Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Relating reflex gain modulation in posture control to underlying neural network properties using a neuromusculoskeletal model

During posture control, reflexive feedback allows humans to efficiently compensate for unpredictable mechanical disturbances. Although reflexes are involuntary, humans can adapt their reflexive settings to the characteristics of the disturbances. Reflex modulation is commonly studied by determining reflex gains: a set of parameters that quantify the contributions of Ia, Ib and II afferents to mechanical joint behavior. Many mechanisms, like presynaptic inhibition and fusimotor drive, can account for reflex gain modulations. The goal of this study was to investigate the effects of underlying neural and sensory mechanisms on mechanical joint behavior. A neuromusculoskeletal model was built, in which a pair of muscles actuated a limb, while being controlled by a model of 2,298 spiking neurons in six pairs of spinal populations. Identical to experiments, the endpoint of the limb was disturbed with force perturbations. System identification was used to quantify the control behavior with reflex gains. A sensitivity analysis was then performed on the neuromusculoskeletal model, determining the influence of the neural, sensory and synaptic parameters on the joint dynamics. The results showed that the lumped reflex gains positively correlate to their most direct neural substrates: the velocity gain with Ia afferent velocity feedback, the positional gain with muscle stretch over II afferents and the force feedback gain with Ib afferent feedback. However, position feedback and force feedback gains show strong interactions with other neural and sensory properties. These results give important insights in the effects of neural properties on joint dynamics and in the identifiability of reflex gains in experiments

Use of Self-Selected Postures to Regulate Multi-Joint Stiffness During Unconstrained Tasks

The human motor system is highly redundant, having more kinematic degrees of freedom than necessary to complete a given task. Understanding how kinematic redundancies are utilized in different tasks remains a fundamental question in motor control. One possibility is that they can be used to tune the mechanical properties of a limb to the specific requirements of a task. For example, many tasks such as tool usage compromise arm stability along specific directions. These tasks only can be completed if the nervous system adapts the mechanical properties of the arm such that the arm, coupled to the tool, remains stable. The purpose of this study was to determine if posture selection is a critical component of endpoint stiffness regulation during unconstrained tasks.Three-dimensional (3D) estimates of endpoint stiffness were used to quantify limb mechanics. Most previous studies examining endpoint stiffness adaptation were completed in 2D using constrained postures to maintain a non-redundant mapping between joint angles and hand location. Our hypothesis was that during unconstrained conditions, subjects would select arm postures that matched endpoint stiffness to the functional requirements of the task. The hypothesis was tested during endpoint tracking tasks in which subjects interacted with unstable haptic environments, simulated using a 3D robotic manipulator. We found that arm posture had a significant effect on endpoint tracking accuracy and that subjects selected postures that improved tracking performance. For environments in which arm posture had a large effect on tracking accuracy, the self-selected postures oriented the direction of maximal endpoint stiffness towards the direction of the unstable haptic environment.These results demonstrate how changes in arm posture can have a dramatic effect on task performance and suggest that postural selection is a fundamental mechanism by which kinematic redundancies can be exploited to regulate arm stiffness in unconstrained tasks

Range-based techniques for discovering optimality and analyzing scaling relationships in neuromechanical systems

In this paper, a method for decoupling the neuromuscular function of a set of limbs from the role morphology plays in regulating the performance of an activity is introduced. This method is based on two previous methods: the rescaled range analysis specific to time series data, and the use of scaling laws. A review of the literature suggests that limb geometry can either facilitate or constrain performance as measured experimentally. Whether limb geometry is facilitatory or acts as a constraint depends on the size differential between arm morphology and the underlying muscle. "Changes in size and shape" are theoretically extrapolations of morphological geometry to other members of a population or species, to other species, or to technological manipulations of an individual via prosthetic devices. Three datasets are analyzed using the range-based method and a Monte-Carlo simulation, and are used to test the various ways of executing this analysis. It was found that when performance is kept stable but limb size and shape is scaled by a factor of .25, the greatest gain in performance results. It was also found that introducing force-based perturbations results in 'shifts' in the body geometry/performance relationship. While results such as this could be interpreted as a statistical artifact, the non-linear rise within a measurement class and linear decrease between measurement classes suggests an effect of scale in the optimality of this relationship. Overall, range-based techniques allow for the simulation and modeling of myriad changes in phenotype that result from biological and technological manipulation

Reflex control of the spine and posture: a review of the literature from a chiropractic perspective

