A New Rehabilitation Method for Stroke Patients: A Comparative Study between the Pasta Matrix Reaching Task and the Novel Reaching Task

Stroke is a leading cause of disability worldwide. To promote better outcome for stroke survivors, scientists use animal models to understand basic mechanisms of stroke, rehabilitation, and recovery. Rodent models have revealed that skilled reach training (e.g., coordinated use of digits and limbs) promotes improved functional outcome following stroke. The single-pellet task (SPT) is widely used in rats; however, it can be an insensitive measure in other species, such as mice. The pasta matrix task (PMT) has been effectively implemented in mice; however, the task is limited by its required strength component. This study introduces a novel-reaching task aimed at overcoming the limitations of established tasks. Mice were trained on the PMT, SPT, or the novel task to establish the skill and determine the efficacy of each task. The novel task proved to be difficult for the mice, with performance levels reaching an overall average of 18.5%. After 20 days of training, performance did not reach an asymptotic level. Performance on the PMT and SPT resembled established levels of successful acquisition. Multiple modifications of the novel-reaching task apparatus were explored. Though a poor assessment tool, we believe the novel-reaching task may be particularly useful as a rehabilitative strategy due to the complexity of reach it promotes, which should stimulate high levels of neural plasticity. Findings from this study highlight the importance of drawing comparisons across reaching tasks and caution comparing different task results to one other. A follow-up study is underway whereby each task is compared for its rehabilitative benefits

Probing the time course of facilitation and inhibition in gaze cueing of attention in an upper-limb reaching task

Previous work has revealed that social cues, such as gaze and pointed fingers, can lead to a shift in the focus of another person’s attention. Research investigating the mechanisms of these shifts of attention has typically employed detection or localization button-pressing tasks. Because in-depth analyses of the spatiotemporal characteristics of aiming movements can provide additional insights into the dynamics of the processing of stimuli, in the present study we used a reaching paradigm to further explore the processing of social cues. In Experiments 1 and 2, participants aimed to a left or right location after a nonpredictive eye gaze cue toward one of these target locations. Seven stimulus onset asynchronies (SOAs), from 100 to 2,400 ms, were used. Both the temporal (reaction time, RT) and spatial (initial movement angle, IMA) characteristics of the movements were analyzed. RTs were shorter for cued (gazed-at) than for uncued targets across most SOAs. There were, however, no statistical differences in IMAs between movements to cued and uncued targets, suggesting that action planning was not affected by the gaze cue. In Experiment 3, the social cue was a finger pointing to one of the two target locations. Finger-pointing cues generated significant cueing effects in both RTs and IMAs. Overall, these results indicate that eye gaze and finger-pointing social cues are processed differently. Perception–action coupling (i.e., a tight link between the response and the social cue that is presented) might play roles in both the generation of action and the deviation of trajectories toward cued and uncued targets

Task-dependent Modulation of Cortical Excitability and Balance Control in Individuals with Post-concussion Syndrome

In most cases, symptoms resolve between 7-10 days post-concussion. However, in 10-15% of the concussed population, symptoms can remain unresolved for months to years following the head injury. The purpose of this thesis was two-fold, and was broken up into two studies, where the same individuals participated in both studies. The purpose of the first study was to quantify the differences in balance control between individuals with PCS (i.e., had been experiencing symptoms for \u3c30 days) and non-concussed individuals during a lower-limb reaching task. Participants completed a static balance assessment before and after a lower-limb reaching task, which incorporated a Go/No-Go paradigm. Results from this study revealed no differences in the static stability assessments, however, individuals with PCS demonstrated increased medial-lateral COP displacement as well as greater trunk pitch during the reaching task. Overall, the findings reveal persistent balance impairments in individuals with PCS, which may put this population at an increased risk of further injury. The purpose of the second study was to assess task-dependent modulation of cortical excitability prior to planned index finger abduction contractions comparing a non-concussed population to a population with PCS. The protocol in this study consisted of both single and paired-pulse transcranial magnetic stimulation (TMS) which was applied prior to the beginning of 3 different tasks (i.e., a rest condition with no plan to contract, a precision contraction, and a powerful contraction). In addition to the three tasks, participants also had to respond to a Go/No-Go cue. The results of this study revealed an increase in excitability prior to a precision contraction in both non-concussed and PCS groups. No differences in task-dependent modulation were found between the two groups with respect to intracortical facilitation and inhibition, however a negative correlation between number of symptoms reported (SCAT3 symptom evaluation) and intracortical facilitation was revealed. The increase in corticospinal excitability prior to a precision contraction was not explained by the two cortical mechanisms we assessed and may therefore be due to spinal modulation or a different cortical mechanism. Overall, based on the results from this thesis, it appears that individuals with PCS have balance impairments, which may be a result of an inability to maximally activate their postural muscles. Furthermore, it appears that those individuals who reported a higher number of symptoms had greater reductions in intracortical facilitation, likely reflecting the heterogeneity of this clinical group

