Eye Gaze Correlates of Motor Impairment in VR Observation of Motor Actions

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objective: Identify eye gaze correlates of motor impairment in a virtual reality motor observation task in a study with healthy participants and stroke patients. Methods: Participants consisted of a group of healthy subjects (N = 20) and a group of stroke survivors (N = 10). Both groups were required to observe a simple reach-and-grab and place-and-release task in a virtual environment. Additionally, healthy subjects were required to observe the task in a normal condition and a constrained movement condition. Eye movements were recorded during the observation task for later analysis. Results: For healthy participants, results showed differences in gaze metrics when comparing the normal and arm-constrained conditions. Differences in gaze metrics were also found when comparing dominant and non-dominant arm for saccades and smooth pursuit events. For stroke patients, results showed longer smooth pursuit segments in action observation when observing the paretic arm, thus providing evidence that the affected circuitry may be activated for eye gaze control during observation of the simulated motor action. Conclusions: This study suggests that neural motor circuits are involved, at multiple levels, in observation of motor actions displayed in a virtual reality environment. Thus, eye tracking combined with action observation tasks in a virtual reality display can be used to monitor motor deficits derived from stroke, and consequently can also be used for re -habilitation of stroke patients.

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Stable or able? Effect of virtual reality stimulation on static balance of post-stroke patients and healthy subjects

Human Movement Science ◽

10.1016/j.humov.2020.102569 ◽

2020 ◽

Vol 70 ◽

pp. 102569

Author(s):

Erika D'Antonio ◽

Gaetano Tieri ◽

Fabrizio Patané ◽

Giovanni Morone ◽

Marco Iosa

Keyword(s):

Virtual Reality ◽

Healthy Subjects ◽

Static Balance ◽

Stroke Patients ◽

Post Stroke

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Multi-Fingered Grasping and Manipulation in Virtual Environments Using an Isometric Finger Device

Presence Teleoperators & Virtual Environments ◽

10.1162/pres.16.3.293 ◽

2007 ◽

Vol 16 (3) ◽

pp. 293-306 ◽

Cited By ~ 6

Author(s):

Gregorij Kurillo ◽

Matjaž Mihelj ◽

Marko Munih ◽

Tadej Bajd

Keyword(s):

Virtual Reality ◽

Muscle Strength ◽

Virtual Environments ◽

Healthy Subjects ◽

Haptic Feedback ◽

Virtual Object ◽

Input Device ◽

Haptic Information ◽

Stroke Patients ◽

Post Stroke

In this article we present a new isometric input device for multi-fingered grasping in virtual environments. The device was designed to simultaneously assess forces applied by the thumb, index, and middle finger. A mathematical model of grasping, adopted from the analysis of multi-fingered robot hands, was applied to achieve multi-fingered interaction with virtual objects. We used the concept of visual haptic feedback where the user was presented with visual cues to acquire haptic information from the virtual environment. The virtual object corresponded dynamically to the forces and torques applied by the three fingers. The application of the isometric finger device for multi-fingered interaction is demonstrated in four tasks aimed at the rehabilitation of hand function in stroke patients. The tasks include opening the combination lock on a safe, filling and pouring water from a glass, muscle strength training with an elastic torus, and a force tracking task. The training tasks were designed to train patients' grip force coordination and increase muscle strength through repetitive exercises. The presented virtual reality system was evaluated in a group of healthy subjects and two post-stroke patients (early post-stroke and chronic) to obtain overall performance results. The healthy subjects demonstrated consistent performance with the finger device after the first few trials. The two post-stroke patients completed all four tasks, however, with much lower performance scores as compared to healthy subjects. The results of the preliminary assessment suggest that the patients could further improve their performance through virtual reality training.

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Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study

10.1101/728725 ◽

2019 ◽

Author(s):

Christian Giang ◽

Elvira Pirondini ◽

Nawal Kinany ◽

Camilla Pierella ◽

Alessandro Panarese ◽

...

