for an objective evaluation of this patient population. This study investigated the validity of a device-assisted approach in comparison to the clinical outcome that it is supposed to reflect. Methods In nineteen severely impaired chronic stroke patients, we applied a gravity-compensating, multi-joint arm exoskeleton (Armeo Spring) and compared this sensor-based assessment with the clinical outcome measure Upper Extremity Fugl-Meyer Assessment (UE-FMA) scale. Specifically, we assessed separately and subsequently the range of motion in joint space for four single joints (i.e., wrist, elbow and shoulder flexion/extension (FE), and shoulder internal/external rotation (IER)), and the closing and opening of the hand with a pressure sensor placed in the handle. Results Within the kinematic parameters, a strong correlation was observed between wrist and elbow FE (r > 0.7, p < 0.003; Bonferroni corrected). The UE-FMA was significantly predicted by a multiple regression model (F (5, 13) = 12.22, p < 0.0005, adj. R2 = 0.83). Both shoulder IER and grip pressure added significantly (p < 0.05) to the prediction with the standardized coefficients β of 0.55 and 0.38, respectively. Conclusions By applying an exoskeleton-based self-contained evaluation of single-joint movements, a clinically valid assessment of the upper limb range of motion in severely impaired stroke patients is feasible. Shoulder IER contributed most relevantly to the prediction of the clinical status. These findings need to be confirmed in a large, independent patient cohort.
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Affiliation(s)
- Florian Grimm
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str. 45, 72076, Tübingen, Germany.
| | - Jelena Kraugmann
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str. 45, 72076, Tübingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str. 45, 72076, Tübingen, Germany
| | - Alireza Gharabaghi
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str. 45, 72076, Tübingen, Germany.
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14
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Nibras N, Liu C, Mottet D, Wang C, Reinkensmeyer D, Remy-Neris O, Laffont I, Schweighofer N. Dissociating Sensorimotor Recovery and Compensation During Exoskeleton Training Following Stroke. Front Hum Neurosci 2021; 15:645021. [PMID: 33994981 PMCID: PMC8120113 DOI: 10.3389/fnhum.2021.645021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/30/2021] [Indexed: 01/23/2023] Open
Abstract
The quality of arm movements typically improves in the sub-acute phase of stroke affecting the upper extremity. Here, we used whole arm kinematic analysis during reaching movements to distinguish whether these improvements are due to true recovery or to compensation. Fifty-three participants with post-acute stroke performed ∼80 reaching movement tests during 4 weeks of training with the ArmeoSpring exoskeleton. All participants showed improvements in end-effector performance, as measured by movement smoothness. Four ArmeoSpring angles, shoulder horizontal (SH) rotation, shoulder elevation (SE), elbow rotation, and forearm rotation, were recorded and analyzed. We first characterized healthy joint coordination patterns by performing a sparse principal component analysis on these four joint velocities recorded during reaching tests performed by young control participants. We found that two dominant joint correlations [SH with elbow rotation and SE with forearm rotation] explained over 95% of variance of joint velocity data. We identified two clusters of stroke participants by comparing the evolution of these two correlations in all tests. In the "Recoverer" cluster (N = 19), both joint correlations converged toward the respective correlations for control participants. Thus, Recoverers relearned how to generate smooth end-effector movements while developing joint movement patterns similar to those of control participants. In the "Compensator" cluster (N = 34), at least one of the two joint correlations diverged from the corresponding correlation of control participants. Compensators relearned how to generate smooth end-effector movements by discovering various new compensatory movement patterns dissimilar to those of control participants. New compensatory patterns included atypical decoupling of the SE and forearm joints, and atypical coupling of the SH rotation and elbow joints. There was no difference in clinical impairment level between the two groups either at the onset or at the end of training as assessed with the Upper Extremity Fugl-Meyer scale. However, at the start of training, the Recoverers showed significantly faster improvements in end-effector movement smoothness than the Compensators. Our analysis can be used to inform neurorehabilitation clinicians on how to provide movement feedback during practice and suggest avenues for refining exoskeleton robot therapy to reduce compensatory patterns.
