functional-near-infrared-spectroscopy-sensory-motor-brain-regions

Functional Near Infrared Spectroscopy of the Sensory and Motor Brain Regions with Simultaneous Kinematic and EMG Monitoring During Motor Tasks

There are several advantages that functional near-infrared spectroscopy (fNIRS) presents in the study of the neural control of human movement. It is ...

National Institutes of Health

Total reaching range of motion (work area) diminishes as a function of shoulder abduction loading in the paretic arm in individuals with chronic hemiparetic stroke. This occurs when reaching outward against gravity or during transport of an object.

Progressive shoulder abduction loading is a crucial element of arm rehabilitation in chronic stroke.

The implementation of a robotic system (ACT(3D)) that allowed for a quantitative measurement of abnormal joint torque coupling in chronic stroke survivors and, most importantly, a quantitative means of initiating and progressing an impairment-based intervention, is described. Individuals with chronic moderate to severe stroke (n = 8) participated in this single-group pretest-posttest design study. Subjects were trained over eight weeks by progressively increasing the level of shoulder abduction loading experienced by the participant during reaching repetitions as performance improved. Reaching work area was evaluated pre- and postintervention for ten different shoulder abduction loading levels along with isometric single-joint strength and a qualitative clinical assessment of impairment. There was a significant effect of session (pre versus post) with an increase in reaching work area, despite no change in single-joint strength. This data suggests that specifically targeting the abnormal joint torque coupling impairment through progressive shoulder abduction loading is an effective strategy for improving reaching work area following hemiparetic stroke. Application of robotics, namely, the ACT(3D), allowed for quantitative control of the exercise parameters needed to directly target the synergistic coupling impairment. The targeted reduction of abnormal joint torque coupling is likely the key factor explaining the improvements in reaching range of motion achieved with this intervention.

Impairment-Based 3-D Robotic Intervention Improves Upper Extremity Work Area in Chronic Stroke: Targeting Abnormal Joint Torque Coupling With Progressive Shoulder Abduction Loading.

Cerebral palsy is the most common neurodevelopmental motor disability in children. The condition requires medical, educational, social, and rehabilitative resources throughout the life span. Several countries have developed population-based registries that serve the purpose of prospective longitudinal collection of etiologic, demographic, and functional severity. The United States has not created a comprehensive program to develop such a registry. Barriers have been large population size, poor interinstitution collaboration, and decentralized medical and social systems. The Cerebral Palsy Research Registry was created to fill the gap between population and clinical-based cerebral palsy registries and promote research in the field. This is accomplished by connecting persons with cerebral palsy, as well as their families, to a network of regional researchers. This article describes the development of an expandable cerebral palsy research registry, its current status, and the potential it has to affect families and persons with cerebral palsy in the United States and abroad.

The cerebral palsy research registry: development and progress toward national collaboration in the United States.

This paper details the design of the Wrist and Finger Torque Sensing module (WFTS): a lightweight, portable device that measures isometric wrist and finger flexion and extension joint torques. The WFTS can be used in combination with rehabilitation robots such as the ACT-3D, with isometric measurement stations, or as a stand-alone device. Because many robotic devices are limited in that they involve the hand in isolation, the WFTS is designed to investigate abnormal joint torque coupling at the paretic wrist and fingers in individuals with adult-onset stroke or childhood hemiplegia during 3D arm movements or isometric generation of shoulder and elbow torques. In short, the versatility of the WFTS allows for a variety of applications.

Wrist and Finger Torque Sensor for the quantification of upper limb motor impairments following brain injury.

This study investigated the presence of inter-limb activity at the elbow joint in individuals with childhood-onset hemiparesis, including spontaneous mirror movements during unilateral tasks and the ability to suppress them during bilateral tasks. Eighteen individuals with hemiparesis were divided into three categories of injury timing: before birth (PRE-natal), around the time of birth (PERI-natal), and after 6 months of age (POST-natal). Individuals with hemiparesis, as well as 12 typically developing peers, participated in unilateral and bilateral elbow flexion and extension tasks completed at maximal and submaximal effort while muscle activity was monitored and motor output was quantified by two multiple degrees-of-freedom load cells. Significantly, higher levels of paretic elbow flexion were found only in the PRE- and PERI-natal groups during the flexion of the non-paretic limb, which was modulated by effort level in both unilateral and bilateral tasks. The bilateral activation of elbow flexors in the PRE-/PERI-natal groups indicates potential use of a common cortical command source to drive both upper extremities, while the POST-natal/typically developing groups' flexors appear to receive input from different supraspinal structures.

