Background: In the past two decades, many research groups have shown that when velocity dependent force field is applied to arm motion, subjects learn to compensate for the external perturbation and return a linear path. Thus, adaptation to a novel condition consists of creating an Internal Model of the new environment which is included in the normal unperturbed motor commands to achieve good performances. The efficiency of this motor control mechanism can be compromised by the presence of a pathological disorders or by muscular-skeletal modifications such as the ones connected to natural aging process. In this respect, the present study aimed at identifying the age-related modifications in upper limb motor control strategies during adaptation and de-adaptation processes. Methods: Eight young and eight elderly healthy subjects, were included in the experiment. Subjects were instructed to perform pointing movements in the horizontal plane both in a null field and in a velocity dependent force field . The evolution of smoothness and hand path parameters were evaluated as coordination characteristics of human movements. Furthermore, the ability of modulating the interactive torque have been used as a paradigm to explain the observed discoordinated patterns during the adaptation process. Results: The evolution of the kinematics characteristics during the experiment highlight important behavioural differences between the two groups during the adaptation and de-adaptation processes. Young subjects improvement of movements smoothness was in accordance with the expected learning trend related to the consolidation of the internal model both in the adaptation and in de-adaptation phases. Elders did not show a coherent learning process and needed a more prolonged training to achieve the same performances of young subjects. The kinetic analysis pointed out the presence of different strategies for the compensation of the external perturbation, which in the case of older people required the involvement of the shoulder and results in a different modulation of joints torque components during the evolution of the experiments. Conclusions: The results obtained with the present study seemed to confirm what has been claimed in past works about the presence of different mechanisms influencing motor adaptation related both to kinematic and dynamic recovery. The strategy adopted by young subjects attempted to first minimize hand path errors during adaptation and de-adaptation phases, but provided evidence for a secondary process that is consistent with the optimization of the effort. Elderly subjects instead, seemed to shift the importance of the two processes involved in the control loop slowing the mechanism optimizing kinematic performance and enabling more the dynamic adaptation mechanism.

Background: The control of the head movements during walking allows for the stabilisation of the optic flow, for a more effective processing of the vestibular system signals, and for the consequent control of equilibrium. In young individuals, the oscillations of the upper body during level walking are characterised by an attenuation of the linear acceleration going from pelvis to head level. In elderly subjects the ability to implement this motor strategy is reduced. The aim of this paper is to go deeper into the mechanisms through which the head accelerations are controlled during level walking, in both young and elderly women specifically. Methods: A stereophotogrammetric system was used to reconstruct the displacement of markers located at head, shoulder, and pelvis level while 16 young (age: 24+/-4 years) and 20 older (age: 72+/-4 years) female volunteers walked at comfortable and fast speed along a linear pathway. The harmonic coefficients of the displacements in the medio-lateral (ML), antero-posterior (AP), and vertical (V) directions were calculated via discrete Fourier transform, and relevant accelerations were computed by analytical double differentiation. The root mean square of the accelerations were used to define three coefficients for quantifying the attenuations of the accelerations from pelvis to head, from pelvis to shoulder and from shoulder to head. Results: The coefficients of attenuation were shown to be independent from the walking speed, and hence suitable for group and subject comparison. The acceleration in the AP direction was attenuated by the two groups both from pelvis to shoulder and from shoulder to head. The reduction of the shoulder to head acceleration, however, was less effective in older women, suggesting that the ability to exploit the cervical hinge to attenuate the AP acceleration is challenged in this population. Young women managed to exploit a pelvis to shoulder attenuation strategy also in the ML direction, whereas in the elderly group the head acceleration was even larger than the pelvis acceleration. Conclusion: The control of the head acceleration is fundamental when implementing a locomotor strategy and its loss could be one of the causes for walking instability in elderly women.

Background: Variability in stride velocity during walking characterizes gait instability and predicts falling in older individuals. Walking while executing a cognitive task is also associated with increased risk of falling, particularly in older adults. Variability in stride velocity, particularly during dual task walking conditions, may differ between younger and older individuals. The purpose of this study was to examine whether gait velocity and variability in stride velocity differ between older community-dwelling women and younger women during dual task walking. Methods: Twenty-three older (80 +/- 9 years) and 19 younger (23 +/- 2 years) women walked under each of two conditions: (1) walking at a self-selected velocity and (2) walking at a self-selected velocity while incrementally counting backwards. Gait velocity and variability in stride velocity were measured with GAITRite(R) instrumentation. Results: Gait velocity decreased and variability in stride variability increased, in both groups, during dual task walking. The relative reduction in gait velocity and the magnitude of variability in stride velocity were greater in the older subjects than younger subjects. Conclusions: The gait changes observed in dual task walking characterize reduced gait stability and indicate that cognitively demanding tasks during walking have a destabilizing effect on gait that may place older persons at greater risk of falls.