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Affiliation(s)
- Nadir Nibras
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Chang Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Denis Mottet
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Alès, Montpellier, France
| | - Chunji Wang
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - David Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
| | - Olivier Remy-Neris
- Université de Brest, Centre Hospitalier Universitaire, LaTIM-INSERM UMR 1101, Brest, France
| | - Isabelle Laffont
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Alès, Montpellier, France.,Montpellier University Hospital, Euromov Digital Health in Motion, Montpellier University, Montpellier, France
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Perry B, Sivak J, Stokic D. Providing unloading by exoskeleton improves shoulder flexion performance after stroke. Exp Brain Res 2021; 239:1539-1549. [PMID: 33693984 DOI: 10.1007/s00221-021-06070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/28/2022]
Abstract
Robotic devices can be engaged actively or passively to unload arm weight or impose additional loading. The conditions of variable loading and unloading offer an opportunity to investigate motor performance of the arm affected by a stroke. The objective of this study was to investigate the interactive effects of the proximal arm impairment and passive weight compensation on shoulder flexion performance in the sagittal plane after stroke. Twenty-eight participants (age 57 ± 10 years, 21/28 ≤ 6 weeks post-stroke) played a shoulder flexion game under five standardized weight compensation configurations provided by the Armeo®Spring exoskeleton. Percent of targets acquired and root mean square error were calculated to derive three behavioral and three kinematic outcomes: total score/overall error (loading/unloading conditions and five configurations combined), loading and unloading score/error (five configurations combined), and weight compensation configuration score/error for each setting separately. The total score was positively related and the overall error was negatively related to proximal arm impairment (Fugl-Meyer upper extremity movement subscale, maximum 30, FM30). The unloading score (80 ± 27%) and error (5 ± 4°) were significantly better than the loading score (45 ± 38%, p < 0.01) and error (14± 9°, p < 0.01) with improvements most pronounced in the mid-range of FM30 (4-15 points). The configuration scores/error gradually improved with each increment in unloading for the mid-range FM30 participants, while only error improved in those with low FM30. In conclusion, shoulder flexion performance depends on proximal arm impairment, but it is also influenced by the degree of unloading/loading provided, particularly among individuals with moderate paresis after stroke.
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Affiliation(s)
- Bonnie Perry
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA.
| | - Jenn Sivak
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Dobrivoje Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
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16
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Brihmat N, Loubinoux I, Castel-Lacanal E, Marque P, Gasq D. Kinematic parameters obtained with the ArmeoSpring for upper-limb assessment after stroke: a reliability and learning effect study for guiding parameter use. J Neuroeng Rehabil 2020; 17:130. [PMID: 32993695 PMCID: PMC7523068 DOI: 10.1186/s12984-020-00759-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients. METHODS This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the 'horizontal catch' exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring' data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). RESULTS We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%. CONCLUSIONS After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.
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Affiliation(s)
- Nabila Brihmat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Isabelle Loubinoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Evelyne Castel-Lacanal
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France. .,Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France. .,Service des Explorations Fonctionnelles Physiologiques, Hôpital Rangueil, 1 Avenue du Pr Poulhes, 31059, Toulouse, France.
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Kanzler CM, Schwarz A, Held JPO, Luft AR, Gassert R, Lambercy O. Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals. J Neuroeng Rehabil 2020; 17:128. [PMID: 32977810 PMCID: PMC7517659 DOI: 10.1186/s12984-020-00748-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks. METHODS Arm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity). RESULTS Twenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed. CONCLUSIONS This work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Roger Gassert
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Wang C, Winstein C, D'Argenio DZ, Schweighofer N. The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:881-890. [PMID: 32830617 DOI: 10.1177/1545968320948609] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In motor skill learning, larger doses of practice lead to greater efficacy of practice, lower efficiency of practice, and better long-term retention. Whether such learning principles apply to motor practice after stroke is unclear. Here, we developed novel mixed-effects models of the change in the perceived quality of arm movements during and following task practice. The models were fitted to data from a recent randomized controlled trial of the effect of dose of task practice in chronic stroke. Analysis of the models' learning and retention rates demonstrated an increase in efficacy of practice with greater doses, a decrease in efficiency of practice with both additional dosages and additional bouts of training, and fast initial decay following practice. Two additional effects modulated retention: a positive "self-practice" effect, and a negative effect of dose. Our results further suggest that for patients with sufficient arm use post-practice, self-practice will further improve use.
