Posts Tagged motor performance
Posted by Debbie Overman
Homebound stroke patients practicing piano therapy at home demonstrated positive motor performance results, according to a pilot study conducted by Georgia State University researchers.
The stroke survivors, who had impairment of upper extremity motor function and the ability to follow instructions, participated in the 3-week study using a portable electric piano and a commercial iPad app, Yousician. Participants were encouraged to play the piano assisted by the app for at least 1 hour per day. At the end of the study, the participants showed good training compliance and gave positive feedback, according to a media release from Georgia State University.
The study, led by Dr. Yi-An Chen, assistant professor of occupational therapy in the Byrdine F. Lewis College of Nursing and Health Professions, and Dr. Martin Norgaard, associate professor of music education in the School of Music, may help improve outcomes in homebound patients.
Chen and Norgaard shared their initial findings via a conference abstract in the American Journal of Occupational Therapy. The researchers found participants enjoyed the piano therapy, and when interviewed, 80% said they were motivated for rehabilitation by playing the piano. Also, 40% indicated they wanted to keep playing, if possible. Chen and Norgaard will present further results and details in a poster session at the Georgia Occupational Therapy Association virtual conference in October, the release continues.
“We are pleased with the positive results of this pilot study, which demonstrate the feasibility and the effects of in-home piano therapy using a mobile app for individuals with stroke.”
— Dr Martin Norgaard, associate professor of music education, School of Music, Georgia State University
According to Chen, the team is applying for additional grants to test the therapy and app with a larger group of stroke survivors and to examine opportunities to extend the therapy to other types of patients such as those with Parkinson’s disease or multiple sclerosis. The researchers also want to create a training app specifically for this project.
“We are currently working on applying for a few different grants to develop our own app, which will allow us to better tailor the rehab piano training for patients, allow telecommunication between patients and therapists, and will be more patient-friendly.”
— Dr Yi-An Chen, assistant professor of occupational therapy in the Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University
[Source: Georgia State University]
“Sometimes five fingers per hand is just not enough, this is when an extra thumb idea comes quite handy” said UK researchers who have attempted to improve human motor performance.
Dani Clode, a designer and researcher at University College London’s Plasticity Lab, has developed a 3D-printed prosthetic that is controlled with pressure exerted with the big toes.
The robotic finger, which the scientists call the Third Thumb, was designed to extend the natural repertoire of hand movements. A group of people wore the Third Thumb during an observed augmentation test and were studied for changes in motor control and embodiment of the prosthetic.
The scientists also examined how the sensorimotor and body representation of the Thumb changed following the training.
During the 5 days of using the robotic finger, the participants were tasked with picking up wine glasses and building Jenga towers. Another task included holding a plastic cup while extracting a marble with a spoon.
The findings of the study showed that after training, those using the thumb would show fewer differences in brain activity patterns for individual fingers. In other words, the part of the brain – activated when people move their fingers – has a weakened representation of the hand after training with the thumb.
The scientists concluded that technologies designed to augment human motor abilities hold a promise for both disabled and healthy communities.
“Here, we demonstrate that successful integration of motor augmentation can be achieved, with potential for flexible use, reduced cognitive reliance and increased sense of embodiment. Importantly, though, such successful human-robot integration may have consequences on some aspect of body representation and motor control which need to be considered and explored further,” the study said.
[Abstract] Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study
BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A randomized controlled pilot study.
SETTING: A hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037).
CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.
via Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):551-7 – Minerva Medica – Journals
Published on Apr 11, 2018
Motor learning is the understanding of acquisition and/or modification of movement.
As applied to patients, motor learning involves the reacquisition of previously learned movement skills that are lost due to pathology or sensory, motor, or cognitive impairments. This process is often referred to as recovery of function.
[ARTICLE] Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial – Full Text
This study examined the treatment efficacy of proximal-emphasized robotic rehabilitation by using the InMotion ARM (P-IMT) versus distal-emphasized robotic rehabilitation by using the InMotion WRIST (D-IMT) in patients with stroke. A total of 40 patients with stroke completed the study. They received P-IMT, D-IMT, or control treatment (CT) for 20 training sessions. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scale. Secondary outcomes were the Motor Activity Log (MAL) and wrist-worn accelerometers. The differences on the distal FMA, total MRC, distal MRC, and MAL quality of movement scores among the 3 groups were statistically significant (P = 0.02 to 0.05). Post hoc comparisons revealed that the D-IMT group significantly improved more than the P-IMT group on the total MRC and distal MRC. Furthermore, the distal FMA and distal MRC improved more in the D-IMT group than in the CT group. Our findings suggest that distal upper-limb robotic rehabilitation using the InMotion WRIST system had superior effects on distal muscle strength. Further research based on a larger sample is needed to confirm long-term treatment effects of proximal versus distal upper-limb robotic rehabilitation.
