Bimanual coordination and motor learning in children with unilateral motor disorders

Introduction Appropriate bimanual coordination is essential for many tasks in daily life. Children with unilateral cerebral palsy (uCP) however struggle with the execution of such tasks. Extensive research has been done investigating motor impairments on a functional level using standardized procedures. There is a lack of studies however looking at the specific problem of coordination of a bimanual task, especially with respect to the different underlying neuropathologies. Aims & Methods Within this thesis, kinematics of bimanual hand movement during a role differentiated bimanual box opening task in children with uCP, as well as in typically developing children (TDC) of similar ages, were investigated. The aims were: i) to identify behavioural changes in peak periods of development of the corpus callosum and areas of the prefrontal cortex, both of which are related to bimanual function in typically developing children; ii) to explore the relation between motor impairments of children with uCP and their bimanual coordination and iii) to investigate the impact of various underlying neuropathologies on bimanual coordination in children with uCP. Results For the first study, a total of 37 TDC between 5 and 16 years were included and allocated to their respective age-group: Young Children (YC: 5-6 years), Old Children (OC: 7-9 years) and Adolescents (AD: 10-16 years). The two older groups performed the task significantly faster than YC. Likewise, a trend (yet without reaching significance) towards a more ideal temporal sequencing was shown between YC and the two older groups. In contrast, spatial accuracy as expressed by the path length increased only in the AD group. For the second study, a total of 37 children with uCP between 7 and 17 years were included. Children presented manual impairments between levels I and III (according to the Manual Ability Classification System). It could be shown that task duration increased and spatial accuracy decreased with increasing levels of impairment, especially in children with higher levels of impairment (level III). Furthermore it could be shown that a subgroup of children experienced an involuntary interference when moving their affected hand, limiting the use of their less affected hand. The third study utilised a multiple case study involving nine children diagnosed with uCP with neuroimaging and neurophysiological data. The children were found to have various neuropathological patterns resulting in different forms and severities of motor impairments. It could be shown that grey-matter lesions had the most severe impact on manual abilities. Conclusion In TDC, performance of bimanual hand movements was temporally related to peak developmental periods of the corpus callosum, emphasizing the importance of interhemispheric exchange of information for bimanual coordination. In children with uCP, bimanual performance was related to the level of impairment of the affected hand. In addition it was found however that some children show excessive bimanual interference when using their affected hand in a bimanual task which limits the functionality of the less affected hand, possibly related to i) ipsilateral corticomotor projection patterns from the less affected hemisphere to the affected hand or ii) lack of suppression of interhemispheric crosstalk. It could also be shown that the various neuropathologies can affect bimanual motor control differently. Detailed diagnosis of the neuropathology and motor impairment are thus essential for the planning of tailored therapy interventions

Developmental characteristics of disparate bimanual movement skills in typically ceveloping children

Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5–6 years old), older children (7–9 years old), and adolescents (10–16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills

Cognitive, physical and emotional determinants of activities of daily living in nursing home residents—a cross-sectional study within the PROCARE-project

Background Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. Methods The study included $n$ = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant\u27s demographics, frailty, number of falls, and participating institutions\u27 socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). Results Indices showed (Chi$^2$(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. Discussion and conclusion Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

Background Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. Methods A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45–60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents’ capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). Discussion This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. Trial registration The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018

Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial

Introduction Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness. Methods and analysis A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20–30 min) and subsequently, back-fitness training (12 weeks, once a week for 45–60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up). Ethics and dissemination The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences

Predicting object properties based on movement kinematics

Abstract In order to grasp and transport an object, grip and load forces must be scaled according to the object’s properties (such as weight). To select the appropriate grip and load forces, the object weight is estimated based on experience or, in the case of robots, usually by use of image recognition. We propose a new approach that makes a robot’s weight estimation less dependent on prior learning and, thereby, allows it to successfully grasp a wider variety of objects. This study evaluates whether it is feasible to predict an object’s weight class in a replacement task based on the time series of upper body angles of the active arm or on object velocity profiles. Furthermore, we wanted to investigate how prediction accuracy is affected by (i) the length of the time series and (ii) different cross-validation (CV) procedures. To this end, we recorded and analyzed the movement kinematics of 12 participants during a replacement task. The participants’ kinematics were recorded by an optical motion tracking system while transporting an object, 80 times in total from varying starting positions to a predefined end position on a table. The object’s weight was modified (made lighter and heavier) without changing the object’s visual appearance. Throughout the experiment, the object’s weight (light/heavy) was randomly changed without the participant’s knowledge. To predict the object’s weight class, we used a discrete cosine transform to smooth and compress the time series and a support vector machine for supervised learning from the achieved discrete cosine transform parameters. Results showed good prediction accuracy (up to $$95\%$$ 95 % , depending on the CV procedure and the length of the time series). Even at the beginning of a movement (after only 300 ms), we were able to predict the object weight reliably (within a classification rate of $$88-94\%$$ 88 - 94 % )

Finger Tapping as a Biomarker to Classify Cognitive Status in 80+-Year-Olds

This study examined the association between finger tapping and cognitive function in a group of 225 elderly participants (116 males; age 79&ndash;92 years; M = 82.5; SD = 2.4). Finger tapping was assessed in two conditions: self-selected pace and fast pace. Based on cognitive assessments, including the MoCA and CERA-NP test battery, participants were classified as cognitively healthy individuals (CHI), participants with mild cognitive impairments (MCI), and those with possible MCI (pMCI). Results of the analyses show significant differences between groups, sex and the group &times; sex interaction in four parameters for the self-selected pace condition and eight parameters for the fast pace condition. These parameters were used for classification by means of linear discriminant analysis (LDA). The first LDA component showed significant differences between CHI and pMCI and between CHI and MCI. Furthermore, the second LDA component showed significant differences between CHI and pMCI as well as between pMCI and MCI. Nevertheless, the algorithm correctly classified only 50% of participants, regardless of group, suggesting that tapping parameters are only partially useful for classification in early stages of dementia. We discuss these findings in terms of the diadochokinetic nature of finger tapping as associated with the age-related degeneration of cortical and subcortical motor areas

How Age, Cognitive Function and Gender Affect Bimanual Force Control

International audienc

An interrater reliability study of gait analysis systems with the dual task paradigm in healthy young and older adults

Background and aims: One reason for the controversial discussion of whether the dual task (DT) walking paradigm has an added value for diagnosis in clinical conditions might be the use of different gait measurement systems. Therefore, the purpose was 1) to detect DT effects of central gait parameters obtained from five different gait analysis devices in young and old adults, 2) to assess the consistency of the measurement systems, and 3) to determine if the absolut and proportional DT costs (DTC) are greater than the system-measurement error under ST. Methods: Twelve old (72.2 ± 7.9y) and 14 young adults (28.3 ± 6.2y) walked a 14.7-m distance under ST and DT at a self-selected gait velocity. Interrater reliability, precision of the measurement and sensitivity to change were calculated under ST and DT. Results: An age effect was observed in almost all gait parameters for the ST condition. For DT only differences for stride length (p < .029, ɳ2p = .239) as well as single and double limb support (p = .036, ɳ2p = .227; p = .034, ɳ2p = .218) remained. The measurement systems showed a lower absolute agreement compared to consistency across all systems. Conclusions: When reporting DT effects, the real changes in performance and random measurement errors should always be accounted for. These findings have strong implications for interpreting DT effects