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

Bipedal steps in the development of rhythmic behavior in humans

We contrast two related hypotheses of the evolution of dance: H1: Maternal bipedal walking influenced the fetal experience of sound and associated movement patterns; H2: The human transition to bipedal gait produced more isochronous/predictable locomotion sound resulting in early music-like behavior associated with the acoustic advantages conferred by moving bipedally in pace. The cadence of walking is around 120 beats per minute, similar to the tempo of dance and music. Human walking displays long-term constancies. Dyads often subconsciously synchronize steps. The major amplitude component of the step is a distinctly produced beat. Human locomotion influences, and interacts with, emotions, and passive listening to music activates brain motor areas. Across dance-genres the footwork is most often performed in time to the musical beat. Brain development is largely shaped by early sensory experience, with hearing developed from week 18 of gestation. Newborns reacts to sounds, melodies, and rhythmic poems to which they have been exposed in utero. If the sound and vibrations produced by footfalls of a walking mother are transmitted to the fetus in coordination with the cadence of the motion, a connection between isochronous sound and rhythmical movement may be developed. Rhythmical sounds of the human mother locomotion differ substantially from that of nonhuman primates, while the maternal heartbeat heard is likely to have a similar isochronous character across primates, suggesting a relatively more influential role of footfall in the development of rhythmic/musical abilities in humans. Associations of gait, music, and dance are numerous. The apparent absence of musical and rhythmic abilities in nonhuman primates, which display little bipedal locomotion, corroborates that bipedal gait may be linked to the development of rhythmic abilities in humans. Bipedal stimuli in utero may primarily boost the ontogenetic development. The acoustical advantage hypothesis proposes a mechanism in the phylogenetic development

Swayed by sound: sonic guidance as a neurorehabilitation strategy in the cerebellar ataxias

Cerebellar disease leads to problems in controlling movement. The most common difficulties are dysmetria and instability when standing. Recent understanding of cerebellar function has expanded to include non -motor aspects such as emotional, cognitive and sensory processing. Deficits in the acquisition and processing of sensory information are one explanation for the movement problems observed in cerebellar ataxia. Sensory deficits result in an inability to make predictions about future events; a primary function of the cerebellum. A question therefore, is whether augmenting or replacing sensory information can improve motor performance in cerebellar disease. This question is tested in this thesis by augmenting sensory information through the provision of an auditory movement guide.A variable described in motor control theory (tau) was used to develop auditory guides that were continuous and dynamic. A reaching experiment using healthy individuals showed that the timing of peak velocity, audiomotor coordination accuracy, and velocity of approach, could be altered in line with the movement parameters embedded in the auditory guides. The thesis then investigated the use of these sonic guides in a clinical population with cerebellar disease. Performance on neurorehabilitation exercises for balance control was tested in twenty people with cerebellar atrophy, with and without auditory guides. Results suggested that continuous, predictive, dynamic auditory guidance is an effective way of improving iii movement smoothness in ataxia (as measured by jerk). In addition, generating and swaying with imaginary auditory guides was also found to increase movement smoothness in cerebellar disease.Following the tests of instantaneous effects, the thesis then investigated the longterm consequences on motor behaviour of following a two -month exercise with auditory guide programme. Seven people with cerebellar atrophy were assessed pre - and post -intervention using two measures, weight -shifting and walking. The results of the weight -shifting test indicated that the sonic -guide exercise programme does not initiate long -term changes in motor behaviour. Whilst there were minor, improvements in walking, because of the weight -shifting results, these could not be attributed to the sonic guides. This finding confirms the difficulties of motor rehabilitation in people with cerebellar disease.This thesis contributes original findings to the field of neurorehabilitation by first showing that on -going and predictive stimuli are an appropriate tool for improving motor behaviour. In addition, the thesis is the first of its kind to apply externally presented guides that convey continuous meaningful information within a clinical population. Finally, findings show that sensory augmentation using the auditory domain is an effective way of improving motor coordination in some forms of cerebellar disease

Virtual reality-based assessment and rehabilitation of functional mobility

The advent of virtual reality (VR) as a tool for real-world training dates back to the mid-twentieth century and the early years of driving and flight simulators. These simulation environments, while far below the quality of today’s visual displays, proved to be advantageous to the learner due to the safe training environments the simulations provided. More recently, these training environments have proven beneficial in the transfer of user-learned skills from the simulated environment to the real world [5, 31, 48, 51, 57]. Of course the VR technology of today has come a long way. Contemporary displays boast high-resolution, wide-angle fields of view and increased portability. This has led to the evolution of new VR research and training applications in many different arenas, several of which are covered in other chapters of this book. This is true of clinical assessment and rehabilitation as well, as the field has recognized the potential advantages of incorporating VR technologies into patient training for almost 20 years [7, 10, 18, 45, 78]

