Effect of Visual Motor Coordination with Body Awareness Training on Balance, Coordination and Intensity of Tremor in patients with Cerebellar Ataxia

This study is to find out the effectiveness of visual motor coordination and body awareness training on balance, coordination and intensity of tremor in patients with cerebellar ataxia. Based on the selection criteria 15 subjects were selected. They were assigned into a single group, All 15 subjects were involved for pre-test assessment for balance, coordination and intensity of tremor using the Berg balance scale, Nine hole peg test and Fahn’s tremor rating scale. The 8 weeks treatment program was given for 5 days per week, 60 minutes per session. where each session consists of 5 mins of warm-up, followed by physiotherapy intervention including Proximal stability training, Balance training, Functional movement training using the principles of Visual Motor Coordination and Body Awareness Training, after the 8 weeks of the treatment program the post-test assessment for the Balance, Coordination and Intensity of Tremor was done using the outcome measures. The results were analyzed using student‘t’ test, that showed a significant improvement. Hence it can be concluded that the visual motor coordination with body awareness training is effective in patients with cerebellar ataxia

State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

The research team, in consultation with collaborating clinician Sarah Bicker, an OTR/L at Harborview Medical Center, researched everyday technology applications. The team conducted a systematic review considering what evidence exists about the effectiveness of commercially available everyday technology (ET) for improving upper extremity motor control and/or motivation to participate in therapy in clients post-stroke. The evidence was promising in support of the use of ET as indicated by improved upper extremity motor control outcomes and client and clinician reports of satisfaction, motivation, and engagement in post-stroke rehabilitation. Clinicians should consider the benefits of implementing ET for upper extremity motor recovery for clients post-stroke. Due to the changing nature of ET, the research team chose to minimize recommendations of specific applications. Instead, the team created a decision chart to help therapists identify what elements to consider when choosing a technology application to address the upper extremity motor control conditions/impairments with clients post-stroke. The decision tree considers performance skills according to the Occupational Therapy Practice Framework (OTPF), and includes current applications as examples. The research findings and decision chart were presented as an in-service to occupational therapy (OT) practitioners at Harborview Medical Center. Feedback from the in-service indicated that practitioners were positively receptive to the information provided and were more likely to incorporate ET into rehabilitation with their clients as a result of learning the research findings. Reviewing the literature indicates the need for more research regarding technology use for rehabilitation of individuals post-stroke

Immersive Virtual Reality Training Improved Upper Extremity Function in Patients with Spinal Cord Injuries: A Case Series

Virtual reality (VR) is an emerging treatment tool to engage people in environments that appear and feel similar to real-world objects and events.1 There are various levels of evidence that VR can potentially promote functional activity and neuroplasticity in patients with neurological disorders like spinal cord injury (SCI).2,3 In this case series, we explored the feasibility of using commercially available immersive VR technology as an augmented treatment in the SCI population and compare participant’s suitability for this intervention. Three male SCI participants were recruited in a subacute inpatient rehabilitation facility and participated in VR intervention twice a week in addition to their conventional therapies. Manual strength and functional testing were recorded biweekly until participants discharged. Training includes reaching activities, wrist rotation, gripping, and thumb movement to simulate real-life activities. A questionnaire regarding their experience with VR training was administered at the end. All participants had improvement in strength and functional tests. 9-hole peg test demonstrated clinically meaningful change in two of three participants. Manual muscle test changes were 2, 4.5 and 13.5 points individually. Participants with lower manual muscle test scores at baseline showed more potential to change compared to those who had high scores, which would possibly due to plateau effect. Pinch and grip strength demonstrated small changes which were not clinically important. Participants also rated VR technology of high reality level and great enjoyment in the questionnaire. This case series suggests that immersive VR with head mount display may be viable to provide safe and effective treatment for patients with SCI. VR training appears to be a possible adjunct to physical and occupational therapy as a method of muscle strengthening, improving upper extremity function and improving motivation during subacute rehabilitation

The Click Test: A Novel Tool to Quantify the Age-Related Decline of Fast Motor Sequencing of the Thumb