Most stroke survivors are burdened with significant physical dysfunction, and approximately 60% to 80% continue to have upper-limb (UL) motor deficits into the chronic phase of stroke that have a large effect on their daily life1,2. Developing effective rehabilitation interventions to maxmize UL motor recovery and functional independence of patients with stroke is therefore one of the top priorities in clinical practice and research3,4.
Robot-assisted therapy (RT) has emerged during the last decade as a novel rehabilitation approach to intensify UL motor function5,6,7,8. RT helps provide intensive, repetitive, and interactive training in a controlled environment to promote motor control and recovery of patients9,10,11,12,13,14. Although positive results of RT on motor outcomes have been noted13,14,15, there are disparate effects and heterogeneities between trials depending on the robotic types (eg, exoskeleton versus end-effector, or proximal versus distal approach), protocols, dosages, and problems of patients15,16.
Very few studies have directly compared the relative effects of different robotic devices. A recent systematic review15 investigated the effect of robotic types and reported a trend favoring end-effector rather than exoskeleton robotic devices on motor function. However, the superiority of treatment effect on the UL joints targeted by robotics remains unknown, especially for distal robotics15. Thus, comparative trials of different robotic types (eg, proximal versus distal robots) are warranted to tailor robot-aided UL rehabilitation to patient’s needs.
This study mainly compared the treatment effects of the InMotion ARM versus the InMotion WRIST robotic systems. The major difference between the 2 robotic devices is that the InMotion ARM focuses on training shoulder and elbow movements (ie, proximal UL), and the InMotion WRIST targets wrist and forearm movements (ie, distal UL). The proximal UL segments are critical for stability and transport of the arm, and the distal UL joints are mainly responsible for object manipulation and are important for performing daily activities17,18.
Motor control of the proximal UL and distal UL might be driven by different descending pathways19. The dorsolateral pathways (eg, corticospinal and rubrospinal tracts) are important for control of distal UL movements, and the ventromedial pathways (eg, reticulospinal, vestibulospinal, and tectospinal tracts) act more on the axial and proximal UL muscles and movements20,21. Although the neural bases act on proximal and distal UL segments and their functional roles appear to be different, direct comparisons of the clinical efficacy of proximal versus distal UL training in stroke patients are lacking.
Mazzeloni et al.22 used the same robotic systems to evaluate the treatment effects of proximal RT versus distal RT and proximal RT combined in 2 groups. However, the study goals of Mazzeloni et al. and this work are different. The effects of RT directly related to the UL segments specifically treated could not be drawn from the study findings of Mazzeloni et al. The 2 RT systems, InMotion ARM and InMotion WRIST, allow us to directly compare the outcomes affected by the proximal versus distal UL training.
In addition, recent reviews of RT have shown non-significant improvements or small effects on daily function after UL robotic rehabilitation in patients with stroke14,15,23. Major goals of stroke rehabilitation are to improve not only motor function but also functional performance on daily activities. Moreover, many patients were unable to translate the improvements of motor function and muscle strength to daily activity performance, which led to persistent functional dependence24. Therefore, this study provided functional task practice after RT to enhance the gains from proximal and distal UL robotic rehabilitation on motor function and muscle strength transfer into the patients’ daily functional performance.
The study purposes were to investigate the treatment effects of proximal-emphasized RT by using the InMotion ARM (P-IMT) versus distal-emphasized RT by using the InMotion WRIST (D-IMT) compared with a control treatment (CT) in patients with stroke. We designed a conventional rehabilitation program as the CT to provide a higher-level of clinical evidence, which decreased the influence of nondirective research environment and participant factors on treatment efficacy (eg, the Hawthorne effect), and to pose a more ethical approach instead of no treatment or placebo.[…]
[Abstract] Transcranial direct current stimulation over multiple days enhances motor performance of a grip task
Background. Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery.
Objective. Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke.
Methods. Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning.
Results. Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model.
Conclusion. Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.
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