Training spatial hearing skills in virtual reality through a sound-reaching task

Sound localization is crucial for interacting with the surrounding world. This ability can be learned across time and improved by multisensory and motor cues. In the last decade, studying the contributions of multisensory and motor cues has been facilitated by the increased adoption of virtual reality (VR). In a recent study, sound localization had been trained through a task where the visual stimuli were rendered through a VR headset, and the auditory ones through a loudspeaker moved around by the experimenter. Physically reaching to sound sources reduced sound localization errors faster and to a greater extent if compared to naming sources’ positions. Interestingly, training efficacy extended also to hearing-impaired people. Yet, this approach is unfeasible for rehabilitation at home. Fullyvirtual approaches have been used to study spatial hearing learning processes, performing headphones-rendered acoustic simulations. In the present study, we investigate whether the effects of our reaching-based training can be observed when taking advantage of such simulations, showing that the improvement is comparable between the full-VR and blended VR conditions. This validates the use of training paradigms that are completely based on portable equipment and don’t require an external operator, opening new perspectives in the field of remote rehabilitation

Remote concussion history does not affect visually-guided reaching in young adult females

Aim: We examined the long-term effects of concussions in young adult females on visuomotor behavior during a visually-guided reaching task of various complexities. Materials & methods: 20 females with a history of longer than 6 months since a concussion and 20 healthy females quickly and accurately performed a delayed reach to a previously cued target. Results: As both cognitive and motor load increased, task performance decreased for both groups (p \u3c 0.05). However, contrary to our primary hypothesis, no differences in task performance were found between the two experimental groups (p \u3e 0.05). Conclusion: The young adult females with a remote history of concussion demonstrated no deficits in visuomotor behavior on an attention-mediated reaching task as compared with control participants. Lay abstract: Current literature is inconclusive regarding the long-term effects of concussion. Some have argued that the differing results are due to many uncontrolled factors in study design. In this study, 20 females with a history of concussion more than 6 months ago and 20 healthy females performed a reaching task under different levels of difficulty. As the reaching task got harder, both groups had greater difficulty doing the task quickly and accurately (p \u3c 0.05). Surprisingly, however, no differences in reaching performance existed between the two groups (p \u3e 0.05). Young adult females with a remote history of concussion demonstrated no greater problems with complicated reaching tasks when compared with control participants when experimental conditions are tightly controlled

Effect of Reinforcement History on Hand Choice in an Unconstrained Reaching Task

Choosing which hand to use for an action is one of the most frequent decisions people make in everyday behavior. We developed a simple reaching task in which we vary the lateral position of a target and the participant is free to reach to it with either the right or left hand. While people exhibit a strong preference to use the hand ipsilateral to the target, there is a region of uncertainty within which hand choice varies across trials. We manipulated the reinforcement rates for the two hands, either by increasing the likelihood that a reach with the non-dominant hand would successfully intersect the target or decreasing the likelihood that a reach with the dominant hand would be successful. While participants had minimal awareness of these manipulations, we observed an increase in the use of the non-dominant hand for targets presented in the region of uncertainty. We modeled the shift in hand use using a Q-learning model of reinforcement learning. The results provided a good fit of the data and indicate that the effects of increasing and decreasing the rate of positive reinforcement are additive. These experiments emphasize the role of decision processes for effector selection, and may point to a novel approach for physical rehabilitation based on intrinsic reinforcement

A Force-Feedback Exoskeleton for Upper-Limb Rehabilitation in Virtual Reality

This paper presents the design and the clinical validation of an upper-limb force-feedback exoskeleton, the L-EXOS, for robotic-assisted rehabilitation in virtual reality (VR). The L-EXOS is a five degrees of freedom exoskeleton with a wearable structure and anthropomorphic workspace that can cover the full range of motion of human arm. A specific VR application focused on the reaching task was developed and evaluated on a group of eight post-stroke patients, to assess the efficacy of the system for the rehabilitation of upper limb. The evaluation showed a significant reduction of the performance error in the reaching task (paired t-test, p < 0.02

Whisker and Nose Tactile Sense Guide Rat Behavior in a Skilled Reaching Task.