International audienceAbstract : Background: The thumb plays a critical role for manual tasks during the activities of daily life and the incidence of neurological or musculoskeletal disorders affecting the voluntary movements of the thumb is high in the elderly. There is currently no tool to assess repetitive motor sequencing of the thumb during ageing.Objectives: To report a novel procedure (the Click Test) assessing the effects of ageing on fast motor sequencing of the thumb.Methods : Healthy subjects (n = 252; mean age +/- SD: 49.76 +/- 19.97 years; range: 19-89 years; F/M: 151/101) were asked to perform fast repeated flexion/extension movements of the thumb using a mechanical counter.Results: Motor performances (assessed by the number of clicks during 3 time periods: 15, 30 and 45 sec), significantly decreased as a function of age for both the dominant (age effect; p< 0.0001 for 15, 30 and 45 sec) and the non-dominant hand (p<0.0001 for 15, 30 and 45 sec). The number of clicks was significantly higher in males (gender effect; p<0.001) and was higher on the dominant side as compared to the non-dominant side (handedness effect: p<0.001). The Click Test is characterized by high repeatability (coefficients of variation from 3.20 to 4.47%), excellent intra-rater reliability (intra-class coefficients ICC ranging from 0.89 to 0.98), high inter-rater reproducibility (Pearson’s product correlation ranging from 0.85 to 0.96), high internal consistency (Cronbach alpha coefficient=0.95) and is highly correlated in terms of relative performances with the box and block test and the 9-hole peg test (positive linear correlation with the results of the box and block test: p<0.001 for 15, 30 and 45 sec for both the dominant and the non-dominant hand; negative linear correlation with the results of the 9-hole peg test: p<0.001 for 15, 30 and 45 sec for both the dominant and the non-dominant hand).Conclusion : The Click Test is an entirely novel and very low cost tool to reliably discriminate the ageing effects upon the performances during fast repetitive motor sequencing of the thumb. The potential clinical and research applications for motor functions are multiple, especially in acute and chronic neurological disorders affecting the thumb as well as in the field of rheumatology and orthopedics

A Training Program to Develop Specific Manual Dexterity Skills of Down’s Syndrome Children

This study was designed to determine if the fine motor skills of three young Down’s Syndrome children functioning below average in manual dexterity skills could be improved through a systematic training program. The selected subjects were met individually for thirty minutes a day, four days per week (Monday through Thursday), for a period of seven weeks. Each child was trained by repeated practice on ten specific tasks involving arm, hand, and finger manipulation. Subjective data recorded during each session by the investigator indicated that, generally, all three subjects appeared to improve on the manual dexterity tasks. These results were supported by gains generally found in the Purdue Pegboard, the Crawford Small Parts Dexterity Test, and the Stromberg Dexterity Test which were administered prior to and at the completion of training. However, limitations of the study prohibit the conclusion that improvement was due to the systematic training program employed in the study

On Neuromechanical Approaches for the Study of Biological Grasp and Manipulation

Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition, dramatically different and can even be antithetical. Even our approach to each is diametrically opposite: inductive science for the study of biological systems vs. engineering synthesis for the design and construction of robotic systems. The past 20 years have seen several conceptual advances in both fields and the quest to unify them. Chief among them is the reluctant recognition that their underlying fundamental mechanisms may actually share limited common ground, while exhibiting many fundamental differences. This recognition is particularly liberating because it allows us to resolve and move beyond multiple paradoxes and contradictions that arose from the initial reasonable assumption of a large common ground. Here, we begin by introducing the perspective of neuromechanics, which emphasizes that real-world behavior emerges from the intimate interactions among the physical structure of the system, the mechanical requirements of a task, the feasible neural control actions to produce it, and the ability of the neuromuscular system to adapt through interactions with the environment. This allows us to articulate a succinct overview of a few salient conceptual paradoxes and contradictions regarding under-determined vs. over-determined mechanics, under- vs. over-actuated control, prescribed vs. emergent function, learning vs. implementation vs. adaptation, prescriptive vs. descriptive synergies, and optimal vs. habitual performance. We conclude by presenting open questions and suggesting directions for future research. We hope this frank assessment of the state-of-the-art will encourage and guide these communities to continue to interact and make progress in these important areas