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Affiliation(s)
- Chunji Wang
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Carolee Winstein
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - David Z D'Argenio
- Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Nicolas Schweighofer
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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19
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de Kam D, Iturralde PA, Torres-Oviedo G. Cerebral Contribution to the Execution, But Not Recalibration, of Motor Commands in a Novel Walking Environment. eNeuro 2020; 7:ENEURO.0493-19.2020. [PMID: 32001549 PMCID: PMC7053171 DOI: 10.1523/eneuro.0493-19.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
Abstract
Human movements are flexible as they continuously adapt to changes in the environment. The recalibration of corrective responses to sustained perturbations (e.g., constant force) altering one's movement contributes to this flexibility. We asked whether the recalibration of corrective actions involve cerebral structures using stroke as a disease model. We characterized changes in muscle activity in stroke survivors and control subjects before, during, and after walking on a split-belt treadmill moving the legs at different speeds. The recalibration of corrective muscle activity was comparable between stroke survivors and control subjects, which was unexpected given the known deficits in feedback responses poststroke. Also, the intact recalibration in stroke survivors contrasted their limited ability to adjust their muscle activity during steady-state split-belt walking. Our results suggest that the recalibration and execution of motor commands are partially dissociable: cerebral lesions interfere with the execution, but not the recalibration, of motor commands on novel movement demands.
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Affiliation(s)
- Digna de Kam
- Swanson School of Engineering, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, HB 6500, The Netherlands
| | - Pablo A Iturralde
- Swanson School of Engineering, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Depto. de Ingeniería, Facultad de Ingeniería y Tecnologías, Universidad Católica del Uruguay, CP 11600, Montevideo, Uruguay
| | - Gelsy Torres-Oviedo
- Swanson School of Engineering, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
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20
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Comparisons between end-effector and exoskeleton rehabilitation robots regarding upper extremity function among chronic stroke patients with moderate-to-severe upper limb impairment. Sci Rep 2020; 10:1806. [PMID: 32019981 PMCID: PMC7000418 DOI: 10.1038/s41598-020-58630-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/19/2020] [Indexed: 11/08/2022] Open
Abstract
End-effector (EE) and exoskeleton (Exo) robots have not been directly compared previously. The present study aimed to directly compare EE and Exo robots in chronic stroke patients with moderate-to-severe upper limb impairment. This single-blinded, randomised controlled trial included 38 patients with stroke who were admitted to the rehabilitation hospital. The patients were equally divided into EE and Exo groups. Baseline characteristics, including sex, age, stroke type, brain lesion side (left/right), stroke duration, Fugl–Meyer Assessment (FMA)–Upper Extremity score, and Wolf Motor Function Test (WMFT) score, were assessed. Additionally, impairment level (FMA, motor status score), activity (WMFT), and participation (stroke impact scale [SIS]) were evaluated. There were no significant differences in baseline characteristics between the groups. After the intervention, improvements were significantly better in the EE group with regard to activity and participation (WMFT–Functional ability rating scale, WMFT–Time, and SIS–Participation). There was no intervention-related adverse event. The EE robot intervention is better than the Exo robot intervention with regard to activity and participation among chronic stroke patients with moderate-to-severe upper limb impairment. Further research is needed to confirm this novel finding.
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21
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Schwarz A, Kanzler CM, Lambercy O, Luft AR, Veerbeek JM. Systematic Review on Kinematic Assessments of Upper Limb Movements After Stroke. Stroke 2019; 50:718-727. [PMID: 30776997 DOI: 10.1161/strokeaha.118.023531] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Assessing upper limb movements poststroke is crucial to monitor and understand sensorimotor recovery. Kinematic assessments are expected to enable a sensitive quantification of movement quality and distinguish between restitution and compensation. The nature and practice of these assessments are highly variable and used without knowledge of their clinimetric properties. This presents a challenge when interpreting and comparing results. The purpose of this review was to summarize the state of the art regarding kinematic upper limb assessments poststroke with respect to the assessment task, measurement system, and performance metrics with their clinimetric properties. Subsequently, we aimed to provide evidence-based recommendations for future applications of upper limb kinematics in stroke recovery research. Methods- A systematic search was conducted in PubMed, Embase, CINAHL, and IEEE Xplore. Studies investigating clinimetric properties of applied metrics were assessed for risk of bias using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The quality of evidence for metrics was determined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Results- A total of 225 studies (N=6197) using 151 different kinematic metrics were identified and allocated to 5 task and 3 measurement system groups. Thirty studies investigated clinimetrics of 62 metrics: reliability (n=8), measurement error (n=5), convergent validity (n=22), and responsiveness (n=2). The metrics task/movement time, number of movement onsets, number of movement ends, path length ratio, peak velocity, number of velocity peaks, trunk displacement, and shoulder flexion/extension received a sufficient evaluation for one clinimetric property. Conclusions- Studies on kinematic assessments of upper limb sensorimotor function are poorly standardized and rarely investigate clinimetrics in an unbiased manner. Based on the available evidence, recommendations on the assessment task, measurement system, and performance metrics were made with the goal to increase standardization. Further high-quality studies evaluating clinimetric properties are needed to validate kinematic assessments, with the long-term goal to elucidate upper limb sensorimotor recovery poststroke. Clinical Trial Registration- URL: https://www.crd.york.ac.uk/prospero/ . Unique identifier: CRD42017064279.
