Skills Learning in Robot-Assisted Surgery Is Benefited by Task-Specific Augmented Feedback

Background: Providing augmented visual feedback is one way to enhance robot-assisted surgery (RAS) training. However, it is unclear whether task specificity should be considered when applying augmented visual feedback. Methods: Twenty-two novice users of the da Vinci Surgical System underwent testing and training in 3 tasks: simple task, bimanual carrying (BC); intermediate task, needle passing (NP); and complex task, suture tying (ST). Pretraining (PRE), training, and posttraining (POST) trials were performed during the first session. Retention trials were performed 2 weeks later (RET). Participants were randomly assigned to 1 of 4 feedback training groups: relative phase (RP), speed, grip force, and video feedback groups. Performance measures were time to task completion (TTC), total distance traveled (D), speed (S), curvature, relative phase, and grip force (F). Results: Significant interaction for TTC and curvature showed that the RP feedback training improved temporal measures of complex ST task compared to simple BC task. Speed feedback training significantly improved the performance in simple BC task in terms of TTC, D, S, curvature, and F even after retention. There was also a lesser long-term effect of speed feedback training on complex ST task. Grip force feedback training resulted in significantly greater improvements in TTC and curvature for complex ST task. For the video feedback training group, the improvements in most of the outcome measures were evident only after RET. Conclusions: Task-specific augmented feedback is beneficial to RAS skills learning. Particularly, the RP and grip force feedback could be useful for training complex tasks

Gaze and posture coordinate differently with the complexity of visual stimulus motion

In this study, we explored whether gaze and posture would exhibit coordination with the motion of a presented visual stimulus, specifically with regard to the complexity of the motion structure. Fourteen healthy adults viewed a set of four visual stimulus motion conditions, in both self-selected and semi-tandem stance, during which the stimulus moved horizontally across a screen, with position updated to follow a sine, chaos, surrogate, or random noise trajectory. Posture was measured using a standard force platform in self-selected and semi-tandem stance conditions while gaze was recorded using image-based eye-tracking equipment. Cross-correlation confirmed the continuous coordination of gaze with each type of stimulus motion, with increasing lag as stimulus motion complexity increased. Correlation dimension and approximate entropy were used to assess the complexity of the measured gaze and posture behaviors, with these values compared against those of the actual stimulus via ANOVA and dependent t tests. We found that gaze behavior was particularly sensitive to the complexity of the stimulus motion, according to both metrics. Posture seemed to be unaffected by stimulus motion viewing; however, different stance conditions did exhibit differences in posture metrics. Our results support an evolving understanding of how vision is used for determining perception and action

Frontal joint dynamics when initiating stair ascent from a walk versus a stand

Ascending stairs is a challenging activity of daily living for many populations. Frontal plane joint dynamics are critical to understand the mechanisms involved in stair ascension as they contribute to both propulsion and medio-lateral stability. However, previous research is limited to understanding these dynamics while initiating stair ascent from a stand. We investigated if initiating stair ascent from a walk with a comfortable self-selected speed could affect the frontal plane lower-extremity joint moments and powers as compared to initiating stair ascent from a stand and if this difference would exist at consecutive ipsilateral steps on the stairs. Kinematics data using a 3-D motion capture system and kinetics data using two force platforms on the first and third stair treads were recorded simultaneously as ten healthy young adults ascended a custom-built staircase. Data were collected from two starting conditions of stair ascent, from a walk (speed: 1.42±0.21 m/s) and from a stand. Results showed that subjects generated greater peak knee abductor moment and greater peak hip abductor moment when initiating stair ascent from a walk. Greater peak joint moments and powers at all joints were also seen while ascending the second ipsilateral step. Particularly, greater peak hip abductor moment was needed to avoid contact of the contralateral limb with the intermediate step by counteracting the pelvic drop on the contralateral side. This could be important for therapists using stair climbing as a testing/training tool to evaluate hip strength in individuals with documented frontal plane abnormalities (i.e. knee and hip osteoarthritis, ACL injury)

Center of pressure and the projection of the time-course of sitting skill acquisition

A normal time-course for the acquisition of sitting is essential. A delay in sitting may affect other developmental milestones, resulting in deficiencies in overall skill. Therefore, our aim was to identify variables whose measures at the very beginning of sitting would allow for the projection of the evolution of the sitting skill. Center of pressure data were collected from the postural sway of twenty-six typically developing infants while sitting on a force platform with a beginning ability to sit upright. Spatial, temporal and frequency variables of postural sway were obtained from both the medial/lateral and anterior/posterior directions of sway. Discriminant function analysis was conducted to identify potential predictors of the duration between onset and fully independent sitting. Gender (p=0.025), Median Frequency (p=0.006), and Correlation Dimension (p=0.002) were identified to be predictive of grouping with 73.1% correct classification of the participating infants into short, mid, and long delay groups. In conclusion, measures taken at the earliest stage of sitting may allow the projection of the time-course to achieve independent sitting for typical infants. This approach may be useful for monitoring typical development