Background: Slowness is a well-recognized feature of movements in aging. One of the possible reasons for slowness suggested by previous research is production of corrective submovements that compensate for shortened primary submovement to the target. Here, we re-examine this traditional interpretation and argue that the majority of submovements in older adults may be a consequence rather than the cause of slowness. Methods: Pointing movements in young and older adults were recorded. Conditions for submovement emergence were manipulated by using small and large targets and three movement modes: discrete (required stopping on the target), reciprocal (required reversal on the target), and passing (required crossing the target and stopping after that). Movements were parsed into a primary and secondary submovement based on zero-crossings of velocity (type 1 submovements), acceleration (type 2 submovements), and jerk (type 3 submovements). In the passing mode, secondary submovements were analyzed only after crossing the target to exclude that they were accuracy adjustments. Results: Consistent with previous research, the primary submovement was shortened and total secondary submovement incidence was increased in older adults. However, comparisons across conditions suggested that many submovements were non-corrective in both groups. Type 1 submovements were non-corrective because they were more frequent for large than small targets. They predominantly emerged due to arm stabilization and energy dissipation during motion termination in the discrete and passing mode. Although type 2 and 3 submovements were more frequent for small than large targets, this trend was also observed in the passing mode, suggesting that many of these submovements were non-corrective. Rather, they could have been velocity fluctuations associated predominantly with low speed of movements to small targets. Conclusions: The results question the traditional interpretation of frequent submovements in older adults as corrective adjustments. Rather, the increased incidence of submovements in older adults is directly related to low movement speed observed in aging, whereas the relationship between submovement incidence and target size is a result of speed-accuracy trade-off. Aging-related declines in muscular control that may contribute to the disproportional increases in submovement incidence during slow movements of older adults are discussed.

Background: It has been suggested in the past that the ability to walk while concurrently engaging in a second task deteriorates in old age, and that this deficit is related to the high incidence of falls in the elderly. However, previous studies provided inconsistent findings about the existence of such an age-related dual-task deficit (ARD). In an effort to explain this inconsistency, we explored whether ARD while walking emerges for some, but not for other types of task. MethodHealthy young and elderly subjects were tested under five different combinations of a walking and a non-walking task. The results were analysed jointly with those of a previous study from our lab, such that a total of 13 task combinations were evaluated. For each task combination and subject, we calculated the mean dual-task costs across both constituent tasks, and quantified ARD as the difference between those costs in elderly and in young subjects. Results: An analysis of covariance yielded no significant effects of obstacle presence and overall task difficulty on ARD, but a highly significant effect of visual demand: non-walking tasks which required ongoing visual observation led to ARD of more than 8%, while those without such requirement led to near-zero ARD. We therefore concluded that the visual demand of the non-walking task is critical for the emergence of ARD while walking. Conclusions: Combinations of walking and concurrent visual observation, which are common in everyday life, may contribute towards disturbed gait and falls during daily activities in old age. Prevention and rehabilitation programs for seniors should therefore include training of such combinations.

No abstract

In this primer, we give a review of the inverse problem for EEG source localization. This is intended for the researchers new in the field to get insight in the state-of-the-art techniques used to find approximate solutions of the brain sources giving rise to a scalp potential recording. Furthermore, a review of the performance results of the different techniques is provided to compare these different inverse solutions. The authors also include the results of a Monte-Carlo analysis which they performed to compare four non parametric algorithms and hence contribute to what is presently recorded in the literature. An extensive list of references to the work of other researchers is also provided. This paper starts off with a mathematical description of the inverse problem and proceeds to discuss the two main categories of methods which were developed to solve the EEG inverse problem, mainly the non parametric and parametric methods. Various techniques falling within these categories are described including minimum norm estimates and their generalizations, LORETA, sLORETA, VARETA, S-MAP, ST-MAP, Backus-Gilbert, LAURA, Shrinking LORETA FOCUSS (SLF), SSLOFO and ALF for non parametric methods and beamforming techniques, BESA, subspace techniques such as MUSIC and methods derived from it, FINES, simulated annealing and computational intelligence algorithms for parametric methods. From a review of the performance of these techniques as documented in the literature, one could conclude that in most cases the LORETA solution gives satisfactory results. In situations involving clusters of dipoles, higher resolution algorithms such as MUSIC or FINES are however preferred. Imposing reliable biophysical and psychological constraints, as done by LAURA has given superior results. The Monte-Carlo analysis performed, comparing WMN, LORETA, sLORETA and SLF, for different noise levels and different simulated source depths has shown that for single source localization, regularized sLORETA gives the best solution in terms of both localization error and ghost sources. Furthermore the computationally intensive solution given by SLF was not found to give any additional benefits under such simulated conditions.

