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Can Startle Elicit Sequential Movements in Highly Trained Individuals?

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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

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.

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2018-05

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Startle can evoke individuated movements of the fingers; implications for neural control

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

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.

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2016-12

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StartReact and its Effect on Functional Upper Extremity Motor Tasks

Description

The phenomenon known as startReact is the fast, involuntary execution of a planned movement triggered by a startling acoustic stimulus. StartReact has previously been analyzed in simple motor movements such as finger abduction tasks, hand grasp tasks, and elbow extension

The phenomenon known as startReact is the fast, involuntary execution of a planned movement triggered by a startling acoustic stimulus. StartReact has previously been analyzed in simple motor movements such as finger abduction tasks, hand grasp tasks, and elbow extension tasks. More complex movements have also been analyzed, but there have been limited studies that look into functional complex tasks that require end-point accuracy. The objective of this project was to assess the ability to elicit startReact in tasks that simulate activities of daily living like feeding or picking up a glass of water. We hypothesized that a startReact response would be present in complex functional tasks, but the response would not be as accurate due to the increase in speed. Five subjects performed a simulated feeding task by moving kidney beans from one target to another where the end target changed in diameter as well as, a simulated drinking task where the subject moved a cup full of beads from one target to another. The hypothesis was supported due to a significant difference between no stimulus and stimulus trials for tricep muscle onset time, duration time, and the accuracy parameters of amount of beans dropped and weight in beads dropped. The results coincided with previous studies where subjects compensated for the change in diameter by increasing reaction time as the target diameter size decreased. The data obtained contradicted a previous study in relation to the duration time between the tasks due to our smallest diameter size having a faster duration time in comparison to the other diameter sizes. This study provides preliminary data that could assist researchers and clinicians in improving physical therapy methods for patients with impaired upper extremity motor movements.

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Date Created
2020-12

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Startle-evoked movement in multi-jointed, two-dimensional reaching tasks

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

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.

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Date Created
2016-12

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Evaluating the Effects of Ankle-Foot-Orthoses, Functional Electrical Stimulators, and Trip-specific Training on Fall Outcomes in Individuals with Stroke

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This dissertation aimed to evaluate the effectiveness and drawbacks of promising fall prevention strategies in individuals with stroke by rigorously analyzing the biomechanics of laboratory falls and compensatory movements required to prevent a fall. Ankle-foot-orthoses (AFOs) and functional electrical stimulators

This dissertation aimed to evaluate the effectiveness and drawbacks of promising fall prevention strategies in individuals with stroke by rigorously analyzing the biomechanics of laboratory falls and compensatory movements required to prevent a fall. Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FESs) are commonly prescribed to treat foot drop. Despite well-established positive impacts of AFOs and FES devices on balance and gait, AFO and FES users fall at a high rate. In chapter 2 (as a preliminary study), solely mechanical impacts of a semi-rigid AFO on the compensatory stepping response of young healthy individuals following trip-like treadmill perturbations were evaluated. It was found that a semi-rigid AFO on the stepping leg diminished the propulsive impulse of the compensatory step which led to decreased trunk movement control, shorter step length, and reduced center of mass (COM) stability. These results highlight the critical role of plantarflexors in generating an effective compensatory stepping response. In chapter 3, the underlying biomechanical mechanisms leading to high fall risk in long-term AFO and FES users with chronic stroke were studied. It was found that AFO and FES users fall more than Non-users because they have a more impaired lower limb that is not fully addressed by AFO/FES, therefore leading to a more impaired compensatory stepping response characterized by increased inability to generate a compensatory step with paretic leg and decreased trunk movement control. An ideal future AFO that provides dorsiflexion assistance during the swing phase and plantarflexion assistance during the push-off phase of gait is suggested to enhance the compensatory stepping response and reduce more falls. In chapter 4, the effects of a single-session trip-specific training on the compensatory stepping response of individuals with stroke were evaluated. Trunk movement control was improved after a single session of training suggesting that this type of training is a viable option to enhance compensatory stepping response and reduce falls in individuals with stroke. Finally, a future powered AFO with plantarflexion assistance complemented by a trip-specific training program is suggested to enhance the compensatory stepping response and decrease falls in individuals with stroke.

