Comparison of embedded and added motor imagery training in patients after stroke: Study protocol of a randomised controlled pilot trial using a mixed methods approach

Copyright @ 2009 Schuster et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Two different approaches have been adopted when applying motor imagery (MI) to stroke patients. MI can be conducted either added to conventional physiotherapy or integrated within therapy sessions. The proposed study aims to compare the efficacy of embedded MI to an added MI intervention. Evidence from pilot studies reported in the literature suggests that both approaches can improve performance of a complex motor skill involving whole body movements, however, it remains to be demonstrated, which is the more effective one.Methods/Design: A single blinded, randomised controlled trial (RCT) with a pre-post intervention design will be carried out. The study design includes two experimental groups and a control group (CG). Both experimental groups (EG1, EG2) will receive physical practice of a clinical relevant motor task ('Going down, laying on the floor, and getting up again') over a two week intervention period: EG1 with embedded MI training, EG2 with MI training added after physiotherapy. The CG will receive standard physiotherapy intervention and an additional control intervention not related to MI.The primary study outcome is the time difference to perform the task from pre to post-intervention. Secondary outcomes include level of help needed, stages of motor task completion, degree of motor impairment, balance ability, fear of falling measure, motivation score, and motor imagery ability score. Four data collection points are proposed: twice during baseline phase, once following the intervention period, and once after a two week follow up. A nested qualitative part should add an important insight into patients' experience and attitudes towards MI. Semi-structured interviews of six to ten patients, who participate in the RCT, will be conducted to investigate patients' previous experience with MI and their expectations towards the MI intervention in the study. Patients will be interviewed prior and after the intervention period.Discussion: Results will determine whether embedded MI is superior to added MI. Findings of the semi-structured interviews will help to integrate patient's expectations of MI interventions in the design of research studies to improve practical applicability using MI as an adjunct therapy technique

Virtualia 2016. La réalité virtuelle au service de la recherche: Actes du séminaire organisé par le CIREVE à Caen (19 octobre 2016),