Dynamics of Stride Interval Characteristics during Continuous Stairmill Climbing

It has been shown that statistical persistence in stride intervals characteristics exist during walking, running and cycling and were speed- dependent among healthy young adults. The purpose of this study was to determine if such statistical persistence in stride time interval, stride length and stride speed also exists during self-paced continuous stairmill climbing and if the strength is dependent on stepping rate. Stride time, stride length, and stride speed were collected from nine healthy participants during 3 min of stairmill climbing at 100, 110, and 120% of their preferred stepping rate (PSR) and 5 min of treadmill walking at preferred walking speed (PWS). The amount of variability (assessed by standard deviation and coefficient of variation) and dynamics (assessed by detrended fluctuation analysis and sample entropy) of the stride time, stride length, and stride speed time series were investigated. The amounts of variability were significantly higher during stairmill climbing for the stride time, stride length, and stride speed and did only change with increased stepping rate for stride speed. In addition to a more irregular pattern during stairmill climbing, the detrended fluctuation analysis (DFA) revealed that the stride length fluctuations were statistical anti-persistent for all subjects. On a group level both stride time and stride speed fluctuations were characterized by an uncorrelated pattern which was more irregular compared to that during treadmill walking. However, large inter-participant differences were observed for these two variables. In addition, the dynamics did not change with increase in stepping rate

Do lower-extremity joint dynamics change when stair negotiation is initiated with a self-selected comfortable gait speed?

Previous research on the biomechanics of stair negotiation has ignored the effect of the approaching speed. We examined if initiating stair ascent with a comfortable self-selected speed can affect the lower-extremity joint moments and powers as compared to initiating stair ascent directly in front of the stairs. Healthy young adults ascended a custom-built staircase instrumented with force platforms. Kinematics and kinetics data were collected simultaneously for two conditions: starting from farther away and starting in front of the stairs and analyzed at the first and second ipsilateral steps. Results showed that for the first step, participants produced greater peak knee extensor moment, peak hip extensor and flexor moments and peak hip positive power while starting from farther away. Also, for both the conditions combined, participants generated lesser peak ankle plantiflexor, greater peak knee flexor moment, lesser peak ankle negative power and greater peak hip negative power while encountering the first step. These results identify the importance of the starting position in experiments dealing with biomechanics of stair negotiation. Further, these findings have important implications for studying stair ascent characteristics of other populations such as older adults

Path Integration: Effect of Curved Path Complexity and Sensory System on Blindfolded Walking

Path integration refers to the ability to integrate continuous information of the direction and distance traveled by the system relative to the origin. Previous studies have investigated path integration through blindfolded walking along simple paths such as straight line and triangles. However, limited knowledge exists regarding the role of path complexity in path integration. Moreover, little is known about how information from different sensory input systems (like vision and proprioception) contributes to accurate path integration. The purpose of the current study was to investigate how sensory information and curved path complexity affect path integration. Forty blindfolded participants had to accurately reproduce a curved path and return to the origin. They were divided into four groups that differed in the curved path, circle (simple) or figure-eight (complex), and received either visual (previously seen) or proprioceptive (previously guided) information about the path before they reproduced it. The dependent variables used were average trajectory error, walking speed, and distance traveled. The results indicated that (a) both groups that walked on a circular path and both groups that received visual information produced greater accuracy in reproducing the path. Moreover, the performance of the group that received proprioceptive information and later walked on a figure-eight path was less accurate than their corresponding circular group. The groups that had the visual information also walked faster compared to the group that had proprioceptive information. Results of the current study highlight the roles of different sensory inputs while performing blindfolded walking for path integration