Loss of independent limb control in childhood hemiparesis is related to time of brain injury onset.

Extensive neuromotor development occurs early in human life, and the timing of brain injury may affect the resulting motor impairment. In Part I of this series, it was demonstrated that the distribution of weakness in the upper extremity depended on the timing of brain injury in individuals with childhood-onset hemiparesis.

Motor impairments related to brain injury timing in early hemiparesis. Part II: abnormal upper extremity joint torque synergies.

Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments.

Motor impairment factors related to brain injury timing in early hemiparesis. Part I: expression of upper-extremity weakness.

Motor impairments following unilateral brain injuries may be related to changes in the corpus callosum. The purpose of this study was to determine if the corpus callosum is impacted differently in pediatric versus adult hemiplegia. Diffusion tensor imaging was completed on 41 participants (11 pediatric hemiplegia, 10 adult hemiplegia, 10 pediatric control and 10 adult control). Fractional anisotropy values and cross-sectional areas for five regions of the corpus callosum were compared between subject groups. Additionally, the amount of involuntary activity in the paretic elbow was quantified during non-paretic elbow flexion tasks for a subset of pediatric hemiplegia participants. Fractional anisotropy values were reduced in pediatric hemiplegia compared to pediatric control subjects in callosal regions corresponding to premotor and supplementary motor areas, primary sensory cortex, and parietal, temporal, and occipital cortices. Differences in fractional anisotropy between adult stroke and adult controls were only found in the region corresponding to parietal, temporal, and occipital cortices. Cross-sectional area was affected in all regions of the corpus callosum in pediatric hemiplegia, but only in the primary sensory region in adult hemiplegia. Additionally, changes in the cross-sectional areas were correlated with involuntary mirror movements in the pediatric hemiplegia group. In conclusion, the corpus callosum is affected to a greater extent in pediatric compared to adult hemiplegia, which may explain why unsuppressed mirror movements and difficulty with bimanual coordination are greater problems in this population.

The effect of injury timing on white matter changes in the corpus callosum following unilateral brain injury.

To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy.

Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice?

Article	Year
Progressive shoulder abduction loading is a crucial element of arm rehabilitation in chronic stroke. Neurorehabilitation and neural repair\| PubMed ID: 19454622	2009
Impairment-Based 3-D Robotic Intervention Improves Upper Extremity Work Area in Chronic Stroke: Targeting Abnormal Joint Torque Coupling With Progressive Shoulder Abduction Loading. IEEE transactions on robotics : a publication of the IEEE Robotics and Automation Society\| PubMed ID: 20657711	2009
The cerebral palsy research registry: development and progress toward national collaboration in the United States. Journal of child neurology\| PubMed ID: 21677201	2011
Wrist and Finger Torque Sensor for the quantification of upper limb motor impairments following brain injury. IEEE ... International Conference on Rehabilitation Robotics : [proceedings]\| PubMed ID: 22275662	2011
Loss of independent limb control in childhood hemiparesis is related to time of brain injury onset. Experimental brain research\| PubMed ID: 23411673	2013
Motor impairments related to brain injury timing in early hemiparesis. Part II: abnormal upper extremity joint torque synergies. Neurorehabilitation and neural repair\| PubMed ID: 23911972	2014
Motor impairment factors related to brain injury timing in early hemiparesis. Part I: expression of upper-extremity weakness. Neurorehabilitation and neural repair\| PubMed ID: 24009182	2014
The effect of injury timing on white matter changes in the corpus callosum following unilateral brain injury. NeuroImage. Clinical\| PubMed ID: 24179855	2013
Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? Archives of physical medicine and rehabilitation\| PubMed ID: 24792141	2014

Theresa Sukal-Moulton

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