International audienceLe séminaire Virtualia est né en 2006 en même temps que le Centre Interdisciplinaire de Réalité Virtuelle (CIREVE) de l’Université de Caen Normandie. Son objectif est de permettre aux équipes associées au CIREVE d’exposer leurs méthodologies et les résultats de leurs travaux dans le domaine de la Réalité Virtuelle, tout en s’ouvrant à des communications extérieures. Il a connu quatre éditions de 2006 à 2009.2016 fut l’occasion de relancer VIRTUALIA et de concrétiser le partenariat avec les Universités de Rouen et du Havre dans le cadre de la COMUE. Une Structure Fédérative de Recherche « CIREVE » est en effet en cours de labellisation au sein de Normandie Université. 2016 est également une année importante car elle marque à la fois le dixième anniversaire du CIREVE et la finalisation d’une plate-forme de réalité virtuelle normande, unique en son genre sur le territoire français. Elle est composée d’une salle immersive quatre faces de 45 m2, équipée d’un tapis roulant particulièrement adapté pour l’analyse de la marche en temps réel (GRAIL de Motek Medical). Les calculateurs de cette salle immersive sont mutualisés avec un amphithéâtre attenant de 150 places, de manière que les expérimentations effectuées avec un sujet unique dans la salle immersive puissent être suivies par un auditoire nombreux (besoins de formation notamment). Les équipes utilisent le matériel au fur et à mesure des développements informatiques et de nouveaux protocoles d’expérimentation germent dans l’esprit des chercheurs qui voient dans la réalité virtuelle des possibilités de tests jamais atteintes.Une centaine de chercheurs utilise régulièrement le plateau technique CIREVE, dans des visées de recherche qui leur sont propres. Il est toutefois apparu qu’un certain nombre de problématiques concernaient toutes les disciplines et qu’une partie de la réflexion sur les mondes virtuels pouvait être mutualisée. Le séminaire VIRTUALIA permet d’offrir un espace de rencontre à ces chercheurs, issus d’horizons différents, pour discuter de l’utilisation de l’outil d’un point de vue épistémologique. Il est par exemple capital de s’interroger sur la notion de présence. Le sujet se comporte-il de la même façon dans l’environnement virtuel et dans le monde réel ? Les chemins de circulation choisis dans le modèle virtuel sont-ils les mêmes que ceux qui seraient empruntés en réalité ? Les conclusions établies dans le modèle virtuel sont-elles directement transposables à la réalité ? Un des enjeux du travail est d’évaluer la pertinence subjective des modèles virtuels, ce qui est capital avant de généraliser leur utilisation dans des actions de formation par exemple. L’utilisation d’une technologie n’est jamais complètement neutre. Dans le cadre des mondes virtuels, l’interaction de l’homme avec le monde de synthèse n’est possible qu’au travers de logiciels et d’interfaces matérielles. Il faut s’assurer que les processus cognitifs soient adéquats avant de s’interroger sur le résultat des simulations. Naturellement, le séminaire permet également à chaque discipline d’exposer les résultats des dernières recherches réalisées grâce à la réalité virtuelle.Les domaines scientifiques concernés par la réalité virtuelle sont multiples : les civilisations et les patrimoines culturels, la médecine, les neurosciences, la psychologie, les sciences du mouvement et du sport, l’ingénierie, l’informatique. L’Université de Caen Normandie étant pluridisciplinaire, le spectre des utilisations est très large. Elles se répartissent en trois axes principaux et un axe en émergence :LA REPRÉSENTATION : la réalité virtuelle permet de représenter et de visualiser, interactivement et en trois dimensions, des environnements disparus, dégradés, inaccessibles, ou des environnements futurs.Domaines concernés : civilisations, patrimoine, linguistique...L'EXPÉRIMENTATION : en permettant d'interagir en temps réel avec un monde numérique 3D, la réalité virtuelle offre de nouvelles perspectives d'expérimentations dans des environnements de plus en plus proches du réel et en même temps parfaitement contrôlables.Domaines concernés : santé, neuropsychologie, psychologie, activités physiques et sportives...LA CREATION ET LE DEVELOPPEMENT D’OUTILS : les informaticiens créent et testent des applications concernant les méthodes de navigation en monde virtuel, de restitution de la réalité.Domaine concerné : informatique.LA FORMATION (axe en émergence) : par la représentation de la connaissance, par les diverses possibilités d'expérimentation, la réalité virtuelle est un formidable outil de formation.Domaines concernés : sciences du langage, médecine, informatique (serious game, simulation...).Une partie importante de la réflexion développée lors du séminaire Virtualia 2016 a été consacrée aux enjeux sociétaux liés à la réalité virtuelle : notions de mémoire, d’apprentissage des gestes techniques, d’être humain « augmenté » etc. Les articles publiés attestent du savoir-faire, bien réel cette fois, que le CIREVE a acquis en termes de création de mondes virtuels pour représenter, expérimenter et former. La publication des actes du séminaire Virtualia vise à mettre en lumière des recherches particulièrement innovantes qui s’effectuent dans un cadre technologique exceptionnel.- S. Madeleine, Virtualia 2016. Introduction (et direction de l'édition)- J. Grieu, F. Lecroq, Th. Galinho, H. Boukachour, Environnements industriels virtualisés et processus d’apprentissage- Ph. Brunet, J. Dehut, Images 3D et humanités numériques : modélisation et restitution du geste théâtral- G. Lecouvey, J. Gonneaud, N. Legrand, G. Rauchs, F. Eustache, B. Desgranges, Réalité virtuelle et mémoire- N. Benguigui, C. Mandil, M. Mallek, L. Lejeune, R. Thouvarecq, Étude des liens entre perception et action dans des environnements virtuels- E.-G. Dupuy, A. Maneuvrier, E. Vlamynck, S. Besnard, B. Bienvenu, L.-M. Decker, Le syndrome d’Ehlers-Danlos type hypermobile : évolution des stratégies posturales en réponse à un programme de rééducation à visée somesthésique- C. Weismann-Arcache, Réalité virtuelle et humain augmenté : subjectivation, désubjectivation ?- L. Haddouk, Réalité psychique en visioconsultatio

Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines

<p>Abstract</p> <p>Background</p> <p>The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention.</p> <p>Methods</p> <p>An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time.</p> <p>Results</p> <p>Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%.</p> <p>Conclusions</p> <p>MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term.</p

Errata

Erratum Firas Massaad, Thierry M. Lejeune and Christine Detrembleur Rehabilitation and Physical Medicine Unit, Université catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium The paper by Massaad et al. contains the following errors: Page 792 the legend of fi g 1 B line 5: should have read: left to right Page 793 the second column line 9: should have read: 14.34 +/- 4.8% in fl at walking Page 796 the second column line 3: should have read: by using metabolic energy with no apparent work produced. The Publisher regrets this error. References Firas Massaad, Thierry M. Lejeune & Christine Detrembleur (2007). The up and down bobbing of human walking: a compromise between muscle work and ef fi ciency. 582, 789-799

Importance of cutaneous feedback in maintaining a secure grip during manipulation of hand-held objects

Previous research has shown that grip and load forces are modulated simultaneously during manipulation of a hand-held object. This close temporal coupling suggested that both forces are controlled by an internal model within the CNS that predicts the changes in tangential force on the fingers. The objective of the present study was to examine how the internal model would compensate for the loss of cutaneous sensation through local anesthesia of the index and thumb. Ten healthy adult subjects (5 men and 5 women aged 20-57 yr) were asked to grasp, lift, and hold stationary, a 250 g object for 20 s. Next, the subjects were asked to perform vertical oscillatory movements over a distance of 20 cm at a rate of 1.0 Hz for 30 s. Eleven trials were performed with intact sensation, and 11 trials after a local ring-block anesthesia of the index and thumb with bupivacain (5 mg/ml). During static holding, loss of cutaneous sensation produced a significant increase in the safety margin. However, the grip force declined significantly over the 20-s static hold period. During oscillatory arm movements, grip and load forces were continuously modulated together in a predictive manner as suggested by Flanagan and Wing. Again, the grip force declined over the 30-s movement, and 7/10 subjects dropped the object at least once. With intact sensation, the object was never dropped; but with the fingers anesthetized, it was dropped on 36% of the trials, and a significant slip occurred on a further 12%. The mean correlation between the grip and load forces for all subjects deteriorated from 0.71 with intact sensation to 0.48 after digital anesthesia. However, a cross-correlation calculated between the grip and load forces indicated that the phase lag was approximately zero both with and without digital anesthesia. Taken together, the data from the present study suggest that cutaneous afferents are required for setting and maintaining the background level of the grip force in addition to their phasic slip-detection function and their role in adapting the grip force/load force ratio to the friction on initial contact with an object. Finally, at a more theoretical level, they correct and maintain an internal model of the physical properties of hand-held objects

Engineers speak to therapists: Development of rehabilitation robotics

Initially developed for industrial applications, in particular to assist or replace humans in dangerous, strenuous or repetitive, robots today have applications in many other fields, including in healthcare [1]. In the specific context of the rehabilitation of brain-injured patients, the robots have the advantage of being able to repeat the movements with high intensity and frequency, and in an attractive environment for the patient [2]. They also provide assistance to therapists by relieving them physically, but also by providing a quantitative and objective assessment of the patient's performance. First robots for upper limb rehabilitation were industrial manipulators diverted from their original use [1]. Since then, these robots have evolved and can be classified in two categories: end-effector robots which mobilize the arm through the hand or the forearm, and exoskeletons placed parallel to the osteological chain which drive independently all upper limb joints. The technical development of rehabilitation robots has gone hand in hand with an intensification of the collaboration between engineers and therapists. This led to the development of solutions always better addressing the clinical needs but also to the identification of the pros and cons specific to each of the two categories of robots. Such multidisciplinary collaboration is established since 2006 at the Université catholique de Louvain between the Center for Research in Mechatronics and the Cliniques universitaires Saint-Luc and has led to the development of two robotic devices. The first one, REAplan, is an end-effector robot which has undergone numerous evolutions after several clinical trials to fit at best to the clinical environment. The second one, AFREXOS, is an exoskeleton robot for the shoulder complex whose innovative mechanical structure results from taking into account the clinical needs during the early stages of the design process