Keyword(s):

Motor Impairment ◽

Motor Deficits ◽

Pilot Test ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

Model Based ◽

Link Type ◽

Upper Limb Exoskeleton ◽

Subacute Stroke ◽

Motor Improvement

AbstractBackgroundIn the past years, robotic systems have become increasingly popular in both upper and lower limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches.MethodsHere, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions and comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper limb exoskeleton and tested it with seventeen healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test.ResultsThe experiments illustrated the model’s capability to differentiate distinct motor improvement progressions among subjects and subtasks. The model suggested personalized training schedules based on motor improvement estimations for each movement in different directions. Patients’ motor performances were retained when training movements were reintroduced at a later stage.ConclusionsOur results demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing auspicious results for the applicability in clinical settings.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300).

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EFFECT OF ACTION OBSERVATION THERAPY ON IMPROVING UPPER LIMB FUNCTIONS IN ACUTE STROKE PATIENTS: AN EXPERIMENTAL STUDY

10.36106/ijsr/3403937 ◽

2021 ◽

pp. 33-36

Author(s):

Sudha Desale

Keyword(s):

Acute Stroke ◽

Upper Limb ◽

Action Observation ◽

Motor Impairment ◽

Motor Recovery ◽

P Value ◽

Daily Routine ◽

Motor Sequence ◽

Stroke Patients ◽

Observation Training

BACKGROUND & PURPOSE: The most common disabling motor decit following stroke is the loss of upper limb function. 5-20% of patients presenting an upper limb paralysis at onset may improve the motor impairment overtime. Action observation training is a novel rehabilitation approach exploiting this mirror mechanism and its potential role in motor learning for motor recovery. Aim of this study was to examine the effects of action observation therapy on upper limb functions in acute stroke patients. METHODOLOGY: Stroke survivors (N= 50) were consecutively recruited 22 days (±5) after a rst-ever stroke and participants watched video footage of daily routine tasks (actions). Each action based on some relevant ADLs motor sequence display in order of ascending difculty and lasting for 3 minutes and therapist prompted the patient to perform the same movement for 2 minutes. At the end of each sequence, patients were given conventional physiotherapy and AOT 1 hour daily for 5 days/week for 4 weeks. RESULTS: Upper Limb part of FMA, Modied Ashworth Scale scores & nine-hole peg test were taken at baseline and after 4 weeks as outcome measure. Paired 't' test and Wilcoxon's signed-rank has been used for analysis of Fugl Meyer scale, Modied Ashwarth Scale and Nine-hole peg pre and post treatment scores respectively (p value<0.05) So, a statistically signicant difference was found after treatment for all variables. CONCLUSION: The nding of this study is suggesting that Action observation training programs contribute to improve motor recovery in acute stroke patients.

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Design a Haptic-Combined Virtual Reality System to Improve Box and Block Test (BBT) for Upper Extremity Function Assessment

10.21203/rs.3.rs-32776/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ying Dong ◽

Xiaoyu Liu ◽

Min Tang ◽

Hongqiang Huo ◽

Duo Chen ◽

...

Keyword(s):

Virtual Reality ◽

Upper Extremity ◽

Healthy Subjects ◽

Kinematic Parameters ◽

Stroke Patients ◽

Retest Reliability ◽

Zero Crossings ◽

Block Test ◽

Test Retest Reliability ◽

Function Assessment

Abstract Background: The Box and Block Test (BBT) has been widely used to assess gross upper extremity (UE) motor function. We designed a haptic-combined virtual reality (VR) system, named VBBT, to improve BBT with kinematic parameters for more specific assessments.Methods: According to the block-transfer task in BBT, we designed a VBBT system with a haptic device to provide a sense of the grasping force and block's gravity during task performance for UE function assessment. Besides the number of transferred blocks (N-TB), some kinematic parameters were also collected in VBBT for more specific assessment, including the number of zero-crossings of moving acceleration (NZC-ACC), the number of zero-crossings of derivative of releasing force (NZC-DRF), the ratio of path length and linear length (PLR) and the distance between barrier partition and drop position (DDP). 16 post-stroke patients and 113 healthy subjects were recruited to examine quantitative performances, concurrent validity, test-retest reliability and subjective preference between the BBT and VBBT.Results: Based on the measurements of 95% healthy subjects, the normative ranges of quantitative performances were established for BBT and VBBT. Deficiencies in patients’ UE function could be identified when their measurements fell outsides. A moderate correlation was found in the N-TBs between the VBBT and BBT (r = 0.42). The measurements in VBBT presented a stronger age-related correlation than that in BBT (R2 = 0.57 and R2 = 0.16). The N-TBs in both BBT and VBBT were strongly correlated to the Action Research Arm Test (ARAT) (|r| = 0.84 and 0.83), and the NZC-ACC and NZC-DRF in VBBT also showed significant correlations. (|r| = 0.76 and 0.79). The N-TB, NZC-ACC and NZC-DRF in VBBT showed a good test-retest reliability (ICC = 0.75, 0.78 and 0.80) while a moderate reliability was found in BBT (ICC = 0.62). For the patient preference, VBBT was given a higher score than the BBT (p < 0.05) for its enjoyment and completion effort performing.Conclusion: The VBBT improved a gross manual assessment in BBT, which can provide clinically validated, reliable and motivative assessment with kinematic parameters for specific UE motor functions of post-stroke patients.