Introducing wearable haptics for rendering velocity feedback in VR serious games for neuro-rehabilitation of children

Rehabilitation in virtual reality offers advantages in terms of flexibility and parametrization of exercises, repeatability, and continuous data recording and analysis of the progress of the patient, also promoting high engagement and cognitive challenges. Still, most of the proposed virtual settings provide a high quality, immersive visual and audio feedback, without involving the sense of touch. In this paper, we show the design, implementation, and first evaluation of a gaming scenario for upper limb rehabilitation of children with cerebral palsy. In particular, we took care to introduce haptic feedback as a useful source of sensory information for the proposed task, considering—at the same time—the strict constraints for haptic wearable devices to comply with patient’s comfort, residual motor abilities, and with the embedded tracking features of the latest VR technologies. To show the potential of haptics in a rehabilitation setup, the proposed device and rendering method have been used to improve the velocity control of upper limb movements during the VR exercise, given its importance as a motor recovery metric. Eight healthy participants were enrolled, and results showed that haptic feedback can lead to lower speed tracking errors and higher movement smoothness, making the proposed setup suitable to be used in a rehabilitation context as a way to promote movement fluidity during exercises

Respiratory, postural and spatio-kinetic motor stabilization, internal models, top-down timed motor coordination and expanded cerebello-cerebral circuitry: a review

Human dexterity, bipedality, and song/speech vocalization in Homo are reviewed within a motor evolution perspective in regard to &#xd;&#xa;&#xd;&#xa;(i) brain expansion in cerebello-cerebral circuitry, &#xd;&#xa;(ii) enhanced predictive internal modeling of body kinematics, body kinetics and action organization, &#xd;&#xa;(iii) motor mastery due to prolonged practice, &#xd;&#xa;(iv) task-determined top-down, and accurately timed feedforward motor adjustment of multiple-body/artifact elements, and &#xd;&#xa;(v) reduction in automatic preflex/spinal reflex mechanisms that would otherwise restrict such top-down processes. &#xd;&#xa;&#xd;&#xa;Dual-task interference and developmental neuroimaging research argues that such internal modeling based motor capabilities are concomitant with the evolution of &#xd;&#xa;(vi) enhanced attentional, executive function and other high-level cognitive processes, and that &#xd;&#xa;(vii) these provide dexterity, bipedality and vocalization with effector nonspecific neural resources. &#xd;&#xa;&#xd;&#xa;The possibility is also raised that such neural resources could &#xd;&#xa;(viii) underlie human internal model based nonmotor cognitions. &#xd;&#xa

Robot-assisted therapy for upper limb impairments in cerebral palsy:A scoping review and suggestions for future research

A growing number of studies investigate the use of robotics therapy for motor (re)habilitation with children with cerebral palsy (CP). Most of these studies use functional robots in very repetitive sessions. While the therapy is effective, very few studies employ social robots, which appears to be a missed opportunity to design more compelling and enjoyable sessions for the children. In this article, we will review robot-assisted upper limb motor (re)habilitation for children with CP. Previous reviews of robot-assisted therapy for CP had mostly focused on lower limbs, or the review was made from a medical point of view, with the sole concern being the therapy's effectiveness. Here, we focus our review on robot-assisted upper limb (re)habilitation and address human-robot interaction considerations. We searched PubMed, Scopus, and IEEE databases and argue that although this area of research is promising and already effective, it would benefit from the inclusion of social robots for a more engaging and enjoyable experience. We suggest four scenarios that could be developed in this direction. The goal of this article is to highlight the relevance of the past work and encourage the development of new ideas where therapy will socially engage and motivate children.</p

Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial

BACKGROUND Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. OBJECTIVE To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). METHODS A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. RESULTS There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. CONCLUSIONS Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy