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Description
Parkinson's disease (PD) is a neurodegenerative disorder that produces a characteristic set of neuromotor deficits that sometimes includes reduced amplitude and velocity of movement. Several studies have shown that people with PD improved their motor performance when presented with external cues. Other work has demonstrated that high velocity and large amplitude exercises can increase the amplitude and velocity of movement in simple carryover tasks in the upper and lower extremities. Although the cause for these effects is not known, improvements due to cueing suggest that part of the neuromotor deficit in PD is in the integration of sensory feedback to produce motor commands. Previous studies have documented some somatosensory deficits, but only limited information is available regarding the nature and magnitude of sensorimotor deficits in the shoulder of people with PD. The goals of this research were to characterize the sensorimotor impairment in the shoulder joint of people with PD and to investigate the use of visual feedback and large amplitude/high velocity exercises to target PD-related motor deficits. Two systems were designed and developed to use visual feedback to assess the ability of participants to accurately adjust limb placement or limb movement velocity and to encourage improvements in performance of these tasks. Each system was tested on participants with PD, age-matched control subjects and young control subjects to characterize and compare limb placement and velocity control capabilities. Results demonstrated that participants with PD were less accurate at placing their limbs than age-matched or young control subjects, but that their performance improved over the course of the test session such that by the end, the participants with PD performed as well as controls. For the limb velocity feedback task, participants with PD and age-matched control subjects were less accurate than young control subjects, but at the end of the session, participants with PD and age-matched control subjects were as accurate as the young control subjects. This study demonstrates that people with PD were able to improve their movement patterns based on visual feedback of performance and suggests that this feedback paradigm may be useful in exercise programs for people with PD.
ContributorsSmith, Catherine (Author) / Abbas, James J (Thesis advisor) / Ingalls, Todd (Thesis advisor) / Krishnamurthi, Narayanan (Committee member) / Buneo, Christopher (Committee member) / Rikakis, Thanassis (Committee member) / Arizona State University (Publisher)
Created2015
Description
As the application of interactive media systems expands to address broader problems in health, education and creative practice, they fall within a higher dimensional space for which it is inherently more complex to design. In response to this need an emerging area of interactive system design, referred to as experiential media systems, applies hybrid knowledge synthesized across multiple disciplines to address challenges relevant to daily experience. Interactive neurorehabilitation (INR) aims to enhance functional movement therapy by integrating detailed motion capture with interactive feedback in a manner that facilitates engagement and sensorimotor learning for those who have suffered neurologic injury. While INR shows great promise to advance the current state of therapies, a cohesive media design methodology for INR is missing due to the present lack of substantial evidence within the field. Using an experiential media based approach to draw knowledge from external disciplines, this dissertation proposes a compositional framework for authoring visual media for INR systems across contexts and applications within upper extremity stroke rehabilitation. The compositional framework is applied across systems for supervised training, unsupervised training, and assisted reflection, which reflect the collective work of the Adaptive Mixed Reality Rehabilitation (AMRR) Team at Arizona State University, of which the author is a member. Formal structures and a methodology for applying them are described in detail for the visual media environments designed by the author. Data collected from studies conducted by the AMRR team to evaluate these systems in both supervised and unsupervised training contexts is also discussed in terms of the extent to which the application of the compositional framework is supported and which aspects require further investigation. The potential broader implications of the proposed compositional framework and methodology are the dissemination of interdisciplinary information to accelerate the informed development of INR applications and to demonstrate the potential benefit of generalizing integrative approaches, merging arts and science based knowledge, for other complex problems related to embodied learning.
ContributorsLehrer, Nicole (Author) / Rikakis, Thanassis (Committee member) / Olson, Loren (Committee member) / Wolf, Steven L. (Committee member) / Turaga, Pavan (Committee member) / Arizona State University (Publisher)
Created2014
Description
Stroke is a leading cause of disability with varying effects across stroke survivors necessitating comprehensive approaches to rehabilitation. Interactive neurorehabilitation (INR) systems represent promising technological solutions that can provide an array of sensing, feedback and analysis tools which hold the potential to maximize clinical therapy as well as extend therapy to the home. Currently, there are a variety of approaches to INR design, which coupled with minimal large-scale clinical data, has led to a lack of cohesion in INR design. INR design presents an inherently complex space as these systems have multiple users including stroke survivors, therapists and designers, each with their own user experience needs. This dissertation proposes that comprehensive INR design, which can address this complex user space, requires and benefits from the application of interdisciplinary research that spans motor learning and interactive learning. A methodology for integrated and iterative design approaches to INR task experience, assessment, hardware, software and interactive training protocol design is proposed within the comprehensive example of design and implementation of a mixed reality rehabilitation system for minimally supervised environments. This system was tested with eight stroke survivors who showed promising results in both functional and movement quality improvement. The results of testing the system with stroke survivors as well as observing user experiences will be presented along with suggested improvements to the proposed design methodology. This integrative design methodology is proposed to have benefit for not only comprehensive INR design but also complex interactive system design in general.