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Does Proprioceptive Loss Influence Recovery of the Upper Extremity After Stroke?

Neurorehabilitation and Neural Repair ◽

10.1177/154596839901300104 ◽

1999 ◽

Vol 13 (1) ◽

pp. 15-21 ◽

Cited By ~ 25

Author(s):

Debbie Rand ◽

Patrice L. (Tamar) Weiss ◽

Daniel Gottlieb

Keyword(s):

Upper Extremity ◽

Detrimental Effect ◽

Motor Impairment ◽

Motor Deficits ◽

Functional Abilities ◽

Stroke Patients ◽

Motor Paralysis ◽

Significant Difference ◽

Localization Test ◽

Pure Motor

Stroke patients with motor paralysis and proprioceptive deficits are considered to have a worse functional outcome than those with pure motor paralysis, but the mechanism of this detrimental effect is not clear. In order to clarify it, we compared the motor and functional recovery of the affected upper extremity in stroke patients having pure motor paralysis with that of such patients with both motor and proprioceptive deficits. Forty patients undergoing stroke rehabilitation were studied: 20 with pure motor deficits and 20 also with proprioceptive deficits. They were assessed on four occasions during the first six weeks of rehabilitation. Motor impairment was assessed with the Fugl-Meyer subscale of the upper extremity, disability with the Frenchay Arm Test, and proprio ception by the Thumb Localization Test. Significant within-group improvement of the motor and functional abilities was demonstrated in both groups, between admission to six weeks later (p < 0.001, either group). However, no significant difference was found between the two groups, although pure motor patients had a slightly better outcome. It was concluded that the proprioception deficit did not influence limb recovery in the first six weeks of rehabilitation. Therefore, the upper extremity of all patients should be treated and given a similar chance because significant improvement can be expected in all cases. Key Words: Upper Extremity—Stroke—Proprioception—Rehabilitation.

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Time Course of Wrist Hyper-Resistance in Relation to Upper Limb Motor Recovery Early Post Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320932135 ◽

2020 ◽

Vol 34 (8) ◽

pp. 690-701

Author(s):

Aukje Andringa ◽

Carel Meskers ◽

Ingrid van de Port ◽

Erwin van Wegen ◽

Gert Kwakkel

Keyword(s):

Upper Limb ◽

Mixed Models ◽

Time Course ◽

Motor Impairment ◽

Motor Recovery ◽

Motor Deficits ◽

Stroke Patients ◽

Post Stroke ◽

Resistance Components ◽

Finger Extension

Background. Patients with an upper limb motor impairment are likely to develop wrist hyper-resistance during the first months post stroke. The time course of wrist hyper-resistance in terms of neural and biomechanical components, and their interaction with motor recovery, is poorly understood. Objective. To investigate the time course of neural and biomechanical components of wrist hyper-resistance in relation to upper limb motor recovery in the first 6 months post stroke. Methods. Neural (NC), biomechanical elastic (EC), and viscous (VC) components of wrist hyper-resistance (NeuroFlexor device), and upper limb motor recovery (Fugl-Meyer upper extremity scale [FM-UE]), were assessed in 17 patients within 3 weeks and at 5, 12, and 26 weeks post stroke. Patients were stratified according to the presence of voluntary finger extension (VFE) at baseline. Time course of wrist hyper-resistance components and assumed interaction effects were analyzed using linear mixed models. Results. On average, patients without VFE at baseline (n = 8) showed a significant increase in NC, EC, and VC, and an increase in FM-UE from 13 to 26 points within the first 6 months post stroke. A significant increase in NC within 5 weeks preceded a significant increase in EC between weeks 12 and 26. Patients with VFE at baseline (n = 9) showed, on average, no significant increase in components from baseline to 6 months whereas FM-UE scores improved from 38 to 60 points. Conclusion. Our findings suggest that the development of neural and biomechanical wrist hyper-resistance components in patients with severe baseline motor deficits is determined by lack of spontaneous neurobiological recovery early post stroke.

