Gamification in Stroke Rehabilitation

Stroke rehabilitation aims to improve patients' abilities to realize daily life activities and, consequently, regain their self-confidence and improve independence and quality of life. Gamification can be defined as the application of game-design elements, dynamics, and principles such as competition, narratives, point-scoring, and awards in non-game contexts, including rehabilitation. It has emerged as a therapeutic alternative or complement to traditional rehabilitation to make motor practice more intense and increase a person's motivation, interest, and satisfaction by bringing meaningful and intrinsically motivational playful experiences. Compared to the same amount of conventional therapy, gamification can increase the number of movements and involve safe and intensive rehabilitation exercises, essential for a successful rehabilitation process.

Black-box testing in motor sequence learning

During learning of novel motor sequences, practice leads to the consolidation of hierarchical structures, namely motor chunks, facilitating the accurate execution of sequences at increasing speeds. Recent studies show that such hierarchical structures are largely represented upstream of the primary motor cortex in the motor network, suggesting their function to be more related to the encoding, storage, and retrieval of sequences rather than their sole execution. We isolated different components of motor skill acquisition related to the consolidation of spatiotemporal features and followed their evolution over training. We found that optimal motor skill acquisition relies on the storage of the spatial features of the sequence in memory, followed by the optimization of its execution and increased execution speeds (i.e., a shift in the speed-accuracy trade-off) early in training, supporting the model proposed by Hikosaka in 1999. Contrasting the dynamics of these components during ageing, we identified less-than-optimal mechanisms in older adults explaining the observed differences in performance. We applied noninvasive brain stimulation in an attempt to support the aging brain to compensate for these deficits. The present study found that anodal direct current stimulation applied over the motor cortex restored the mechanisms involved in the consolidation of spatial features, without directly affecting the speed of execution of the sequence. This led older adults to sharply improve their accuracy, resulting in an earlier yet gradual emergence of motor chunks. The results suggest the early storage of the sequence in memory, largely independent of motor practice, is crucial for an optimal motor acquisition and retrieval of this motor behavior. Nevertheless, the consolidation of optimal temporal patterns, detected as motor chunks at a behavioral level, is not a direct consequence of storing the sequence elements, but rather of motor practice.

A Single Bout of High-Intensity Cardiovascular Exercise Does Not Enhance Motor Performance and Learning of a Visuomotor Force Modulation Task, but Triggers Ipsilateral Task-Related EEG Activity

Acute cardiovascular exercise (aCE) seems to be a promising strategy to improve motor performance and learning. However, results are heterogeneous, and the related neurophysiological mechanisms are not well understood. Oscillatory brain activitiy, such as task-related power (TRPow) in the alpha and beta frequencies, are known neural signatures of motor activity. Here, we tested the effects of aCE on motor performance and learning, along with corresponding modulations in EEG TRPow over the sensorimotor cortex. Forty-five right-handed participants (aged 18–34 years) practiced a visuomotor force-matching (FM) task after either high-intensity (HEG), low-intensity (LEG), or no exercise (control group, CG). Motor performance was assessed immediately, 15 min, 30 min, and 24 h after aCE/control. EEG was measured during the FM task. Results of frequentist and Bayesian statistics revealed that high- and low-intensity aCE had no effect at the behavioral level, adding to the previous mixed results. Interestingly, EEG analyses showed an effect of aCE on the ipsilateral sensorimotor cortex, with a stronger decrease in β-TRPow 15 min after exercise in both groups compared to the CG. Overall, aCE applied before motor practice increased ipsilateral sensorimotor activity, while motor learning was not affected; it remains to be seen whether aCE might affect motor learning in the long run.

Crosstalk between Gross and Fine Motor Domains during Late Childhood: The Influence of Gross Motor Training on Fine Motor Performances in Primary School Children

Gross and fine motor competence have a close relationship during development and are shown to correlate to some extent. However, the study of the interaction between these domains still requires further insights. In this study, we investigated the developmental changes in overall motor skills as well as the effects of gross motor training programs on fine motor skills in children (aged 6–11, n = 240). Fine motor skills were assessed before and after gross motor intervention using the Box and Block Test. The gross motor intervention was based on the Test of Gross Motor Development—3rd Edition. Results showed that gross and fine motor skills correlate across all years of primary school, both significantly improving with age. Finally, the gross motor intervention appeared to not influence fine motor skills. Our findings show that during primary school age, overall motor development is continuous, but non-linear. From age nine onward, there seems to be a major step-up in overall motor competence, of which teachers/educators should be aware of in order to design motor educational programs accordingly. While gross and fine motor domains might be functionally integrated to enhance children’s motor performances, further research is needed to clarify the effect of gross motor practice on fine motor performances.