OBJECTIVE: This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics of the postural reflexes by reporting previous observations of subjects during periods of microgravity or weightlessness. BACKGROUND: Historically, chiropractic has centered around the concept that the nervous system controls and regulates all other bodily systems; and that disruption to normal nervous system function can contribute to a wide variety of common ailments. Surprisingly, the chiropractic literature has paid relatively little attention to the importance of neurological regulation of static upright human posture. With so much information available on how posture may affect health and function, we felt it important to review the neuroanatomical structures and pathways responsible for maintaining the spine and posture. Maintenance of static upright posture is regulated by the nervous system through the various postural reflexes. Hence, from a chiropractic standpoint, it is clinically beneficial to understand how the individual postural reflexes work, as it may explain some of the clinical presentations seen in chiropractic practice. METHOD: We performed a manual search for available relevant textbooks, and a computer search of the MEDLINE, MANTIS, and Index to Chiropractic Literature databases from 1970 to present, using the following key words and phrases: "posture," "ocular," "vestibular," "cervical facet joint," "afferent," "vestibulocollic," "cervicocollic," "postural reflexes," "spaceflight," "microgravity," "weightlessness," "gravity," "posture," and "postural." Studies were selected if they specifically tested any or all of the postural reflexes either in Earth's gravity or in microgravitational environments. Studies testing the function of each postural component, as well as those discussing postural reflex interactions, were also included in this review. DISCUSSION: It is quite apparent from the indexed literature we searched that posture is largely maintained by reflexive, involuntary control. While reflexive components for postural control are found in skin and joint receptors, somatic graviceptors, and baroreceptors throughout the body, much of the reflexive postural control mechanisms are housed, or occur, within the head and neck region primarily. We suggest that the postural reflexes may function in a hierarchical fashion. This hierarchy may well be based on the gravity-dependent or gravity-independent nature of each postural reflex. Some or all of these postural reflexes may contribute to the development of a postural body scheme, a conceptual internal representation of the external environment under normal gravity. This model may be the framework through which the postural reflexes anticipate and adapt to new gravitational environments. CONCLUSION: Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system structures. This review of the postural reflex structures and mechanisms adds to the growing body of posture rehabilitation literature relating specifically to chiropractic treatment. Chiropractic interest in these reflexes may enhance the ability of chiropractic physicians to treat and correct global spine and posture disorders. With the knowledge and understanding of these postural reflexes, chiropractors can evaluate spinal configurations not only from a segmental perspective, but can also determine how spinal dysfunction may be the ultimate consequence of maintaining an upright posture in the presence of other postural deficits. These perspectives need to be explored in more detail

Development and implementation of Inflight Neurosensory Training for Adaptation/Readaptation (INSTAR)

Resolution of space motion sickness, and improvements in spatial orientation, posture and motion control, and compensatory eye movements occur as a function of neurosensory and sensorimotor adaptation to microgravity. These adaptive responses, however, are inappropriate for return to Earth. Even following relatively brief space Shuttle missions, significant re-adaptation disturbances related to visual performance, locomotion, and perceived self-motion have been observed. Russian reports suggest that these disturbances increase with mission duration and may be severe following landing after prolonged microgravity exposure such as during a voyage to Mars. Consequently, there is a need to enable the astronauts to be prepared for and more quickly re-adapt to a gravitational environment following extended space missions. Several devices to meet this need are proposed including a virtual environment - centrifuge device (VECD). A short-arm centrifuge will provide centripetal acceleration parallel to the astronaut's longitudinal body axis and a restraint system will be configured to permit head movements only in the plane of rotation (to prevent 'cross-coupling'). A head-mounted virtual environment system will be used to develop appropriate 'calibration' between visual motion/orientation signals and inertial motion/orientation signals generated by the centrifuge. This will permit vestibular, visual and somatosensory signal matches to bias central interpretation of otolith signals toward the 'position' responses and to recalibrate the vestibulo-ocular reflex (VOR)