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Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319829454 ◽

2019 ◽

Vol 33 (3) ◽

pp. 167-178 ◽

Cited By ~ 5

Author(s):

Deanna Anderlini ◽

Guy Wallis ◽

Welber Marinovic

Keyword(s):

Stroke Rehabilitation ◽

Current Trend ◽

Motor Impairment ◽

Motor Recovery ◽

Motor Deficits ◽

Common Site ◽

Stroke Patients ◽

Patients Experience ◽

Developed World ◽

Choice Of Therapy

Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca’s aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca’s area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.

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Abstract 72: A Novel VLSM-CST Lesion Load Model is a Superior Predictor of Motor Outcomes of Acute Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.72 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Jasmine Wang ◽

Wayne Feng ◽

Pratik Y Chhatbar ◽

Gottfried Schlaug

Keyword(s):

Acute Stroke ◽

Motor Impairment ◽

Motor Deficits ◽

Precentral Gyrus ◽

Stroke Patients ◽

Lesion Load ◽

Days Of Therapy ◽

Motor Outcome ◽

Motor Tracts ◽

Best Fit

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR<0.05. Resulting VLSM T-maps were multiplied using our probabilistic CST maps, and then summed to form a canonical VLSM-weighted CST tract. Individual lesion maps from 76 acute stroke patients were overlaid onto the VLSM-weighted CST map to calculate lesion load. Patients were assessed for motor impairment (UE-FM) at baseline and at 3 months. Linear regressions were fit for baseline UE-FM, wCST-LL, and Days-of-Therapy (DoT) to determine predictions of 3-months outcome. A multivariate regression was run using VSLM-weighted CST-LL, controlling for baseline UE-FM and DoT. Age was not a significant regressor. Akaike Information Criterion was run to select the best fit model. Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

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Functional and structural plasticity following action observation training in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458518792771 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1472-1487 ◽

Cited By ~ 4

Author(s):

Maria A Rocca ◽

Alessandro Meani ◽

Silvia Fumagalli ◽

Elisabetta Pagani ◽

Roberto Gatti ◽

...

Keyword(s):

Multiple Sclerosis ◽

Upper Limb ◽

Action Observation ◽

Gray Matter Volume ◽

Motor Impairment ◽

Motor Deficits ◽

Dominant Hand ◽

Upper Limb Function ◽

Mri Scans ◽

Observation Training

Background: Hand motor deficits contribute to multiple sclerosis (MS)-related disability. Action observation training (AOT) is promising to improve upper limb function in neurologic patients. Objectives: In this preliminary study, we investigated AOT effects on dominant-hand motor performance in MS patients with upper limb motor impairment and performed an explorative analysis of their anatomical and functional magnetic resonance imaging (MRI) substrates. Methods: In total, 46 healthy controls (HC) and 41 MS patients with dominant-hand motor impairment were randomized to AOT (HC-AOT = 23; MS-AOT = 20; watching daily-life action videos and execution) or control-training (HC-Control = 23; MS-Control = 21; watching landscapes videos and execution). Behavioral, structural, and functional (at rest and during object manipulation) MRI scans were acquired before and after a 2-week training. Results: After training, MS groups improved in right upper limb functions, mainly in AOT group ( p from 0.02 to 0.0001). All groups showed regional increased and decreased gray matter volume, with specific AOT effects in fronto-temporal areas in MS-AOT ( p < 0.001), without white matter (WM) integrity modifications. Increased and reduced recruitments of the action observation matching system and its connections in MS-AOT were found ( p < 0.001). Motor improvements were correlated with volumetric and functional MRI modifications ( r from −0.78 to 0.77, p < 0.001). Conclusion: The 10-day AOT promotes clinical improvements in MS patients through structural and functional modifications of the action observation matching system.

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