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Description
The efficacy of deep brain stimulation (DBS) in Parkinson's disease (PD) has been convincingly demonstrated in studies that compare motor performance with and without stimulation, but characterization of performance at intermediate stimulation amplitudes has been limited. This study investigated the effects of changing DBS amplitude in order to assess dose-response characteristics, inter-subject variability, consistency of effect across outcome measures, and day-to-day variability. Eight subjects with PD and bilateral DBS systems were evaluated at their clinically determined stimulation (CDS) and at three reduced amplitude conditions: approximately 70%, 30%, and 0% of the CDS (MOD, LOW, and OFF, respectively). Overall symptom severity and performance on a battery of motor tasks - gait, postural control, single-joint flexion-extension, postural tremor, and tapping - were assessed at each condition using the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and quantitative measures. Data were analyzed to determine whether subjects demonstrated a threshold response (one decrement in stimulation resulted in ≥ 70% of the maximum change) or a graded response to reduced stimulation. Day-to-day variability was assessed using the CDS data from the three testing sessions. Although the cohort as a whole demonstrated a graded response on several measures, there was high variability across subjects, with subsets exhibiting graded, threshold, or minimal responses. Some subjects experienced greater variability in their CDS performance across the three days than the change induced by reducing stimulation. For several tasks, a subset of subjects exhibited improved performance at one or more of the reduced conditions. Reducing stimulation did not affect all subjects equally, nor did it uniformly affect each subject's performance across tasks. These results indicate that altered recruitment of neural structures can differentially affect motor capabilities and demonstrate the need for clinical consideration of the effects on multiple symptoms across several days when selecting DBS parameters.
ContributorsConovaloff, Alison (Author) / Abbas, James (Thesis advisor) / Krishnamurthi, Narayanan (Committee member) / Mahant, Padma (Committee member) / Jung, Ranu (Committee member) / Helms Tillery, Stephen (Committee member) / Arizona State University (Publisher)
Created2013
Description
Gait and balance disorders are the second leading cause of falls in the elderly. Investigating the changes in static and dynamic balance due to aging may provide a better understanding of the effects of aging on postural control system. Static and dynamic balance were evaluated in a total of 21 young (21-35 years) and 22 elderly (50-75 years) healthy subjects while they performed three different tasks: quiet standing, dynamic weight shifts, and over ground walking. During the quiet standing task, the subjects stood with their eyes open and eyes closed. When performing dynamic weight shifts task, subjects shifted their Center of Pressure (CoP) from the center target to outward targets and vice versa while following real-time feedback of their CoP. For over ground walking tasks, subjects performed Timed Up and Go test, tandem walking, and regular walking at their self-selected speed. Various quantitative balance and gait measures were obtained to evaluate the above respective balance and walking tasks. Total excursion, sway area, and mean frequency of CoP during quiet standing were found to be the most reliable and showed significant increase with age and absence of visual input. During dynamic shifts, elderly subjects exhibited higher initiation time, initiation path length, movement time, movement path length, and inaccuracy indicating deterioration in performance. Furthermore, the elderly walked with a shorter stride length, increased stride variability, with a greater turn and turn-to-sit duration. Significant correlations were also observed between measures derived from the different balance and gait tasks. Thus, it can be concluded that aging deteriorates the postural control system affecting static and dynamic balance and some of the alterations in CoP and gait measures may be considered as protective mechanisms to prevent loss of balance.
ContributorsBalasubramanian, Shruthi (Author) / Krishnamurthi, Narayanan (Thesis advisor) / Abbas, James (Thesis advisor) / Buneo, Christopher (Committee member) / Arizona State University (Publisher)
Created2014
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
Although tremor, rigidity, and bradykinesia are cardinal symptoms of Parkinson's disease (PD), impairments of gait and balance significantly affect quality of life, especially as the disease progresses, and do not respond well to anti-parkinsonism medications. Many studies have shown that people with PD can walk better when appropriate cues are presented but, to the best of our knowledge, the effects of real-time feedback of step length and uprightness of posture on gait and posture have not been specifically investigated. If it can be demonstrated that real-time feedback can improve posture and gait, the resultant knowledge could be used to design effective rehabilitation strategies to improve quality of life in this population.