Early Childhood Fine Motor Assessment

The development of hand function is ongoing from infancy through adulthood. Hand function is especially important in the early years as a child prepares for school. As with all skills, the level of hand function can range from excellent to average to clumsy or immature. Stability, strength, and endurance are key components of adequate hand skill development. These components are often areas of weakness in today\u27s society of technology and passive activities. Creating an assessment designed specifically for the identification of skill acquisition, as it pertains to hand function and fine motor development, in the early childhood years will assist therapists in establishing an intervention plan for that child. In tum, this will facilitate the development of pre-writing, pre-cutting, and grasp or manipulation skills. Early childhood education programs are designed to ensure school readiness and it is an appropriate location to incorporate an early childhood fine motor assessment tool for the initial and ongoing analysis of a child\u27s development in hand function and manipulation skills. The methodology used to gather the information for the development of the early childhood fine motor assessment included an extensive review of literature and research regarding the developmental milestones and the ancillary factors contributing to fine motor development in children age eighteen months to five and one half years of age. Consultation and feedback pertaining to the assessment was obtained from professionals within the field of occupational therapy and early childhood special education. Practice trials of the early childhood fine motor assessment tool included one hospital based pediatric setting, one early childhood classroom setting, and one rural consultation based early childhood school setting. The information gathered from an extensive literature review led to and supported the need to develop a quick, user-friendly early childhood fine motor assessment tool for children age eighteen months to five and one half years of age. The assessment tool is specifically intended to serve children in early childhood settings however, it may also be of benefit in the medical model setting. The assessment is specifically designed to address fine motor skill development in children 18 months to five and a half years. The tool can be administered in its entirety, in specific sections, or in segments to accommodate the early learner\u27s attention span and specific needs. Information gathered during this process is meant to be used as baseline for comparative data, for treatment planning, conference reporting, and for classroom, caregiver, and/or parent education. The Early Childhood Fine Motor Assessment Tool administration manual provides brief descriptions of each component to observe. The manual also provides age approximations, skill completion techniques, and observation cues to assist data collection. Each suggestion is intended only as that, as it is certain that each child develops individually and may utilize alternative successful techniques to achieve skills and each child may progress at varying speeds of development

Motor Adaptation and Automaticity in People with Parkinson’s Disease and Freezing of Gait

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by cell death in the substantia nigra pars compacta, resulting in motor symptoms of tremor, rigidity, bradykinesia and gait impairment. Freezing of gait (FOG) is one serious gait disturbance, characterized by a transient inability produce effective stepping during walking and turning, and affects roughly half of people with PD at some point during their disease. Despite the ongoing research on the behavioral, neurological, and cognitive characteristics of people with FOG (PD+FOG), the mechanisms underlying freezing are still poorly understood. The overall aim of this work was to further investigate motor behavior in PD+FOG to provide insight into its potential mechanisms. The first experiment investigated possible cerebellar dysfunction in PD+FOG by examining visuomotor adaptation, a well-known cerebellar-dependent process. We found that there were no differences in reaching or walking adaptation between freezers and non-freezers, however non-freezers exhibited smaller after-effects compared to freezers and healthy older adults. Furthermore, adults with PD, as well as older and younger adults adapt walking patterns slower than reaching patterns, indicating walking is a more complex task requiring greater sensorimotor processing to modify. Overall, this study showed that cerebellar function, in terms of its role in sensorimotor adaptation, is relatively preserved in PD and FOG. In the second experiment, we examined motor automaticity of saccadic eye movements and reaching. Reduced automaticity is a likely motor-cognitive mechanism that contributes to freezing behavior, however automaticity in other motor systems has yet to fully described. Using an anti-saccade task, we found that PD+FOG participants were slower to respond to both automatic and non-automatic eye movements, and had increased saccade velocity variability compared to PD-FOG and controls. These changes were not related to disease severity or general cognition. In contrast, both PD groups were slower to execute (greater latency) reaching movements during both pro- and anti-reaching, but no freezer non-freezer differences were noted. PD+FOG reached with lower peak velocity compared to older adults but were similar to PD-FOG during both automatic and non-automatic conditions. These data show that changes in automaticity and control exist outside locomotor centers, indicating freezing may be a global motor disturbance. Altogether, the work in this dissertation furthers our knowledge on motor control in PD+FOG and provides additional evidence that freezing affects non-gait motor function

Muscle synergies in neuroscience and robotics: from input-space to task-space perspectives

In this paper we review the works related to muscle synergies that have been carried-out in neuroscience and control engineering. In particular, we refer to the hypothesis that the central nervous system (CNS) generates desired muscle contractions by combining a small number of predefined modules, called muscle synergies. We provide an overview of the methods that have been employed to test the validity of this scheme, and we show how the concept of muscle synergy has been generalized for the control of artificial agents. The comparison between these two lines of research, in particular their different goals and approaches, is instrumental to explain the computational implications of the hypothesized modular organization. Moreover, it clarifies the importance of assessing the functional role of muscle synergies: although these basic modules are defined at the level of muscle activations (input-space), they should result in the effective accomplishment of the desired task. This requirement is not always explicitly considered in experimental neuroscience, as muscle synergies are often estimated solely by analyzing recorded muscle activities. We suggest that synergy extraction methods should explicitly take into account task execution variables, thus moving from a perspective purely based on input-space to one grounded on task-space as well