scholarly journals A dual-learning paradigm can simultaneously train multiple characteristics of walking

2016 ◽  
Vol 115 (5) ◽  
pp. 2692-2700 ◽  
Author(s):  
Matthew A. Statton ◽  
Alexis Toliver ◽  
Amy J. Bastian
Keyword(s):  
Training Session ◽  
Motor Adaptation ◽  
Step Length ◽  
Learning Task ◽  
Learning Paradigm ◽  
Motor Patterns ◽  
Walking Pattern ◽  
Peak Knee ◽  
Multiple Characteristics ◽  
Hip Flexion

Impairments in human motor patterns are complex: what is often observed as a single global deficit (e.g., limping when walking) is actually the sum of several distinct abnormalities. Motor adaptation can be useful to teach patients more normal motor patterns, yet conventional training paradigms focus on individual features of a movement, leaving others unaddressed. It is known that under certain conditions, distinct movement components can be simultaneously adapted without interference. These previous “dual-learning” studies focused solely on short, planar reaching movements, yet it is unknown whether these findings can generalize to a more complex behavior like walking. Here we asked whether a dual-learning paradigm, incorporating two distinct motor adaptation tasks, can be used to simultaneously train multiple components of the walking pattern. We developed a joint-angle learning task that provided biased visual feedback of sagittal joint angles to increase peak knee or hip flexion during the swing phase of walking. Healthy, young participants performed this task independently or concurrently with another locomotor adaptation task, split-belt treadmill adaptation, where subjects adapted their step length symmetry. We found that participants were able to successfully adapt both components of the walking pattern simultaneously, without interference, and at the same rate as adapting either component independently. This leads us to the interesting possibility that combining rehabilitation modalities within a single training session could be used to help alleviate multiple deficits at once in patients with complex gait impairments.

scholarly journals A Dual-Learning Paradigm Simultaneously Improves Multiple Features of Gait Post-Stroke

2018 ◽  
Vol 32 (9) ◽  
pp. 810-820 ◽  
Author(s):  
Kendra M. Cherry-Allen ◽  
Matthew A. Statton ◽  
Pablo A. Celnik ◽  
Amy J. Bastian
Keyword(s):  
Knee Flexion ◽  
Joint Angle ◽  
Step Length ◽  
Learning Task ◽  
Gait Pattern ◽  
Learning Paradigm ◽  
Post Stroke ◽  
Learning Conditions ◽  
Hip Flexion ◽  
Gait Impairments

Background. Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously. Objective. To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke. Methods. Twelve individuals with stroke participated. Participants completed 2 sessions during which they received visual feedback reflecting paretic knee flexion during walking. During the learning phase of the experiment, an unseen offset was applied to this feedback, promoting increased paretic knee flexion. During the first session, this task was performed while walking on a split-belt treadmill intended to improve step length asymmetry. During the second session, it was performed during tied-belt walking. Results. The dual-learning task simultaneously increased paretic knee flexion and decreased step length asymmetry in the majority of people post-stroke. Split-belt treadmill walking did not significantly interfere with joint-angle learning: participants had similar rates and magnitudes of joint-angle learning during both single and dual-learning conditions. Participants also had significant changes in the amount of paretic hip flexion in both single and dual-learning conditions. Conclusions. People with stroke can perform a dual-learning paradigm and change 2 clinically relevant gait impairments in a single session. Long-term studies are needed to determine if this strategy can be used to efficiently and permanently alter multiple gait impairments.

scholarly journals Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke

2021 ◽  
pp. 154596832110010
Author(s):  
Margaret A. French ◽  
Matthew L. Cohen ◽  
Ryan T. Pohlig ◽  
Darcy S. Reisman
Keyword(s):  
Cognitive Abilities ◽  
Step Length ◽  
Cognitive Measures ◽  
Retention Models ◽  
Wechsler Memory Scale ◽  
Walking Pattern ◽  
Learning Principles ◽  
The Relationship ◽  
Sequential Regression ◽  
Neurologically Intact

Background There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning. Objective To understand the relationship between locomotor learning and retention and cognition after stroke. Methods Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables. Results Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning ( R2 = 0.17, P = .008; overall model R2 = 0.31, P = .002) and retention (Δ R2 = 0.17, P = .023; overall model R2 = 0.44, P = .002). Conclusions Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.

scholarly journals Neural signatures of reward and sensory error feedback processing in motor learning

2019 ◽  
Vol 121 (4) ◽  
pp. 1561-1574 ◽  
Author(s):  
Dimitrios J. Palidis ◽  
Joshua G. A. Cashaback ◽  
Paul L. Gribble
Keyword(s):  
Visual Feedback ◽  
Motor Adaptation ◽  
Learning Task ◽  
Reward Learning ◽  
P300 Amplitude ◽  
Error Feedback ◽  
Learning Mechanisms ◽  
Visuomotor Rotation ◽  
Feedback Processing ◽  
Motor Commands

