Old adults preserve motor flexibility during rapid reaching

Purpose Our ability to flexibly coordinate the available degrees of freedom allows us to perform activities of daily living under various task constraints. Healthy old adults exhibit subclinical peripheral and central nervous system dysfunctions, possibly compromising the flexibility in inter-joint coordination during voluntary movements and the ability to adapt to varying task constraints. Method We examined how healthy old (75.4 +/- 5.2 years, n = 14) compared with young adults (24.3 +/- 2 years, n = 15) make use of the available motor flexibility to adapt to physical and dexterity constraints during a rapid goal-directed reaching task. We manipulated physical and dexterity demands by changing, respectively, external resistance and target size. Motor flexibility was quantified by an uncontrolled manifold (UCM) analysis. Results We found that healthy young and old adults employ similar motor flexibility as quantified by the ratio between goal equivalent and non-goal equivalent variability (V-Ratio) and were similarly able to adapt to increases in physical and dexterity demands during goal-directed rapid reaching (V-Ratio: p = .092; young: 0.548 +/- 0.113; old: 0.264 +/- 0.117). Age affected end-effector kinematics. Motor flexibility and end-effector kinematics did not correlate. Conclusions The data challenge the prevailing view that old age affects movement capabilities in general and provide specific evidence that healthy old adults preserve motor flexibility during a reaching task. Future studies applying UCM analysis should examine if experimental set-ups limit movement exploration, leaving possible age differences undetected

TIPS for Scaling up Research in Upper Limb Prosthetics

Many research initiatives have been employed in upper limb prosthetics (ULP) in the last few decades. The body of knowledge is growing and inspired by new and interesting technology that has been brought to the market to facilitate functioning of people with upper limb defects. However, a lot of research initiatives do not reach the target population. Several reasons can be identified as to why research does not move beyond the lab, such as lack of research quality, disappointing results of new initiatives, lack of funding to further develop promising initiatives, and poor implementation or dissemination of results. In this paper, we will appraise the current status of the research in ULP. Furthermore, we will try to provide food for thought to scale up research in ULP, focusing on (1) translation of research findings, (2) the quality of innovations in the light of evidence-based medicine and evidence-based practice, (3) patient involvement, and (4) spreading of research findings by focusing on implementation and dissemination of results and collaboration in a national and international perspective. With this paper, we aim to open the discussion on scaling up research in the community of professionals working in the field of ULP

Joint-Angle Coordination Patterns Ensure Stabilization of a Body-Plus-Tool System in Point-to-Point Movements with a Rod

When performing a goal-directed action with a tool, it is generally assumed that the point of control of the action system is displaced from the hand to the tool, implying that body and tool function as one system. Studies of how actions with tools are performed have been limited to studying either end-effector kinematics or joint-angle coordination patterns. Because joint-angle coordination patterns affect end-effector kinematics, the current study examined them together, with the aim of revealing how body and tool function as one system. Seated participants made point-to-point movements with their index finger, and with rods of 10, 20, and 30 cm attached to their index finger. Start point and target were presented on a table in front of them, and in half of the conditions a participant displacement compensated for rod length. Results revealed that the kinematics of the rod’s tip showed higher peak velocity, longer deceleration time, and more curvature with longer rods. End-effector movements were more curved in the horizontal plane when participants were not displaced. Joint-angle trajectories were similar across rod lengths when participants were displaced, whereas more extreme joint-angles were used with longer rods when participants were not displaced. Furthermore, in every condition the end-effector was stabilized to a similar extent; both variability in joint-angle coordination patterns that affected end-effector position and variability that did not affect end-effector position increased in a similar way vis-à-vis rod length. Moreover, the increase was higher in those conditions, in which participants were not displaced. This suggests that during tool use, body and tool are united in a single system so as to stabilize the end-effector kinematics in a similar way that is independent of tool length. In addition, the properties of the actual trajectory of the end-effector, as well as the actual joint-angles used, depend on the length of the tool and the specifics of the task

