Interactive cueing with walk-Mate for Hemiparetic Stroke Rehabilitation

Background: Many techniques that compensate for locomotion problems in daily life using externally controlled stimulation have recently been reported. These techniques are beneficial for effortlessly supporting patients' locomotive functions, but the users of such devices must necessarily remain dependent on them. It is possible that some individuals with gait impairment may be prevented recovering locomotive function. From a rehabilitation viewpoint, it may therefore be supposed that ideally, devices that can be used in daily life to improve the locomotive functions of the body itself should be proposed. Methods: We evaluate the effectiveness of Walk-Mate, which has been used mainly as a gait compensation device, as a gait rehabilitation training device by analyzing improvement in locomotion before, during and after rehabilitation in hemiparetic patients and comparing it with a previous gait training method. Walk-Mate generates a model walking rhythm in response to a user's locomotion in real time, and by indicating this rhythm using auditory stimuli, provides a technology that supports walking by reducing asymmetries and fluctuations in foot contact rhythm. If patients can use the system to learn a regulated walking rhythm, then it may also be expected to fulfil the functions of a gait rehabilitation training device for daily life. Results: With regard to asymmetry, significantly improvements were seen for compensatory movement during training using Walk-Mate, but improvements were not retained as rehabilitative results. Regarding fluctuations in the foot contact period, significant improvement was observed for compensatory movement during training and these significant improvements were retained as rehabilitative results. In addition, it became clear that such improvement could not be adequately obtained by the previously proposed training technique utilizing constant rhythmic auditory stimulation. Conclusions: Walk-Mate effectively compensated for locomotion problems of hemiparetic patients by improving gait rhythm both during and after training, suggesting that locomotive function can be effectively recovered in some patients. The interactive mechanism of Walk-Mate may be capable of simultaneously achieving the aims of gait compensation and gait rehabilitation training methods previously developed under individual frameworks. Walk-Mate is a promising technology for assisting the reintegration of disabled persons into society

The complexity of the relationship between neuropsychological deficits and impairment in everyday tasks after stroke

Background and purpose: A large body of research reports that stroke patients are debilitated in terms of daily independence after dismissal from the hospital unit. Patients struggle with the use of daily objects or performing complex actions. Differences between individual deficits of patients are often associated with the site of the brain damage. However, clinical studies suggest that patients exhibit varied constellations of action-associated difficulties and neuropsychological deficits. There is a lack of conclusive evidence indicating how different neuropsychological symptoms link to the impaired ability to perform activities of daily living (ADL). Materials and methods: To further address this matter, in this study we compared the behavior of patients with left brain damage (LBD) and right brain damage (RBD) following stroke in two naturalistic task scenarios (tea making and document filing),and compared the committed action errors to the neuropsychological screening results. Results: We observed mild to severe impairments in both the LBD and RBD groups amounting to 37-55% of failure rate in attainment of action goal. Interestingly, the performance on both tasks was not correlated to each other, suggesting that the tasks involved a different set of higher cognitive functions. Despite similar behavioral manifestations, in the LBD group poor task performance was related to deficits in praxis performance and unilateral tactile and visual extinction. The presence of aphasia did not correlate with task performance, except for a link between low scores in Aachen aphasia test scales and misestimation error in the tea making task. In the RBD group, difficulties with performance were primarily linked to deficit in praxis and unilateral visual extinction. Conclusions: Despite similar behavior, the underlying mechanisms of the deficits after stroke might be different (in patients with LBD and RBD) and reveal complex interlinks of cognitive networks involved in the ability to carry on everyday tasks

Adjustments of Speed and Path when Avoiding Collisions with Another Pedestrian

When walking in open space, collision avoidance with other pedestrians is a process that successfully takes place many times. To pass another pedestrian (an interferer) walking direction, walking speed or both can be adjusted. Currently, the literature is not yet conclusive of how humans adjust these two parameters in the presence of an interferer. This impedes the development of models predicting general obstacle avoidance strategies in humans' walking behavior. The aim of this study was to investigate the adjustments of path and speed when a pedestrian is crossing a non-reactive human interferer at different angles and speeds, and to compare the results to general model predictions. To do so, we designed an experiment where a pedestrian walked a 12 m distance to reach a goal position. The task was designed in such a way that collision with an interferer would always occur if the pedestrian would not apply a correction of movement path or speed. Results revealed a strong dependence of path and speed adjustments on crossing angle and walking speed, suggesting local planning of the collision avoidance strategy. Crossing at acute angles (i.e. 45 degrees and 90 degrees) seems to require more complex collision avoidance strategies involving both path and speed adjustments than crossing at obtuse angles, where only path adjustments were observed. Overall, the results were incompatible with predictions from existing models of locomotor collision avoidance. The observed initiations of both adjustments suggest a collision avoidance strategy that is temporally controlled. The present study provides a comprehensive picture of human collision avoidance strategies in walking, which can be used to evaluate and adjust existing pedestrian dynamics models, or serve as an empirical basis to develop new models