At least two distinct processes have been identified by which motor commands are adapted according to movement-related feedback: reward-based learning and sensory error-based learning. In sensory error-based learning, mappings between sensory targets and motor commands are recalibrated according to sensory error feedback. In reward-based learning, motor commands are associated with subjective value, such that successful actions are reinforced. We designed two tasks to isolate reward- and sensory error-based motor adaptation, and we used electroencephalography in humans to identify and dissociate the neural correlates of reward and sensory error feedback processing. We designed a visuomotor rotation task to isolate sensory error-based learning that was induced by altered visual feedback of hand position. In a reward learning task, we isolated reward-based learning induced by binary reward feedback that was decoupled from the visual target. A fronto-central event-related potential called the feedback-related negativity (FRN) was elicited specifically by binary reward feedback but not sensory error feedback. A more posterior component called the P300 was evoked by feedback in both tasks. In the visuomotor rotation task, P300 amplitude was increased by sensory error induced by perturbed visual feedback and was correlated with learning rate. In the reward learning task, P300 amplitude was increased by reward relative to nonreward and by surprise regardless of feedback valence. We propose that during motor adaptation the FRN specifically reflects a reward-based learning signal whereas the P300 reflects feedback processing that is related to adaptation more generally. NEW & NOTEWORTHY We studied the event-related potentials evoked by feedback stimuli during motor adaptation tasks that isolate reward- and sensory error-based learning mechanisms. We found that the feedback-related negativity was specifically elicited by binary reward feedback, whereas the P300 was observed in both tasks. These results reveal neural processes associated with different learning mechanisms and elucidate which classes of errors, from a computational standpoint, elicit the feedback-related negativity and P300.

scholarly journals Persons with essential tremor can adapt to new walking patterns

2019 ◽  
Vol 122 (4) ◽  
pp. 1598-1605 ◽  
Author(s):  
Jaimie A. Roper ◽  
Sarah A. Brinkerhoff ◽  
Benjamin R. Harrison ◽  
Abigail C. Schmitt ◽  
Ryan T. Roemmich ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Motor Adaptation ◽  
Step Length ◽  
Cross Sectional Study ◽  
Motor Deficits ◽  
Cross Sectional ◽  
Gait Adaptation ◽  
Locomotor Adaptation ◽  
Temporal Aspects ◽  
Walking Adaptation

Essential tremor (ET) is a common movement disorder that causes motor deficits similar to those seen in cerebellar disorders. These include kinetic tremor, gait ataxia, and impaired motor adaptation. Previous studies of motor adaptation in ET have focused on reaching while the effects of ET on gait adaptation are currently unknown. The purpose of this study was to contrast locomotor adaptation in persons with and without ET. We hypothesized that persons with ET would show impaired gait adaptation. In a cross-sectional study, persons with ET ( n = 14) and healthy matched controls ( n = 12) walked on a split-belt treadmill. Participants walked with the belts moving at a 2:1 ratio, followed by overground walking to test transfer, followed by a readaptation period and finally a deadaptation period. Step length asymmetry was measured to assess the rate of adaptation, amount of transfer, and rates of readaptation and deadaptation. Spatial, temporal, and velocity contributions to step length asymmetry were analyzed during adaptation. There were no group by condition interactions in step length asymmetry or contributions to step length asymmetry. Regardless of condition, persons with ET walked slower and exhibited lower temporal ( P < 0.001) and velocity ( P = 0.001) contributions to step length asymmetry than controls. Persons with ET demonstrated a preserved ability to adapt to, store, and transfer a new walking pattern. Despite probable cerebellar involvement in ET, locomotor adaptation is an available mechanism to teach persons with ET new gait patterns. NEW & NOTEWORTHY This study is the first to investigate walking adaptation abilities of people with essential tremor. Despite evidence of cerebellar impairment in this population, people with essential tremor can adapt their walking patterns. However, people with essential tremor do not modulate the timing of their footsteps to meet walking demands. Therefore, this study is the first to report impairments in the temporal aspects of walking in people with essential tremor during both typical and locomotor learning.

scholarly journals Feasibility of Using Foot–Ground Clearance Biofeedback Training in Treadmill Walking for Post-Stroke Gait Rehabilitation

2020 ◽  
Vol 10 (12) ◽  
pp. 978
Author(s):  
Hanatsu Nagano ◽  
Catherine M. Said ◽  
Lisa James ◽  
Rezaul K. Begg
Keyword(s):  
Real Time ◽  
Training Session ◽  
Step Length ◽  
Gait Training ◽  
Treadmill Walking ◽  
Biofeedback Training ◽  
Step Width ◽  
Double Support ◽  
Post Stroke ◽  
Foot Clearance

Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals.

scholarly journals Learning the spatial features of a locomotor task is slowed after stroke

2014 ◽  
Vol 112 (2) ◽  
pp. 480-489 ◽  
Author(s):  
Christine M. Tyrell ◽  
Erin Helm ◽  
Darcy S. Reisman
Keyword(s):  
Motor Learning ◽  
Spatial Pattern ◽  
Retention Test ◽  
Step Length ◽  
Treadmill Walking ◽  
Neurological Dysfunction ◽  
Stroke Survivors ◽  
Spatial Features ◽  
Walking Pattern ◽  
Neurologically Intact

The capacity for humans to learn a new walking pattern has been explored with a split-belt treadmill during single sessions of adaptation, but the split-belt treadmill can also be used to study longer-term motor learning. Although the literature provides some information about motor learning after stroke, existing studies have primarily involved the upper extremity and the results are mixed. The purpose of this study was to characterize learning of a novel locomotor task in stroke survivors. We hypothesized that the presence of neurological dysfunction from stroke would result in slower learning of a locomotor task and decreased retention of what was learned and that these deficits would be related to level of sensorimotor impairment. Sixteen participants with stroke and sixteen neurologically intact participants walked on a split-belt treadmill for 15 min on 5 consecutive days and during a retention test. Step length and limb phase were measured to capture learning of the spatial and temporal aspects of walking. Learning the spatial pattern of split-belt treadmill walking was slowed after stroke compared with neurologically intact subjects, whereas there were no differences between these two groups in learning the temporal pattern. During the retention test, poststroke participants demonstrated equal retention of the split-belt treadmill walking pattern compared with those who were neurologically intact. The results suggest that although stroke survivors are slower to learn a new spatial pattern of gait, if given sufficient time they are able to do so to the same extent as those who are neurologically intact.

scholarly journals Examining Three-way Binding as a Constraint on Statistical Learning

2018 ◽  
Author(s):  
Hyungwook Yim ◽  
Simon Dennis ◽  
Vladimir Sloutsky
Keyword(s):  
Statistical Learning ◽  
Explicit Memory ◽  
Paired Associate ◽  
Empirical Studies ◽  
Learning Task ◽  
Paired Associate Learning ◽  
The Other ◽  
Learning Paradigm ◽  
Associate Learning ◽  
Memory Structures

Models of statistical learning do not place constraints on the complexity of the memory structure that is formed during statistical learning, while empirical studies using the statistical learning task have only examined the formation of simple memory structures (e.g., two-way binding). On the other hand, the memory literature, using explicit memory tasks, has shown that people are able to form memory structures of different complexities and that more complex memory structures (e.g., three-way binding) are usually more difficult to form. We examined whether complex memory structures such as three-way bindings can be implicitly formed through statistical learning by utilizing manipulations that have been used in the paired-associate learning paradigm (e.g., AB/ABr condition). Through three experiments, we show that while simple two-way binding structures can be formed implicitly, three-way bindings can only be formed with explicit instructions. The results indicate that explicit attention may be a necessary component in forming three-way memory structures and suggest that existing models should place constraints on the representational structures that can be formed.

scholarly journals Hip Angle Behavior in Landing After Drop Jump in Children; and their Implicance in Prevention Programs

2019 ◽  
Vol 1 (1) ◽  
pp. 11-21
Author(s):  
Jair Burboa G ◽  
Matias Bahamondes F ◽  
Mauricio Inostroza M ◽  
Paloma Lillo U ◽  
Jaime Hinzpeter
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Training Session ◽  
Acl Injury ◽  
Physical Load ◽  
Drop Jump ◽  
Protective Capacity ◽  
Level Of Evidence ◽  
Before And After ◽  
Hip Flexion

Background The Anterior Cruciate Ligament (ACL) injury is uncommon, but constitutes an important percentage of the lesions requiring more than 8 weeks of recovery in sports. Most ACL injuries do not require external contact and are associated with biomechanical risk factors that stress this ligament ACL: like an increase in knee valgus angle (KV) and hip flexion (HF) and a decreased in knee flexion (KF). The ACL requires muscle cooperation to resist the load; however, when there is fatigue, the protective capacity of the musculature would decrease. The objective of the study is to analyze the angular behavior before and after a physical load for HF in children of 14-15 years old. Hypothesis The physical load applied in a single training session is enough to change some biomechanical risk factors of ACL injury. Study Design Experimental study Level of Evidence 2b Methods The sample consisted of 50 students from different soccer schools between 14-15 years old. We analyzed the hip angular behavior of hip flexion before and after a training session. The angles where obtained from inertioal sensor while the students performed a Drop Jump test from a 30 centimeters drawer. Results Statistically significant differences were found in the differences between pre physical load HF / post-load HF (p = 0.00053), right pre physical load HF / right post- load HF (p = 0.0086) and left post- load (p = 0.0248206). Conclusions It was concluded that the angular behavior of HF increases significantly in both post-training limbs, after performing a physical load. Clinical Relevance This study analyzed the importance of using prevention injury programs since early stages, and give importance to the eccentric role of hamstring, gluteus and core exercises.