Biomechanical analyses of stair-climbing while dual-tasking

Stair-climbing while doing a concurrent task like talking or holding an object is a common activity of daily living which poses high risk for falls. While biomechanical analyses of overground walking during dual-tasking have been studied extensively, little is known on the biomechanics of stair-climbing while dual-tasking. We sought to determine the impact of performing a concurrent cognitive or motor task during stair-climbing. We hypothesized that a concurrent cognitive task will have a greater impact on stair climbing performance compared to a concurrent motor task and that this impact will be greater on a higher-level step. Ten healthy young adults performed 10 trials of stair-climbing each under four conditions: stair ascending only, stair ascending and performing subtraction of serial sevens from a three-digit number, stair ascending and carrying an empty opaque box and stair ascending, performing subtraction of serial sevens from a random three-digit number and carrying an empty opaque box. Kinematics (lower extremity joint angles and minimum toe clearance) and kinetics (ground reaction forces and joint moments and powers) data were collected. We found that a concurrent cognitive task impacted kinetics but not kinematics of stair-climbing. The effect of dual-tasking during stair ascent also seemed to vary based on the different phases of stair ascent stance and seem to have greater impact as one climbs higher. Overall, the results of the current study suggest that the association between the executive functioning and motor task (like gait) becomes stronger as the level of complexity of the motor task increases

Lower limb joint angle variability and dimensionality are different in stairmill climbing and treadmill walking

The present study tested if the quadratic relationship which exists between stepping frequency and gait dynamics in walking can be generalized to stairmill climbing. To accomplish this, we investigated the joint angle dynamics and variability during continuous stairmill climbing at stepping frequencies both above and below the preferred stepping frequency (PSF). Nine subjects performed stairmill climbing at 80, 90, 100, 110 and 120% PSF and treadmill walking at preferred walking speed during which sagittal hip, knee and ankle angles were extracted. Joint angle dynamics were quantified by the largest Lyapunov exponent (LyE) and correlation dimension (CoD). Joint angle variability was estimated by the mean ensemble standard deviation (meanSD). MeanSD and CoD for all joints were significantly higher during stairmill climbing but there were no task differences in LyE. Changes in stepping frequency had only limited effect on joint angle variability and did not affect joint angle dynamics. Thus, we concluded that the quadratic relationship between stepping frequency and gait dynamics observed in walking is not present in stairmill climbing based on the investigated parameters

Prostaglandin D2/J2 signaling pathway in a rat model of neuroinflammation displaying progressive parkinsonian-like pathology: potential novel therapeutic targets

Background: Prostaglandins are products of the cyclooxygenase pathway, which is implicated in Parkinson’s disease (PD). Limited knowledge is available on mechanisms by which prostaglandins contribute to PD neurodegeneration. To address this gap, we focused on the prostaglandin PGD2/J2 signaling pathway, because PGD2 is the most abundant prostaglandin in the brain, and the one that increases the most under pathological conditions. Moreover, PGJ2 is spontaneously derived from PGD2. Methods: In this study, we determined in rats the impact of unilateral nigral PGJ2-microinfusions on COX-2, lipocalin-type PGD2 synthase (L-PGDS), PGD2/J2 receptor 2 (DP2), and 15 hydroxyprostaglandin dehydrogenase (15-PGDH). Nigral dopaminergic (DA) and microglial distribution and expression levels of these key factors of the prostaglandin D2/J2 pathway were evaluated by immunohistochemistry. PGJ2-induced motor deficits were assessed with the cylinder test. We also determined whether oral treatment with ibuprofen improved the PD-like pathology induced by PGJ2. Results: PGJ2 treatment induced progressive PD-like pathology in the rats. Concomitant with DA neuronal loss in the substantia nigra pars compacta (SNpc), PGJ2-treated rats exhibited microglia and astrocyte activation and motor deficits. In DA neurons, COX-2, L-PGDS, and 15-PGDH levelsincreased significantly in PGJ2-treated rats compared to controls, while DP2 receptor levels were unchanged. In microglia, DP2 receptors were basically non-detectable, while COX-2 and L-PGDS levels increased upon PGJ2-treatment, and 15-PGDH remained unchanged. 15-PGDH was also detected in oligodendrocytes. Notably, ibuprofen prevented most PGJ2-induced PD-like pathology. Conclusions: The PGJ2-induced rat model develops progressive PD pathology, which is a hard-to-mimic aspect of this disorder. Moreover, prevention of most PGJ2-induced PD-like pathology with ibuprofen suggests a positive feedback mechanism between PGJ2 and COX-2 that could lead to chronic neuroinflammation. Notably, this is the first study that analyzes the nigral dopaminergic and microglial distribution and levels of factors of the PGD2/J2 signaling pathway in rodents. Our findings support the notions that upregulation of COX-2 and L-PGDS may be important in the PGJ2 evoked PD-like pathology, and that neuronal DP2 receptor antagonists and L-PGDS inhibitors may be novel pharmacotherapeutics to relieve neuroinflammation-mediated neurodegeneration in PD, circumventing the adverse side effects of cyclooxygenase inhibitors