Skilled reaching is a complex movement in which a forelimb is extended to grasp food for eating. Video-recordings analysis of control rats enables us to distinguish several components of skilled reaching: Orient, approaching the front wall of the reaching box and poking the nose into the slot to locate the food pellet; Transport, advancing the forelimb through the slot to reach-grasp the pellet; and Withdrawal of the grasped food to eat. Although food location and skilled reaching is guided by olfaction, the importance of whisker/nose tactile sense in rats suggests that this too could play a role in reaching behavior. To test this hypothesis, we studied skilled reaching in rats trained in a single-pellet reaching task before and after bilateral whisker trimming and bilateral infraorbital nerve (ION) severing. During the task, bilaterally trimmed rats showed impaired Orient with respect to controls. Specifically, they detected the presence of the wall by hitting it with their nose (rather than their whiskers), and then located the slot through repetitive nose touches. The number of nose touches preceding poking was significantly higher in comparison to controls. On the other hand, macrovibrissae trimming resulted in no change in reaching/grasping or withdrawal components of skilled reaching. Bilaterally ION-severed rats, displayed a marked change in the structure of their skilled reaching. With respect to controls, in ION-severed rats: (a) approaches to the front wall were significantly reduced at 3-5 and 6-8 days; (b) nose pokes were significantly reduced at 3-5 days, and the slot was only located after many repetitive nose touches; (c) the reaching-grasping-retracting movement never appeared at 3-5 days; (d) explorative paw movements, equal to zero in controls, reached significance at 9-11 days; and (e) the restored reaching-grasping-retracting sequence was globally slower than in controls, but the success rate was the same. These findings strongly indicate that whisker trimming affected Orient, but not the reaching-grasping movement, while ION severing impaired both Orient (persistently) and reaching-grasping-retracting (transiently, for 1-2 weeks) components of skilled reaching in rats

Statistical Analysis and Kinematic Assessment of Upper Limb Reaching Task in Parkinson’s Disease

The impact of neurodegenerative disorders is twofold; they affect both quality of life and healthcare expenditure. In the case of Parkinson’s disease, several strategies have been attempted to support the pharmacological treatment with rehabilitation protocols aimed at restoring motor function. In this scenario, the study of upper limb control mechanisms is particularly relevant due to the complexity of the joints involved in the movement of the arm. For these reasons, it is difficult to define proper indicators of the rehabilitation outcome. In this work, we propose a methodology to analyze and extract an ensemble of kinematic parameters from signals acquired during a complex upper limb reaching task. The methodology is tested in both healthy subjects and Parkinson’s disease patients (N = 12), and a statistical analysis is carried out to establish the value of the extracted kinematic features in distinguishing between the two groups under study. The parameters with the greatest number of significances across the submovements are duration, mean velocity, maximum velocity, maximum acceleration, and smoothness. Results allowed the identification of a subset of significant kinematic parameters that could serve as a proof-of-concept for a future definition of potential indicators of the rehabilitation outcome in Parkinson’s disease

Memory for spatial locations in a patient with near space neglect and optic ataxia: Involvement of the occipitotemporal stream

Previous studies suggested that the occipitoparietal stream orients attention toward the near/lower space and is involved in immediate reaching, whereas the occipitotemporal stream orients attention toward the far/upper space and is involved in delayed reaching. In the present study, we investigated the role of the occipitotemporal stream in attention orienting and delayed reaching in a patient (GP) with bilateral damage to the occipitoparietal areas and optic ataxia. GP and healthy controls took part in three experiments. In the experiment 1, the participants bisected lines oriented along radial, vertical, and horizontal axes. GP bisected radial lines farther, and vertical lines more above, than the controls, consistent with an attentional bias toward the far/upper space and near/lower space neglect. The experiment 2 consisted of two tasks: (1) an immediate reaching task, in which GP reached target locations under visual control and (2) a delayed visual reaching task, in which GP and controls were asked to reach remembered target locations visually presented. We measured constant and variable distance and direction errors. In immediate reaching task, GP accurately reached target locations. In delayed reaching task, GP overshot remembered target locations, whereas the controls undershot them. Furthermore, variable errors were greater in GP than in the controls. In the experiment 3, GP and controls performed a delayed proprioceptive reaching task. Constant reaching errors did not differ between GP and the controls. However, variable direction errors were greater in GP than in the controls. We suggest that the occipitoparietal damage, and the relatively intact occipitotemporal region, produced in GP an attentional orienting bias toward the far/upper space (experiment 1). In turns, the attentional bias selectively shifted toward the far space remembered visual (experiment 2), but not proprioceptive (experiment 3), target locations. As a whole, these findings further support the hypothesis of an involvement of the occipitotemporal stream in delayed reaching. Furthermore, the observation that in both delayed reaching tasks the variable errors were greater in GP than in the controls suggested that in optic ataxia is present not only a visuo- but also a proprioceptivo-motor integration deficit