The Construction of the Fusion and Symbiosis Path of Infant Sports Development Based on Intelligent Environment

In view of the differences and uniqueness of intelligence between people, the application of new educational thoughts is the need of the time; in the educational atmosphere created by the intelligent environment, it is urgent to seek a path of integration and symbiosis. This article takes the development of children's sports driven by the intelligent education project as the main research object, selects our city's children's football as the representative of sports events to carry out case studies, and uses the spectrum education program to explore the intelligent development of intelligent children with logical and mathematical advantages in the field of sports. This paper designs a data fusion method for homogeneous smart sensors. The correlation degree of the nodes in the continuous sampling period is obtained by defining the spatial correlation coefficient, and the confidence value and coherent degree of integration are obtained by applying the angle of attraction between nodes in the definition of fusion strategy in the evaluation of neighborhood, and lastly, the node coefficient of weight is reallocated to validate the fused expression. The feasibility of the simulation is used to confirm the trustworthiness of the solution. Based on the development status of children’s physical education, this article uses intelligent mobile networks to find out the problems in the physical education classes of kindergarten teachers and the problems that are not compatible with the development of children’s physical education. The kindergarten normal students receive targeted physical education and acquire solid professional skills. The study indicates that the percentage of basic motor and basic motility classes in the city's kindergartens is 100%, suggesting that all preschools in the city operate fundamental motor practice classes for a group of children. They have fully realized that basic movement exercises have an impact on children’s body shape.

Frontal increase of beta modulation during the practice of a motor task is enhanced by visuomotor learning

Movement is accompanied by beta power changes over frontal and sensorimotor regions: a decrease during movement (event-related desynchronization, ERD), followed by an increase (event-related synchronization, ERS) after the movement end. We previously found that enhancements of beta modulation (from ERD to ERS) during a reaching test (mov) occur over frontal and left sensorimotor regions after practice in a visuo-motor adaptation task (ROT) but not after visual learning practice. Thus, these enhancements may reflect local cumulative effects of motor learning. Here we verified whether they are triggered by the learning component inherent in ROT or simply by motor practice in a reaching task without such learning (MOT). We found that beta modulation during mov increased over frontal and left areas after three-hour practice of either ROT or MOT. However, the frontal increase was greater after ROT, while the increase over the left area was similar after the two tasks. These findings confirm that motor practice leaves local traces in beta power during a subsequent motor test. As they occur after motor tasks with and without learning, these traces likely express the cost of processes necessary for both usage and engagement of long-term potentiation mechanisms necessary for the learning required by ROT.

Ipsilesional motor cortex activation with high-force unimanual handgrip contractions of the less-affected limb in participants with stroke

Stroke is a leading cause of severe disability that often presents with unilateral motor impairment. Conventional rehabilitation approaches focus on motor practice of the affected limb and aim to suppress brain activity in the contralesional hemisphere to facilitate ipsilesional hemispheric neuroplasticity subserving motor recovery. Previous research has also demonstrated that exercise of the less-affected limb can promote motor recovery of the affected limb through the interlimb transfer of the trained motor task, termed cross-education. One of the leading theories for cross-education proposes that the interlimb transfer manifests from ipsilateral cortical activity during unimanual motor tasks, and that this ipsilateral cortical activity results in motor related neuroplasticity giving rise to contralateral improvements in motor performance. Conversely, exercise of the less-affected limb promotes contralesional brain activity which is typically viewed as contraindicated in stroke recovery due to the interhemispheric inhibitory influence onto the ipsilesional hemisphere. High-force unimanual handgrip contractions are known to increase ipsilateral brain activation in control participants, but it remains to be determined if this would be observed in participants with stroke. Therefore, this study aimed to determine how parametric increases in handgrip force during repeated contractions with the less-affected limb impacts brain activity bilaterally in participants with stroke and in a cohort of neurologically intact controls. In this study, higher force contractions were found to increase brain activation in the ipsilesional/ipsilateral hemisphere in both groups (p = .002), but no between group differences were observed. These data suggest that high-force exercise with the less-affected limb may promote ipsilesional cortical plasticity to promote motor recovery of the affected-limb in participants with stroke.

Explicit motor sequence learning after stroke: a neuropsychological study

Motor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.

Development of a Compensation-aware Virtual Rehabilitation System for Upper Extremity Rehabilitation in Community-Dwelling Older Adults with Stroke

Background: Compensatory movements are commonly observed in older adults with stroke when they take motor practice for rehabilitation, which could limit their motor recovery.Aim: This study aims to develop one virtual rehabilitation system (VRS) that can detect and reduce compensatory movements to improve the quality of upper extremity (UE) movements and hence the outcome of rehabilitation in community-dwelling older adults with stroke. Method: To design and validate the algorithm of compensation detection equipped in VRS, a study was first conducted to recruit 17 healthy and 6 stroke participants to identify and quantify compensatory movements when they played rehabilitation games provided by the VRS. Then a pilot study was conducted to test the feasibility and efficacy of the VRS deployed in community, where 18 stroke participants were assigned to either virtual reality (VR) group or conventional treatment (CT) group, and each participant underwent 10 sessions of an additional 6 minutes of VR games or CT respectively, on top of their usual rehabilitation programme. Participants were assessed before and after interventions using Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Test(WMFT), Stroke Rehabilitation Motivation Scale (SRMS), Range of Motion (ROM) measurements and the number of compensatory movements.Results: VR group demonstrated a trend in reduction of trunk and upper-extremity compensations, increased intrinsic motivation scores, and statistically significant improvements in FMA-UE (p=0.045) and WMFT (p=0.009, p=0.0355) scores. There was, however, no significant difference in all outcome measures between two groups. Conclusion: The compensation-aware VRS demonstrates a trend towards reduced compensation and higher motivation level, which could be an effective adjunct to the conventional therapy with less supervision from a therapist as well as be potentially deployed in a community center or at an elder adult’s home.