On natural attunement:Shared rhythms between the brain and the environment

Rhythms exist both in the embodied brain and the built environment. Becoming attuned to the rhythms of the environment, such as repetitive columns, can greatly affect perception. Here, we explore how the built environment affects human cognition and behavior through the concept of natural attunement, often resulting from the coordination of a person's sensory and motor systems with the rhythmic elements of the environment. We argue that the built environment should not be reduced to mere states, representations, and single variables but instead be considered a bundle of highly related continuous signals with which we can resonate. Resonance and entrainment are dynamic processes observed when intrinsic frequencies of the oscillatory brain are influenced by the oscillations of an external signal. This allows visual rhythmic stimulations of the environment to affect the brain and body through neural entrainment, cross-frequency coupling, and phase resetting. We review how real-world architectural settings can affect neural dynamics, cognitive processes, and behavior in people, suggesting the crucial role of everyday rhythms in the brain-body-environment relationship

Movement Sonification: Effects on Motor Learning beyond Rhythmic Adjustments

Motor learning is based on motor perception and emergent perceptual-motor representations. A lot of behavioral research is related to single perceptual modalities, but during last two decades the contribution of multimodal perception on motor behavior was discovered more and more. A growing number of studies indicate an enhanced impact of multimodal stimuli on motor perception, motor control and motor learning in terms of better precision and higher reliability of the related actions. Behavioral research is supported by neurophysiological data, revealing that multisensory integration supports motor control and learning. But the overwhelming part of both research lines is dedicated to basic research. Besides research in the domains of music, dance and motor rehabilitation there is nearly no evidence about enhanced effectiveness of multisensory information on learning of gross motor skills. To reduce this gap movement sonification is used here in applied research on motor learning in sports.Based on the current knowledge on the multimodal organization of the perceptual system we generate additional real-time movement information being suitable for integration with perceptual feedback streams of visual and proprioceptive modality. With ongoing training synchronously processed auditory information should be initially integrated into the emerging internal models, enhancing the efficacy of motor learning. This is achieved by a direct mapping of kinematic and dynamic motion parameters to electronic sounds, resulting in continuous auditory and convergent audiovisual or audio-proprioceptive stimulus arrays. In sharp contrast to other approaches using acoustic information as error feedback in motor learning settings we try to generate additional movement information suitable for acceleration and enhancement of adequate sensorimotor representations and processible below the level of consciousness. In the experimental setting participants were asked to learn a closed motor skill (technique acquisition of indoor rowing). One group was treated with visual information and two groups with audiovisual information (sonification vs. natural sounds). For all three groups learning became evident and remained stable. Participants treated with additional movement sonification showed better performance compared to both other groups. Results indicate that movement sonification enhances motor learning of a complex gross motor skill – even exceeding usually expected acoustic rhythmical effects on motor learning

A general procedure to measure the pacing of body movements timed to music and metronome in younger and older adults

© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Finger-tapping tasks are classically used to investigate sensorimotor synchronization in relation to neutral auditory cues, such as metronomes. However, music is more commonly associated with an entrained bodily response, such as toe tapping, or dancing. Here we report an experimental procedure that was designed to bridge the gap between timing and intervention studies by directly comparing the effects of metronome and musical cue types on motor timing abilities across the three naturalistic voluntary actions of finger tapping, toe tapping, and stepping on the spot as a simplified case of whole body movement. Both pacing cues were presented at slow, medium, and fast tempi. The findings suggested that the task of stepping on the spot enabled better timing performances than tapping both in younger and older adults (75+). Timing performances followed an inverse U shape with best performances observed in the medium tempi that were set close to the spontaneous motor tempo in each movement type. Finally, music provided an entrainment effect in addition to pace setting that enabled better motor timing and greater stability than classically reported using a metronome. By applying time-stamp analyses to kinetic data, we demonstrate that tapping and stepping engage different timing modes. This work details the importance of translational research for a better understanding of motor timing. It offers a simple procedure that strengthens the validity of applying academic work and contributes in knowledge towards a wide range of therapeutic interventions.Peer reviewe