Optimization of Motor Performance

According to the OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention of Learning) theory of motor learning, enhanced expectancies (EE), autonomy support (AS), and external focus (EF) augment the coupling of a person’s actions to intended movement goals. This goal-action coupling is postulated to boost a person’s focus on goal-related aspects of the motor task while reducing the person’s self-related thoughts, resulting in enhanced performance of skilled movements as well as in improving the acquisition outcomes for the learning of motor skills. The three studies in this compilation report were aimed at providing empirical evidence for the motor performance benefits of the combinatory implementation of the three key motivational (i.e., EE and AS) and attentional (i.e., EF) factors of the OPTIMAL theory. In addition, a preliminary investigation of the neuromechanistic influence of such an implementation on the human motor system was carried out. Using a between-participants design, the first study employed a maximal-effort countermovement jump task to examine the additive effects of the consecutive (or serial) implementation of EE, AS, and EF on motor performance. Results indicated that optimized group participants produced greater relative jump heights than control group participants. The second study used a within-participants design involving a clinical-applied balance test to determine the immediate effects of implementing EE, AS, and EF simultaneously (in parallel) on motor performance. The results showed that participants experienced greater postural stability in terms of making fewer balance errors and producing lower center-of-pressure velocity in the optimized condition than the control condition. Finally, a simple visuomotor task involving the rhythmic production of force via isometric finger abduction was used in the third study with a between-participants design. The neurophysiological and behavioral effects of a simultaneous implementation of EE, AS, and EF in relation to motor performance were examined using a novel TMS-force experimental protocol. The corticospinal excitability of all participants remained stable throughout the experiment. Additionally, the force-accuracy performance of participants in the optimized group was similar to that of participants in the control group

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

Background: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®

Intrinsic dynamics in human sensorimotor control of unilateral hand and forearm coordination

Coordination dynamics is concerned with the underlying principles of cooperative\ud behavior among various body parts during coordinated activity. The intrinsic dynamics of\ud a multicomponent system stem from the innate behavioral tendencies borne out of the\ud inherent properties of the components, be it in their individual or coupled states, under\ud unregulated (or free-choice) conditions. A simple model of the human reach-and-grasp\ud system consisting of two components, namely, the hand and the forearm, unilaterally\ud engaged in the coordinative actions of manipulation and transport was devised for studying\ud the intrinsic dynamics via characterization of movement frequencies in various phasing\ud relationships. The Haken-Kelso-Bunz (HKB) Model provided the framework for\ud parameterizing the coordination behavior of this two-component movement system.\ud Participants were specifically instructed to choose their movement speeds for various\ud visually-guided rhythmic movement conditions in experimental trials conducted over two\ud consecutive days. A comparison of the natural frequencies of the components, before\ud coupling, and the preferred frequencies of the system performing various movement patterns, after coupling, revealed that the forearm was able to cycle at a higher natural rate\ud than the hand. The 0?? and 180?? relative phase patterns of movement had higher preferred\ud movement frequencies and less variability of frequency and relative phase than the\ud movement of the hand and the forearm coupled with a phase angle difference of 247.5??.\ud Hence, the former two patterns were relatively more stable. The natural frequency of\ud neither the hand nor the forearm was more correlated with the preferred frequency of the\ud hand-and-forearm system for all the three relative phases of 0??, 180??, and 247.5??. For all\ud the three movement conditions (with relative phases of 0??, 180??, and 247.5??), the natural\ud combined frequency, defined mathematically as the average of the sum of the natural\ud frequencies of the hand and the forearm, had a higher correlation with the preferred\ud frequencies than the association between the natural separated frequency, expressed\ud mathematically as the absolute difference between the natural frequencies of the hand and\ud the forearm, and the preferred frequencies. This was despite the fact that the natural\ud separated frequency was commonly used to represent aw in movement studies that\ud referenced the HKB Model

Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy

Objectives: The feasibility and safety of the use of neurorehabilitation technology (SMARTfit® Trainer system) by physical therapists in implementing a gamified physical-cognitive dual-task training (DTT) paradigm for individuals with Parkinson disease (IWPD) was examined. Additionally, the efficacy of this gamified DTT was compared to physical single-task training (STT), both of which were optimized using physio-motivational factors, on changes in motor and cognitive outcomes, and self-assessed disability in activities of daily living. Methods: Using a cross-over study design, eight participants with mild-to-moderate idiopathic PD (including one with mild cognitive impairment) completed both training conditions (i.e., gamified DTT and STT). For each training condition, the participants attended 2–3 sessions per week over 8.8 weeks on average, with the total amount of training being equivalent to 24 1 h sessions. A washout period averaging 11.5 weeks was inserted between training conditions. STT consisted of task-oriented training involving the practice of functional tasks, whereas for gamified DTT, the same task-oriented training was implemented simultaneously with varied cognitive games using an interactive training system (SMARTfit®). Both training conditions were optimized through continual adaptation to ensure the use of challenging tasks and to provide autonomy support. Training hours, heart rate, and adverse events were measured to assess the feasibility and safety of the gamified DTT protocol. Motor and cognitive function as well as perceived disability were assessed before and after each training condition. Results: Gamified DTT was feasible and safe for this cohort. Across participants, significant improvements were achieved in more outcome measures after gamified DTT than they were after STT. Individually, participants with specific demographic and clinical characteristics responded differently to the two training conditions. Conclusion: Physical therapists’ utilization of technology with versatile hardware configurations and customizable software application selections was feasible and safe for implementing a tailor-made intervention and for adapting it in real-time to meet the individualized, evolving training needs of IWPD. Specifically in comparison to optimized STT, there was a preliminary signal of efficacy for gamified DTT in improving motor and cognitive function as well as perceived disability in IWPD

Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy.

Objectives: The feasibility and safety of the use of neurorehabilitation technology (SMARTfit® Trainer system) by physical therapists in implementing a gamified physical-cognitive dual-task training (DTT) paradigm for individuals with Parkinson disease (IWPD) was examined. Additionally, the efficacy of this gamified DTT was compared to physical single-task training (STT), both of which were optimized using physio-motivational factors, on changes in motor and cognitive outcomes, and self-assessed disability in activities of daily living. Methods: Using a cross-over study design, eight participants with mild-to-moderate idiopathic PD (including one with mild cognitive impairment) completed both training conditions (i.e., gamified DTT and STT). For each training condition, the participants attended 2-3 sessions per week over 8.8 weeks on average, with the total amount of training being equivalent to 24 1 h sessions. A washout period averaging 11.5 weeks was inserted between training conditions. STT consisted of task-oriented training involving the practice of functional tasks, whereas for gamified DTT, the same task-oriented training was implemented simultaneously with varied cognitive games using an interactive training system (SMARTfit®). Both training conditions were optimized through continual adaptation to ensure the use of challenging tasks and to provide autonomy support. Training hours, heart rate, and adverse events were measured to assess the feasibility and safety of the gamified DTT protocol. Motor and cognitive function as well as perceived disability were assessed before and after each training condition. Results: Gamified DTT was feasible and safe for this cohort. Across participants, significant improvements were achieved in more outcome measures after gamified DTT than they were after STT. Individually, participants with specific demographic and clinical characteristics responded differently to the two training conditions. Conclusion: Physical therapists\u27 utilization of technology with versatile hardware configurations and customizable software application selections was feasible and safe for implementing a tailor-made intervention and for adapting it in real-time to meet the individualized, evolving training needs of IWPD. Specifically in comparison to optimized STT, there was a preliminary signal of efficacy for gamified DTT in improving motor and cognitive function as well as perceived disability in IWPD. Keywords: Parkinson’s disease; exergaming; gamified rehabilitation; integrated dual-task training; motor-cognitive training; neurological rehabilitation; neurotechnology; optimized intervention; patient-focused intervention; physical therapy modalities

Singapore 1994-1996: Bibliographies

10.1177/002200949803300306The Journal of Commonwealth Literature333134-15