Changes in performance over time while learning to use a myoelectric prosthesis

BACKGROUND: Training increases the functional use of an upper limb prosthesis, but little is known about how people learn to use their prosthesis. The aim of this study was to describe the changes in performance with an upper limb myoelectric prosthesis during practice. The results provide a basis to develop an evidence-based training program. METHODS: Thirty-one able-bodied participants took part in an experiment as well as thirty-one age- and gender-matched controls. Participants in the experimental condition, randomly assigned to one of four groups, practiced with a myoelectric simulator for five sessions in a two-weeks period. Group 1 practiced direct grasping, Group 2 practiced indirect grasping, Group 3 practiced fixating, and Group 4 practiced a combination of all three tasks. The Southampton Hand Assessment Procedure (SHAP) was assessed in a pretest, posttest, and two retention tests. Participants in the control condition performed SHAP two times, two weeks apart with no practice in between. Compressible objects were used in the grasping tasks. Changes in end-point kinematics, joint angles, and grip force control, the latter measured by magnitude of object compression, were examined. RESULTS: The experimental groups improved more on SHAP than the control group. Interestingly, the fixation group improved comparable to the other training groups on the SHAP. Improvement in global position of the prosthesis leveled off after three practice sessions, whereas learning to control grip force required more time. The indirect grasping group had the smallest object compression in the beginning and this did not change over time, whereas the direct grasping and the combination group had a decrease in compression over time. Moreover, the indirect grasping group had the smallest grasping time that did not vary over object rigidity, while for the other two groups the grasping time decreased with an increase in object rigidity. CONCLUSIONS: A training program should spend more time on learning fine control aspects of the prosthetic hand during rehabilitation. Moreover, training should start with the indirect grasping task that has the best performance, which is probably due to the higher amount of useful information available from the sound hand

Transfer of mode switching performance:from training to upper-limb prosthesis use

BACKGROUND: Current myoelectric prostheses are multi-articulated and offer multiple modes. Switching between modes is often done through pre-defined myosignals, so-called triggers, of which the training hardly is studied. We evaluated if switching skills trained without using a prosthesis transfer to actual prosthesis use and whether the available feedback during training influences this transfer. Furthermore we examined which clinically relevant performance measures and which myosignal features were adapted during training. METHODS: Two experimental groups and one control group participated in a five day pre-test-post-test design study. Both experimental groups used their myosignals to perform a task. One group performed a serious game without seeing their myosignals, the second group was presented their myosignal on a screen. The control group played the serious game using the touchpad of the laptop. Each training session lasted 15 min. The pre- and post-test were identical for all groups and consisted of performing a task with an actual prosthesis, where switches had to be produced to change grip mode to relocate clothespins. Both clinically relevant performance measures and myosignal features were analysed. RESULTS: 10 participants trained using the serious game, 10 participants trained with the visual myosignal and 8 the control task. All participants were unimpaired. Both experimental groups showed significant transfer of skill from training to prosthesis use, the control group did not. The degree of transfer did not differ between the two training groups. Clinically relevant measure 'accuracy' and feature of the myosignals 'variation in phasing' changed during training. CONCLUSIONS: Training switching skills appeared to be successful. The skills trained in the game transferred to performance in a functional task. Learning switching skills is independent of the type of feedback used during training. Outcome measures hardly changed during training and further research is needed to explain this. It should be noted that five training sessions did not result in a level of performance needed for actual prosthesis use. Trial registration The study was approved by the local ethics committee (ECB 2014.02.28_1) and was included in the Dutch trial registry (NTR5876)

Adjustments in end-effector trajectory and underlying joint angle synergies after a target switch:Order of adjustment is flexible

Goal-directed reaching adapts to meet changing task requirements after unexpected perturbations such as a sudden switch of target location. Literature on adaptive behavior using a target switch has primarily focused on adjustments of the end-effector trajectory, addressing proposed feedback and feedforward processes in planning adjusted actions. Starting from a dynamical systems approach to motor coordination, the current paper focusses on coordination of joint angles after a target switch, which has received little attention in the literature. We argue that joint angles are coordinated in synergies, temporary task-specific units emerging from interactions amongst task, organism, and environmental constraints. We asked whether after a target switch: i) joint angles were coordinated in synergies, ii) joint angles were coordinated in a different synergy than the synergy used when moving to the original target, and iii) synergies or end-effector trajectory was adjusted first. Participants (N = 12) performed manual reaching movements toward a target on a table (stationary target trials), where in some trials the target could unexpectedly switch to a new location (switch trials). Results showed that the end-effector curved to the switched target. Joint angles were synergistically organized as shown by the large extent of co-variation based on Uncontrolled Manifold analyses. At the end of the target switch movement, joint angle configurations differed from the joint angle configurations used to move to the original stationary target. Hence, we argue, a new synergy emerged after the target switch. The order of adjustment in the synergies and in the end-effector was flexible within participants, though most often synergies were adjusted first. These findings support the two-step framework of Kay (1988) to understand the coordination of abundant degrees of freedom and to explain adaptive actions. The flexibility in the order of adjustments of synergies suggests that the coordination of DOF emerges from self-organization

Flexibility in joint coordination remains unaffected by force and balance demands in young and old adults during simple sit-to-stand tasks