In this feasibility study, we have developed a treadmill-based experimental paradigm to provide feedback of step length and upright posture in real-time. Ten subjects (mean age 65.9 ± 7.6 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were evaluated in their ability to successfully utilize real-time feedback presented during quiet standing and treadmill walking tasks during a single data collection session in their medication-on state. During quiet standing tasks in which back angle feedback was provided, subjects were asked to utilize the feedback to maintain upright posture. During treadmill walking tasks, subjects walked at their self-selected speed for five minutes without feedback, with feedback of back angle, or with feedback of step length. During walking tasks with back angle feedback, subjects were asked to utilize the feedback to maintain upright posture. During walking tasks with step length feedback, subjects were asked to utilize the feedback to walk with increased step length. During quiet standing tasks, measurements of back angle were obtained; during walking tasks, measurements of back angle, step length, and step time were obtained.
Subjects stood and walked with significantly increased upright posture during the tasks with real-time back angle feedback compared to tasks without feedback. Similarly, subjects walked with significantly increased step length during tasks with real-time step length feedback compared to tasks without feedback. These results demonstrate that people with PD can utilize real-time feedback to improve upright posture and gait.
In this feasibility study, we have developed a treadmill-based experimental paradigm to provide feedback of step length and upright posture in real-time. Ten subjects (mean age 65.9 ± 7.6 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were evaluated in their ability to successfully utilize real-time feedback presented during quiet standing and treadmill walking tasks during a single data collection session in their medication-on state. During quiet standing tasks in which back angle feedback was provided, subjects were asked to utilize the feedback to maintain upright posture. During treadmill walking tasks, subjects walked at their self-selected speed for five minutes without feedback, with feedback of back angle, or with feedback of step length. During walking tasks with back angle feedback, subjects were asked to utilize the feedback to maintain upright posture. During walking tasks with step length feedback, subjects were asked to utilize the feedback to walk with increased step length. During quiet standing tasks, measurements of back angle were obtained; during walking tasks, measurements of back angle, step length, and step time were obtained.
Subjects stood and walked with significantly increased upright posture during the tasks with real-time back angle feedback compared to tasks without feedback. Similarly, subjects walked with significantly increased step length during tasks with real-time step length feedback compared to tasks without feedback. These results demonstrate that people with PD can utilize real-time feedback to improve upright posture and gait.
ContributorsJellish, Jeremy (Author) / Abbas, James (Thesis advisor) / Krishnamurthi, Narayanan (Thesis advisor) / Ingalls, Todd (Committee member) / Arizona State University (Publisher)
Created2014
Description
Progressive gait disorder in Parkinson's disease (PD) is usually exhibited as reduced step/stride length and gait speed. People with PD also exhibit stooped posture, which can contribute to reduced step length and arm swing. Since gait and posture deficits in people with PD do not respond well to pharmaceutical and surgical treatments, novel rehabilitative therapies to alleviate these impairments are necessary. Many studies have confirmed that people with PD can improve their walking patterns when external cues are presented. Only a few studies have provided explicit real-time feedback on performance, but they did not report how well people with PD can follow the cues on a step-by-step basis. In a single-session study using a novel-treadmill based paradigm, our group had previously demonstrated that people with PD could follow step-length and back angle feedback and improve their gait and posture during treadmill walking. This study investigated whether a long-term (6-week, 3 sessions/week) real-time feedback training (RTFT) program can improve overground gait, upright posture, balance, and quality of life. Three subjects (mean age 70 ± 2 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were enrolled and participated in the program. The RTFT sessions involved walking on a treadmill while following visual feedback of step length and posture (one at any given time) displayed on a monitor placed in front of the subject at eye-level. The target step length was set between 110-120% of the step length obtained during a baseline non-feedback walking trial and the target back angle was set at the maximum upright posture exhibited during a quiet standing task. Two subjects were found to significantly improve their posture and overground walking at post-training and these changes were retained six weeks after RTFT (follow-up) and the third subject improved his upright posture and gait rhythmicity. Furthermore, the magnitude of the improvements observed in these subjects was greater than the improvements observed in reports on other neuromotor interventions. These results provide preliminary evidence that real-time feedback training can be used as an effective rehabilitative strategy to improve gait and upright posture in people with PD.
