Muscle weakness and lack of reflex gain adaptation predominate during post-stroke posture control of the wrist

Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to wrist joint stiffness during an active posture task. Continuous random torque perturbations applied to the wrist joint by a haptic manipulator had to be resisted maximally. Reflex provoking conditions were applied i.e. additional viscous loads and reduced perturbation signal bandwidth. Linear system identification and neuromuscular modeling were used to separate joint stiffness into the intrinsic resistance of the muscles including co-contraction and the reflex mediated contribution. Compared to an age and sex matched control group, patients showed an overall 50% drop in intrinsic elasticity while their reflexive contribution did not respond to provoking conditions. Patients showed an increased mechanical stability compared to control subjects. Post stroke, we found active posture tasking to be dominated by: 1) muscle weakness and 2) lack of reflex adaptation. This adds to existing doubts on reflex blocking therapy as the sole paradigm to improve active task performance and draws attention to muscle strength and power recovery and the role of the inability to modulate reflexes in post stroke movement disorders.Mechanical, Maritime and Materials Engineerin

The relation between neuromechanical parameters and Ashworth score in stroke patients

Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions.BioMechanical EngineeringMechanical, Maritime and Materials Engineerin

Fixed Dystonia in Complex Regional Pain Syndrome: a Descriptive and Computational Modeling Approach

Background: Complex regional pain syndrome (CRPS) may occur after trauma, usually to one limb, and is characterized by pain and disturbed blood flow, temperature regulation and motor control. Approximately 25% of cases develop fixed dystonia. Involvement of dysfunctional GABAergic interneurons has been suggested, however the mechanisms that underpin fixed dystonia are still unknown. We hypothesized that dystonia could be the result of aberrant proprioceptive reflex strengths of position, velocity or force feedback. Methods: We systematically characterized the pattern of dystonia in 85 CRPS-patients with dystonia according to the posture held at each joint of the affected limb. We compared the patterns with a neuromuscular computer model simulating aberrations of proprioceptive reflexes. The computer model consists of an antagonistic muscle pair with explicit contributions of the musculotendinous system and reflex pathways originating from muscle spindles and Golgi tendon organs, with time delays reflective of neural latencies. Three scenarios were simulated with the model: (i) increased reflex sensitivity (increased sensitivity of the agonistic and antagonistic reflex loops); (ii) imbalanced reflex sensitivity (increased sensitivity of the agonistic reflex loop); (iii) imbalanced reflex offset (an offset to the reflex output of the agonistic proprioceptors). Results: For the arm, fixed postures were present in 123 arms of 77 patients. The dominant pattern involved flexion of the fingers (116/123), the wrists (41/123) and elbows (38/123). For the leg, fixed postures were present in 114 legs of 77 patients. The dominant pattern was plantar flexion of the toes (55/114 legs), plantar flexion and inversion of the ankle (73/114) and flexion of the knee (55/114). Only the computer simulations of imbalanced reflex sensitivity to muscle force from Golgi tendon organs caused patterns that closely resembled the observed patient characteristics. In parallel experiments using robot manipulators we have shown that patients with dystonia were less able to adapt their force feedback strength. Conclusions: Findings derived from a neuromuscular model suggest that aberrant force feedback regulation from Golgi tendon organs involving an inhibitory interneuron may underpin the typical fixed flexion postures in CRPS patients with dystonia.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Tele-Manipulation with two asymmetric slaves:two operators perform better than one

\u3cp\u3eCertain tele-manipulation tasks require manipulation by two asymmetric slaves, for example, a crane for hoisting and a dexterous robotic arm for fine manipulation. It is unclear how to best design human-in-the-loop control over two asymmetric slaves. The goal of this paper is to quantitatively compare the standard approach of two co-operating operators that each control a single subtask, to a single operator performing bi-manual control over the two subtasks, and a uni-manual control approach. In a human factors experiment, participants performed a heavy load maneuvering and mounting task using a vertical crane and a robotic arm. We hypothesize that bi-manual control yields worse task performance and control activity compared to co-operation, because of conflicting spatial and temporal constraints. Literature suggests that uni-manual operators should perform better than co-operation, as co-operators critically depend on each other's actions. However, other literature provides evidence that individual operators have limited capabilities in controlling asymmetric axes of two dynamic systems. The results show that the two co-operators perform the maneuvering and mounting task faster than either bi-or uni-manual operators. Compared to co-operators, uni-manual operators required more control activity for the vertical crane and less for the robotic arm. In conclusion, this study suggests that when controlling two asymmetric slaves, a co-operating pair of operators performs better than a single operator.\u3c/p\u3

Modeling the nonlinear cortical response in EEG evoked by wrist joint manipulation

Joint manipulation elicits a response from the sensors in the periphery which, via the spinal cord, arrives in the cortex. The average evoked cortical response recorded using electroencephalography was shown to be highly nonlinear; a linear model can only explain 10% of the variance of the evoked response, and over 80% of the response is generated by nonlinear behavior. The goal of this paper is to obtain a nonparametric nonlinear dynamic model, which can consistently explain the recorded cortical response requiring little a priori assumptions about model structure. Wrist joint manipulation was applied in ten healthy participants during which their cortical activity was recorded and modeled using a truncated Volterra series. The obtained models could explain 46% of the variance of the evoked cortical response, thereby demonstrating the relevance of nonlinear modeling. The high similarity of the obtained models across participants indicates that the models reveal common characteristics of the underlying system. The models show predominantly high-pass behavior, which suggests that velocity-related information originating from the muscle spindles governs the cortical response. In conclusion, the nonlinear modeling approach using a truncated Volterra series with regularization, provides a quantitative way of investigating the sensorimotor system, offering insight into the underlying physiology

Haptic assistance improves tele-manipulation with two asymmetric slaves

\u3cp\u3eTele-manipulation of heavy loads typically requires the simultaneous use of two asymmetric slaves: a crane for vertical weight support and a robot for accurate lateral positioning. The industrial standard prescribes a pair of operators for such tasks (one operator to control each slave), although in principle one operator might control both slaves with a single, hybrid interface. Accurate and safe co-operative handling of the expensive and fragile heavy components is difficult, presumably due to problems in the coordination of the subtasks and the lack of mutual awareness between the two operators. This study proposes a novel haptic assistance system to improve subtask coordination and task performance. Its novelty consists of haptically linking operators/interfaces through the joint task environment. The system's efficacy is evaluated with 15 pairs of co-operators and 15 individual uni-manual operators who maneuvered a heavy load through a bounded path in Virtual Reality. Haptic assistance improves task completion time for both groups. It also reduces control activity and self-reported workload without affecting a number of critical errors made by the operators. Moreover, without haptic assistance, uni-manual operators perform worse than co-operators, but this difference between the interfaces was not found with haptic assistance.\u3c/p\u3