scholarly journals Effects of Treadmill Training in chronic hemiparetic: a randomized, double-blind clinical trial

2020 ◽  
pp. 1-6
Author(s):  
Wildja de Lima Gomes ◽  
Luciara Irene de Nadai Dias ◽  
Rachel Paes Guimarães ◽  
Cínthia Mara Stivali ◽  
Gisele da Rosa Faria ◽  
...  
Keyword(s):  
Motor Function ◽  
Lower Limb ◽  
Plantar Flexion ◽  
The Elderly ◽  
Step Length ◽  
Double Blind Study ◽  
Double Blind ◽  
Rehabilitation Programs ◽  
Abc Scale ◽  
Hip Flexion

Background: It is estimated that the prevalence of cerebrovascular accident (CVA) increases significantly as a result of the increase in the elderly population, leading to dependence and care. Interventions with physical exercises are essential for patients with chronic CVA and hemiparesis to contribute to functional motor recovery. The gait of the hemiparetic patients is very impaired, including decreased speed, unipodal support in the abbreviated paretic limb, increased step length, decreased hip flexion, increased knee flexion and plantar flexion and involves compensatory strategies to deal with deficits of the affected limb. Rehabilitation programs of patients with CVA should focus on the restoration of the individual’s independence and ability to move. Objective: To analyze the effects of the addition of a load on a lower limb not affected in the discharge of weight and motor function of paretic lower limb. Method: Experimental, randomized, double-blind study conducted at the Physiotherapy and Occupational Therapy Outpatient Clinic of the Hospital das Clínicas (HC) - UNICAMP. Participants were assessed by the Confidence and Balance Scale, Fugl-Meyer Assessment of Physical Performance (FMA), Modified Ashworth Scale (MAS), Postural Stroke Scale for post-stroke patients (PSS), Time up and go test (TUG), 10-Meter gait test, Stroke Scale Barthel and weight transfer in the affected lower limb. Participants were treated in 12 walking training sessions on the treadmill with 1 kg added to the ankle of the lower limb. Results: There were variations between the 3 times for gait time (p= 0.005), FMA (p= 0.002), Activities-specific Balance Confidence Scale (ABC scale) (p= 0.007) and EAPA (p= 0.042). Conclusion: Treadmill therapy and weight addition in the healthy limb revealed improvement in motor function, balance in orthostatism and walking speed.

Unintended Changes in Contralateral Limb as a Result of Acute Gait Modification

2020 ◽  
Vol 36 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Oladipo O. Eddo ◽  
Bryndan W. Lindsey ◽  
Shane V. Caswell ◽  
Matt Prebble ◽  
Nelson Cortes
Keyword(s):  
Real Time ◽  
Knee Extensor ◽  
Medial Knee ◽  
Peak Knee ◽  
Biomechanical Changes ◽  
Gait Modification ◽  
Joint Load ◽  
Hip Flexion ◽  
External Loads

Gait modification using real-time biofeedback is a conservative intervention associated with positive outcomes. Results from systematic reviews corroborate the effectiveness of various strategies employing real-time biofeedback for reducing estimated knee joint load. The effects on the nonmodified limb, however, remain unclear. Biomechanical changes to the nonmodified limb were investigated during unilaterally implemented medial knee thrust, lateral trunk lean, and toe-in foot progression. Nineteen healthy participants were recruited. Ten trials were completed for each gait condition including baseline. Assigned magnitude for each gait modification strategy was individualized based on the mean and SD of the gait parameter during baseline. Visual real-time biofeedback was provided. During medial knee thrust, participants’ nonmodified limb presented with increased: first peak medial knee contact force, internal first peak knee extensor moment, as well as knee- and hip-flexion angles at internal first peak knee extensor moment. Observed biomechanical changes are elucidative of the body’s attempt to attenuate increased external loads. These findings may carry significant implications for pathological populations. Load redistribution to the nonmodified side may result in unfavorable long-term outcomes particularly in patients with bilateral diagnosis. Future studies should explore acute and chronic changes in the nonmodified limb of individuals with knee osteoarthritis.

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