ContributorsBaskaran, Deepika (Author) / Krishnamurthi, Narayanan (Thesis advisor) / Abbas, James (Thesis advisor) / Honeycutt, Claire (Committee member) / Arizona State University (Publisher)
Created2017
Description
Adapting to one novel condition of a motor task has been shown to generalize to other naïve conditions (i.e., motor generalization). In contrast, learning one task affects the proficiency of another task that is altogether different (i.e. motor transfer). Much more is known about motor generalization than about motor transfer, despite of decades of behavioral evidence. Moreover, motor generalization is studied as a probe to understanding how movements in any novel situations are affected by previous experiences. Thus, one could assume that mechanisms underlying transfer from trained to untrained tasks may be same as the ones known to be underlying motor generalization. However, the direct relationship between transfer and generalization has not yet been shown, thereby limiting the assumption that transfer and generalization rely on the same mechanisms. The purpose of this study was to test whether there is a relationship between motor generalization and motor transfer. To date, ten healthy young adult subjects were scored on their motor generalization ability and motor transfer ability on various upper extremity tasks. Although our current sample size is too small to clearly identify whether there is a relationship between generalization and transfer, Pearson product-moment correlation results and a priori power analysis suggest that a significant relationship will be observed with an increased sample size by 30%. If so, this would suggest that the mechanisms of transfer may be similar to those of motor generalization.
ContributorsSohani, Priyanka (Author) / Schaefer, Sydney (Thesis advisor) / Daliri, Ayoub (Committee member) / Honeycutt, Claire (Committee member) / Arizona State University (Publisher)
Created2018
Description
Most daily living tasks consist of pairing a series of sequential movements, e.g., reaching to a cup, grabbing the cup, lifting and returning the cup to your mouth. The process by which we control and mediate the smooth progression of these tasks is not well understood. One method which we can use to further evaluate these motions is known as Startle Evoked Movements (SEM). SEM is an established technique to probe the motor learning and planning processes by detecting muscle activation of the sternocleidomastoid muscles of the neck prior to 120ms after a startling stimulus is presented. If activation of these muscles was detected following a stimulus in the 120ms window, the movement is classified as Startle+ whereas if no sternocleidomastoid activation is detected after a stimulus in the allotted time the movement is considered Startle-. For a movement to be considered SEM, the activation of movements for Startle+ trials must be faster than the activation of Startle- trials. The objective of this study was to evaluate the effect that expertise has on sequential movements as well as determining if startle can distinguish when the consolidation of actions, known as chunking, has occurred. We hypothesized that SEM could distinguish words that were solidified or chunked. Specifically, SEM would be present when expert typists were asked to type a common word but not during uncommon letter combinations. The results from this study indicated that the only word that was susceptible to SEM, where Startle+ trials were initiated faster than Startle-, was an uncommon task "HET" while the common words "AND" and "THE" were not. Additionally, the evaluation of the differences between each keystroke for common and uncommon words showed that Startle was unable to distinguish differences in motor chunking between Startle+ and Startle- trials. Explanations into why these results were observed could be related to hand dominance in expert typists. No proper research has been conducted to evaluate the susceptibility of the non-dominant hand's fingers to SEM, and the results of future studies into this as well as the results from this study can impact our understanding of sequential movements.
ContributorsMieth, Justin Richard (Author) / Honeycutt, Claire (Thesis director) / Santello, Marco (Committee member) / Harrington Bioengineering Program (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
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
According to the CDC in 2010, there were 2.8 million emergency room visits costing $7.9 billion dollars for treatment of nonfatal falling injuries in emergency departments across the country. Falls are a recognized risk factor for unintentional injuries among older adults, accounting for a large proportion of fractures, emergency department visits, and urgent hospitalizations. The objective of this research was to identify and learn more about what factors affect balance using analysis techniques from nonlinear dynamics. Human balance and gait research traditionally uses linear or qualitative tests to assess and describe human motion; however, it is growing more apparent that human motion is neither a simple nor a linear task. In the 1990s Collins, first started applying stochastic processes to analyze human postural control system. Recently, Zakynthinaki et al. modeled human balance using the idea that humans will remain erect when perturbed until some boundary, or physical limit, is passed. This boundary is similar to the notion of basins of attraction in nonlinear dynamics and is referred to as the basin of stability. Human balance data was collected using dual force plates and Vicon marker position data for leans using only ankle movements and leans that were unrestricted. With this dataset, Zakynthinaki’s work was extended by comparing different algorithms used to create the critical curve (basin of stability boundary) that encloses the experimental data points as well as comparing the differences between the two leaning conditions.
ContributorsSmith, Victoria (Author) / Spano, Mark L (Thesis advisor) / Lockhart, Thurmon E (Thesis advisor) / Honeycutt, Claire (Committee member) / Arizona State University (Publisher)
Created2016