ContributorsBaran, Michael (Author) / Rikakis, Thanassis (Thesis advisor) / Olson, Loren (Thesis advisor) / Wolf, Steven L. (Committee member) / Ingalls, Todd (Committee member) / Arizona State University (Publisher)
Created2014
Description
Startle-evoked-movement (SEM), the involuntary release of a planned movement via a startling stimulus, has gained significant attention recently for its ability to probe motor planning as well as enhance movement of the upper extremity following stroke. We recently showed that hand movements are susceptible to SEM. Interestingly, only coordinated movements of the hand (grasp) but not individuated movements of the finger (finger abduction) were susceptible. It was suggested that this resulted from different neural mechanisms involved in each task; however it is possible this was the result of task familiarity. The objective of this study was to evaluate a more familiar individuated finger movement, typing, to determine if this task was susceptible to SEM. We hypothesized that typing movements will be susceptible to SEM in all fingers. These results indicate that individuated movements of the fingers are susceptible to SEM when the task involves a more familiar task, since the electromyogram (EMG) latency is faster in SCM+ trials compared to SCM- trials. However, the middle finger does not show a difference in terms of the keystroke voltage signal, suggesting the middle finger is less susceptible to SEM. Given that SEM is thought to be mediated by the brainstem, specifically the reticulospinal tract, this suggest that the brainstem may play a role in movements of the distal limb when those movements are very familiar, and the independence of each finger might also have a significant on the effect of SEM. Further research includes understanding SEM in fingers in the stroke population. The implications of this research can impact the way upper extremity rehabilitation is delivered.
ContributorsQuezada Valladares, Maria Jose (Author) / Honeycutt, Claire (Thesis director) / Santello, Marco (Committee member) / Harrington Bioengineering Program (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
Description
Previous research has shown that a loud acoustic stimulus can trigger an individual's prepared movement plan. This movement response is referred to as a startle-evoked movement (SEM). SEM has been observed in the stroke survivor population where results have shown that SEM enhances single joint movements that are usually performed with difficulty. While the presence of SEM in the stroke survivor population advances scientific understanding of movement capabilities following a stroke, published studies using the SEM phenomenon only examined one joint. The ability of SEM to generate multi-jointed movements is understudied and consequently limits SEM as a potential therapy tool. In order to apply SEM as a therapy tool however, the biomechanics of the arm in multi-jointed movement planning and execution must be better understood. Thus, the objective of our study was to evaluate if SEM could elicit multi-joint reaching movements that were accurate in an unrestrained, two-dimensional workspace. Data was collected from ten subjects with no previous neck, arm, or brain injury. Each subject performed a reaching task to five Targets that were equally spaced in a semi-circle to create a two-dimensional workspace. The subject reached to each Target following a sequence of two non-startling acoustic stimuli cues: "Get Ready" and "Go". A loud acoustic stimuli was randomly substituted for the "Go" cue. We hypothesized that SEM is accessible and accurate for unrestricted multi-jointed reaching tasks in a functional workspace and is therefore independent of movement direction. Our results found that SEM is possible in all five Target directions. The probability of evoking SEM and the movement kinematics (i.e. total movement time, linear deviation, average velocity) to each Target are not statistically different. Thus, we conclude that SEM is possible in a functional workspace and is not dependent on where arm stability is maximized. Moreover, coordinated preparation and storage of a multi-jointed movement is indeed possible.
ContributorsOssanna, Meilin Ryan (Author) / Honeycutt, Claire (Thesis director) / Schaefer, Sydney (Committee member) / Harrington Bioengineering Program (Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
Description
Millions of Americans live with motor impairments resulting from a stroke and the best way to administer rehabilitative therapy to achieve recovery is not well understood. Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. The AMRR system was evaluated in a small (N=3) cohort of stroke survivors to determine best practices for administering adaptive, media-based therapy. A proof of concept study followed, examining changes in clinical scale and kinematic performances among a group of stroke survivors who received either a month of AMRR therapy (N = 11) or matched dosing of traditional repetitive task therapy (N = 10). Both groups demonstrated statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment scores, indicating increased function after the therapy. However, only participants who received AMRR therapy showed a consistent improvement in their kinematic measurements, including those measured in the trained reaching task (reaching to grasp a cone) and in an untrained reaching task (reaching to push a lighted button). These results suggest that that the AMRR system can be used as a therapy tool to enhance both functionality and reaching kinematics that quantify movement quality. Additionally, the AMRR concepts are currently being transitioned to a home-based training application. An inexpensive, easy-to-use, toolkit of tangible objects has been developed to sense, assess and provide feedback on hand function during different functional activities. These objects have been shown to accurately and consistently track hand function in people with unimpaired movements and will be tested with stroke survivors in the future.
ContributorsDuff, Margaret Rose (Author) / Rikakis, Thanassis (Thesis advisor) / He, Jiping (Thesis advisor) / Herman, Richard (Committee member) / Kleim, Jeffrey (Committee member) / Santos, Veronica (Committee member) / Towe, Bruce (Committee member) / Arizona State University (Publisher)
Created2012