Day 2 Wrap-up Roundtable

Roundtable discussion from the 'Neural Correlates of Object Recognition and Action Workshop' presented on September 29, 2009 in the Georgia Tech Hotel and Conference Center

Adjustments of Speed and Path when Avoiding Collisions with Another Pedestrian

When walking in open space, collision avoidance with other pedestrians is a process that successfully takes place many times. To pass another pedestrian (an interferer) walking direction, walking speed or both can be adjusted. Currently, the literature is not yet conclusive of how humans adjust these two parameters in the presence of an interferer. This impedes the development of models predicting general obstacle avoidance strategies in humans' walking behavior. The aim of this study was to investigate the adjustments of path and speed when a pedestrian is crossing a non-reactive human interferer at different angles and speeds, and to compare the results to general model predictions. To do so, we designed an experiment where a pedestrian walked a 12 m distance to reach a goal position. The task was designed in such a way that collision with an interferer would always occur if the pedestrian would not apply a correction of movement path or speed. Results revealed a strong dependence of path and speed adjustments on crossing angle and walking speed, suggesting local planning of the collision avoidance strategy. Crossing at acute angles (i.e. 45 degrees and 90 degrees) seems to require more complex collision avoidance strategies involving both path and speed adjustments than crossing at obtuse angles, where only path adjustments were observed. Overall, the results were incompatible with predictions from existing models of locomotor collision avoidance. The observed initiations of both adjustments suggest a collision avoidance strategy that is temporally controlled. The present study provides a comprehensive picture of human collision avoidance strategies in walking, which can be used to evaluate and adjust existing pedestrian dynamics models, or serve as an empirical basis to develop new models

Stabilization of body balance with light touch following a mechanical perturbation: Adaption of sway and disruption of right Posterior Parietal Cortex by cTBS

Light touch with an earth-fixed reference point improves balance during quite standing. In our current study, we implemented a paradigm to assess the effects of disrupting the right posterior parietal cortex on dynamic stabilization of body sway with and without Light Touch after a graded, unpredictable mechanical perturbation. We hypothesized that the benefit of Light Touch would be amplified in the more dynamic context of an external perturbation, reducing body sway and muscle activations before, at and after a perturbation. Furthermore, we expected sway stabilization would be impaired following disruption of the right Posterior Parietal Cortex as a result of increased postural stiffness. Thirteen young adults stood blindfolded in Tandem-Romberg stance on a force plate and were required either to keep light fingertip contact to an earth-fixed reference point or to stand without fingertip contact. During every trial, a robotic arm pushed a participant's right shoulder in medio-lateral direction. The testing consisted of 4 blocks before TMS stimulation and 8 blocks after, which alternated between Light Touch and No Touch conditions. In summary, we found a strong effect of Light Touch, which resulted in improved stability following a perturbation. Light Touch decreased the immediate sway response, steady state sway following re-stabilization, as well as muscle activity of the Tibialis Anterior. Furthermore, we saw gradual decrease of muscle activity over time, which indicates an adaptive process following exposure to repetitive trials of perturbations. We were not able to confirm our hypothesis that disruption of the rPPC leads to increased postural stiffness. However, after disruption of the rPPC, muscle activity of the Tibialis Anterior is decreased more compared to sham. We conclude that rPPC disruption enhanced the intra-session adaptation to the disturbing effects of the perturbation

Circadian rhythms in handwriting kinematics and legibility

The aim of the present study was to analyze the circadian rhythmicity in handwriting kinematics and legibility and to compare the performance between Dutch and German writers. Two subject groups underwent a 40 h sleep deprivation protocol under Constant Routine conditions either in Groningen (10 Dutch subjects) or in Berlin (9 German subjects). Both groups wrote every 3 ha test sentence of similar structure in their native language. Kinematic handwriting performance was assessed with a digitizing tablet and evaluated by writing speed, writing fluency, and script size. Writing speed (frequency of strokes and average velocity) revealed a clear circadian rhythm, with a parallel decline during night and a minimum around 3:00 h in the morning for both groups. Script size and movement fluency did not vary with time of day in neither group. Legibility of handwriting was evaluated by intra-individually ranking handwriting specimens of the 13 sessions by 10 German and 10 Dutch raters. Whereas legibility ratings of the German handwriting specimens deteriorated during night in parallel with slower writing speed, legibility of the Dutch handwriting deteriorated not until the next morning. In conclusion, the circadian rhythm of handwriting kinematics seems to be independent of script language at least among the two tested western countries. Moreover, handwriting legibility is also subject to a circadian rhythm which, however, seems to be influenced by variations in the assessment protocol. (C) 2010 Elsevier B.V. All rights reserved