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Affiliation(s)
- Anne Schwarz
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.).,Biomedical Signals and Systems, Technical Medical Centre (TechMed Centre), University of Twente, Enschede, the Netherlands (A.S.)
| | - Christoph M Kanzler
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Olivier Lambercy
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Andreas R Luft
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
| | - Janne M Veerbeek
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
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22
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Minimizing Precision-Weighted Sensory Prediction Errors via Memory Formation and Switching in Motor Adaptation. J Neurosci 2019; 39:9237-9250. [PMID: 31582527 DOI: 10.1523/jneurosci.3250-18.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 11/21/2022] Open
Abstract
Humans predict the sensory consequences of motor commands by learning internal models of the body and of environment perturbations. When facing a sensory prediction error, should we attribute this error to a change in our body, and update the body internal model, or to a change in the environment? In the latter case, should we update an existing perturbation model or create a new model? Here, we propose that a decision-making process compares the models' prediction errors, weighted by their precisions, to select and update either the body model or an existing perturbation model. When no model can predict a perturbation, a new perturbation model is created and selected. When a model is selected, both the prediction's mean estimate and uncertainty are updated to minimize future prediction errors and to increase the precision of the predictions. Results from computer simulations, which we verified in an arm visuomotor adaptation experiment with subjects of both sexes, account for short aftereffects and large savings after adaptation to large, but not small, perturbations. Results also clarify previous data in the absence of errors (error-clamp): motor memories show an initial lack of decay after a large perturbation, but gradual decay after a small perturbation. Finally, qualitative individual differences in adaptation were explained by subjects selecting and updating either the body model or a perturbation model. Our results suggest that motor adaptation belongs to a general class of learning according to which memories are created when no existing memories can predict sensory data accurately and precisely.SIGNIFICANCE STATEMENT When movements are followed by unexpected outcomes, such as following the introduction of a visuomotor or a force field perturbation, or the sudden removal of such perturbations, it is unclear whether the CNS updates existing memories or creates new memories. Here, we propose a novel model of adaptation, and investigate, via computer simulations and behavioral experiments, how the amplitude and schedule of the perturbation, as well as the characteristics of the learner, lead to the selection and update of existing memories or the creation of new memories. Our results provide insights into a number of puzzling and contradictory motor adaptation data, as well as into qualitative individual differences in adaptation.
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23
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Schweighofer N, Wang C, Mottet D, Laffont I, Bakhti K, Reinkensmeyer DJ, Rémy-Néris O. Correction to: Dissociating motor learning from recovery in exoskeleton training post-stroke. J Neuroeng Rehabil 2018; 15:120. [PMID: 30558647 PMCID: PMC6297949 DOI: 10.1186/s12984-018-0473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
The original article [1] contained an error whereby the co-author, Karima Bakhti's name was displayed incorrectly.
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Affiliation(s)
- Nicolas Schweighofer
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA.
| | - Chunji Wang
- Neuroscience graduate Program, University of Southern California, Los Angeles, USA
| | - Denis Mottet
- STAPS, Université de Montpellier, Euromov, Montpellier, France
| | - Isabelle Laffont
- Montpellier University Hospital, Euromov, IFRH, Montpellier University, Montpellier, France
| | - Karima Bakhti
- Montpellier University Hospital, Euromov, IFRH, Montpellier University, Montpellier, France
| | - David J Reinkensmeyer
- Departments of Mechanical and Aerospace Engineering, Anatomy and Neurobiology, University of California, Irvine, USA
| | - Olivier Rémy-Néris
- Université de Bretagne Occidentale, Centre hospitalier universitaire, LaTIM-INSERM UMR1101, Brest, France
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