PurposeWe examined the possibility that old adults use flexibility in joint coordination as a compensatory mechanism for the age-related decline in muscle strength when performing the sit-to-stand (STS) task repeatedly under high force and balance demands.MethodYoung (n=14, 22.42.1) and old (n=12, 703.2) healthy adults performed repeated STSs under high and low force and balance demands. The balance demand was manipulated by reducing the base of support and the force demand by increasing body weight with a weight vest. Uncontrolled manifold analysis was used to quantify age differences in motor flexibility.Results p id= Par3 While there were age-typical differences in kinematic STS strategies, flexibility in joint coordination was independent of age and task difficulty during repeated STSs.Discussion p id=Par4That simple manipulations of force and balance demands did not affect flexibility in joint coordination in old and young adults suggests that motor flexibility acts as a compensatory mechanism only at the limits of available muscle strength and balance abilities during STS movements. Intervention studies should identify how changes in specific neuromuscular functions affect flexibility in joint coordination during activities of daily living such as STS

Performance among different types of myocontrolled tasks is not related

Studies on myocontrolled assistive technology (AT), such as myoelectric prostheses, as well as rehabilitation practice using myoelectric controlled interfaces, commonly assume the existence of a general myocontrol skill. This is the skill to control myosignals in such a way that they are employable in multiple tasks. If this skill exists, training any myocontrolled task using a certain set of muscles would improve the use of myocontrolled AT when the AT is controlled using these muscles. We examined whether a general myocontrol skill exists in myocontrolled tasks with and without a prosthesis. Unimpaired, right-handed adults used the sEMG of wrist flexors and extensors to perform several tasks in two experiments. In Experiment 1, twelve participants trained a myoelectric prosthesis-simulator task and a myocontrolled serious game for five consecutive days. Performance was compared between tasks and over the course of the training period. In Experiment 2, thirty-one participants performed five myocontrolled tasks consisting of two serious games, two prosthesis-simulator tasks and one digital signal matching task. All tasks were based on tasks currently used in clinical practice or research settings. Kendall rank correlation coefficients were computed to analyze correlations between the performance on different tasks. In Experiment 1 performance on the tasks showed no correlation for multiple outcome measures. Rankings within tasks did not change over the training period. In Experiment 2 performance did not correlate between any of the tasks. Since performance between different tasks did not correlate, results suggest that a general myocontrol skill does not exist and that each myocontrolled task requires a specific skill. Generalization of those findings to amputees using AT should be done with caution since in both experiments unimpaired participants were included. Moreover, training duration in Experiment 2 was short. Our findings indicate that training and assessment methods for myocontrolled AT use should focus on tasks frequently performed in daily life by the individual using the AT instead of merely focusing on training myosignals

Convergence in myoelectric control:Between individual patterns of myoelectric learning

Objective: To support the design of assistive devices and prostheses, we investigated the changes in upper-limb muscle synergies during the practice of a myoelectric controlled game using proportional-sequential control. Methods: We evaluated 1) whether individual muscle synergies change in their structure; 2) variability; 3) distinctiveness; and 4) whether individuals become more similar with practice. Ten individuals practiced a myoelectric-controlled serious game for ten consecutive days (25 min/day) and one day after one week without training (retention). Results: The results showed that individuals decreased the number of synergies employed and modified their flexor synergies structure, becoming more similar as a group with practice. Nevertheless, within-individual synergies' variability and distinctiveness did not change. Conclusion: These results point out that individuals do not demonstrate muscle patterns less variable or differentiable after practice. However, participants increased performance and became more attuned to the task dynamics. Significance: The present findings indicate that, depending on the task requirements, individuals converge to more similar muscle activation patterns - a feature that should be further explored in prosthetic design

Movements of Individual Digits in Bimanual Prehension Are Coupled into a Grasping Component

The classic understanding of prehension is that of coordinated reaching and grasping. An alternative view is that the grasping in prehension emerges from independently controlled individual digit movements (the double-pointing model). The current study tested this latter model in bimanual prehension: participants had to grasp an object between their two index fingers. Right after the start of the movement, the future end position of one of the digits was perturbed. The perturbations resulted in expected changes in the kinematics of the perturbed digit but also in adjusted kinematics in the unperturbed digit. The latter effects showed up when the end position of the right index finger was perturbed, but not when the end position of the left index finger was perturbed. Because the absence of a coupling between the digits is the core assumption of the double-pointing model, finding any perturbation effects challenges this account of prehension; the double-pointing model predicts that the unperturbed digit would be unaffected by the perturbation. The authors conclude that the movement of the digits in prehension is coupled into a grasping component