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Date Created
2019

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Conventional Vs Robotic Stroke Therapy: Designing a Pilot study

Description

Stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients, thus causing brain cells to die. Stroke is the 5th leading cause of death in the United

Stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients, thus causing brain cells to die. Stroke is the 5th leading cause of death in the United States and is one of the major causes of disability. Conventional therapy is a form of stroke rehabilitation generally consisting of physical and occupational therapy. It focuses on customized exercises based on the patient’s feedback. Physical therapy includes exercises such as weight bearing (affected arm), vibration of affected muscle and gravity-eliminated movement of affected arm. Overall physical therapy aims at strengthening muscle groups and aides in the relearning process. Occupational aspect of conventional therapy includes activities of daily living (ADL) such as dressing, self-feeding, grooming and toileting. Overall occupational therapy focuses on improving the daily activities performed by individuals. In comparison to conventional therapy, robotic therapy is relatively newer therapy. It uses robotic devices to perform repetitive motions and delivers high dosage and high intensity training to stroke patients. Based on the research studies reviewed, it is known that neuroplasticity in stroke patients is linked to interventions which are high in dosage, intensity, repetition, difficulty, salience. Peer-reviewed literature suggests robotic therapy might be a viable option for recovery in stroke patients. However, the extent to which robotic therapy may provide greater benefits than conventional therapy remains unclear. This thesis addresses the key components of a study design for comparing the efficacy of robotic therapy relative to conventional therapy to improve upper limb sensorimotor function in stroke survivors. The study design is based on an extensive review of the literature of stroke clinical trials and robotic therapy studies, analyses of the capabilities of a robotic therapy device (M2, Fourier Intelligence), and pilot data collected on healthy controls to create a pipeline of tasks and analyses to extract biomarkers of sensorimotor functional changes. This work has laid the foundation for a pilot longitudinal study that will be conducted at the Barrow Neurological Institute, Phoenix, AZ, where conventional and robotic therapy will be compared in a small cohort of stroke survivors.

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Date Created
2021

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The Design and Characterization of a Soft Haptic Interface for Rehabilitation of Impaired Hand Function

Description

The human hand comprises complex sensorimotor functions that can be impaired by neurological diseases and traumatic injuries. Effective rehabilitation can bring the impaired hand back to a functional state because of the plasticity of the central nervous system to relearn

The human hand comprises complex sensorimotor functions that can be impaired by neurological diseases and traumatic injuries. Effective rehabilitation can bring the impaired hand back to a functional state because of the plasticity of the central nervous system to relearn and remodel the lost synapses in the brain. Current rehabilitation therapies focus on strengthening motor skills, such as grasping, employ multiple objects of varying stiffness and devices that are bulky, costly, and have limited range of stiffness due to the rigid mechanisms employed in their variable stiffness actuators. This research project presents a portable cost-effective soft robotic haptic device with a broad stiffness range that is adjustable and can be utilized in both clinical and home settings. The device eliminates the need for multiple objects by employing a pneumatic soft structure made with highly compliant materials that act as the actuator as well as the structure of the haptic interface. It is made with interchangeable soft elastomeric sleeves that can be customized to include materials of varying stiffness to increase or decrease the stiffness range. The device is fabricated using existing 3D printing technologies, and polymer molding and casting techniques, thus keeping the cost low and throughput high. The haptic interface is linked to either an open-loop system that allows for an increased pressure during usage or closed-loop system that provides pressure regulation in accordance with the stiffness the user specifies. A preliminary evaluation is performed to characterize the effective controllable region of variance in stiffness. Results indicate that the region of controllable stiffness was in the center of the device, where the stiffness appeared to plateau with each increase in pressure. The two control systems are tested to derive relationships between internal pressure, grasping force exertion on the surface, and displacement using multiple probing points on the haptic device. Additional quantitative evaluation is performed with study participants and juxtaposed to a qualitative analysis to ensure adequate perception in compliance variance. Finally, a qualitative evaluation showed that greater than 60% of the trials resulted in the correct perception of stiffness in the haptic device.

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Date Created
2018