Background: Traditionally synchronous access strategies require users to comply with one or more time constraints in order to communicate intent with a binary human-machine interface (e.g., mechanical, gestural or neural switches). Asynchronous access methods are preferable, but have not been used with binary interfaces in the control of devices that require more than two commands to be successfully operated. Methods: We present the mathematical development and evaluation of a novel asynchronous access method that may be used to translate sporadic activations of binary interfaces into distinct outcomes for the control of devices requiring an arbitrary number of commands to be controlled. With this method, users are required to activate their interfaces only when the device under control behaves erroneously. Then, a recursive algorithm, incorporating contextual assumptions relevant to all possible outcomes, is used to obtain an informed estimate of user intention. We evaluate this method by simulating a control task requiring a series of target commands to be tracked by a model user. Results: When compared to a random selection, the proposed asynchronous access method offers a significant reduction in the number of interface activations required from the user. Conclusions: This novel access method offers a variety of advantages over traditionally synchronous access strategies and may be adapted to a wide variety of contexts, with primary relevance to applications involving direct object manipulation.

Background: Isometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD) because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO) Lokomat. To evaluate the capabilities of this new measurement method, inter- and intra-rater reliability were assessed. Methods: Reliability was assessed in subjects with and without NMD. Subjects were tested twice on the same day by two different therapists to test inter-rater reliability and on two separate days by the same therapist to test intra-rater reliability. Results: Results showed fair to good reliability for the new measurement method to assess isometric muscle force of lower extremities. In subjects without NMD, intraclass correlation coefficients (ICC) for inter-rater reliability ranged from 0.72 to 0.97 and intra-rater reliability from 0.71 to 0.90. In subjects with NMD, ICC ranged from 0.66 to 0.97 for inter-rater and from 0.50 to 0.96 for intra-rater reliability. Conclusion: Inter- and intra- rater reliability of an assessment method for measuring maximal voluntary isometric muscle force of lower extremities was demonstrated. We suggest that this method is a valuable tool for documentation and controlling of the rehabilitation process in patients using a DGO.

Background: Aging leads to increases in gait variability which may explain the large incidence of falls in the elderly. Body weight support training may be utilized to improve gait in the elderly and minimize falls. However, before initiating rehabilitation protocols, baseline studies are needed to identify the effect of body weight support on elderly gait variability. Our purpose was to determine the kinematic variability of the lower extremities in young and elderly healthy females at changing levels of body weight support during walking. Methods: Ten young and ten elderly females walked on a treadmill for two minutes with a body weight support (BWS) system under four different conditions: 1 g, 0.9 g, 0.8 g, and 0.7 g. Three-dimensional kinematics was captured at 60 Hz with a Peak Performance high speed video system. Magnitude and structure of variability of the sagittal plane angular kinematics of the right lower extremity was analyzed using both linear (magnitude; standard deviations and coefficient of variations) and nonlinear (structure; Lyapunov exponents) measures. A two way mixed ANOVA was used to evaluate the effect of age and BWS on variability. Results: Linear analysis showed that the elderly presented significantly more variability at the hip and knee joint than the young females. Moreover, higher levels of BWS presented increased variability at all joints as found in both the linear and nonlinear measures utilized. Conclusion: Increased levels of BWS increased lower extremity kinematic variability. If the intent of BWS training is to decrease variability in gait patterns, this did not occur based on our results. However, we did not perform a training study. Thus, it is possible that after several weeks of training and increased habituation, these initial increased variability values will decrease. This assumption needs to be addressed in future investigation with both "healthy" elderly and elderly fallers. In addition, it is possible that BWS training can have a positive transfer effect by bringing overground kinematic variability to healthy normative levels, which also needs to be explored in future studies.

Background: The functional outcome after stroke is improved by more intensive or sustained therapy. When the affected hand has no functional movement, therapy is mainly passive movements. A novel device for repeating controlled passive movements of paralysed fingers has been developed, which will allow therapists to concentrate on more complicated tasks. A powered cam shaft moves the four fingers in a physiological range of movement. Methods: After refining the training protocol in 2 chronic patients, 8 sub-acute stroke patients were randomised to receive additional therapy with the Finger Trainer for 20 min every work day for four weeks, or the same duration of bimanual group therapy, in addition to their usual rehabilitation. Results: In the chronic patients, there was a sustained reduction in finger and wrist spasticity, but there was no improvement in active movements. In the subacute patients, mean distal Fugl-Meyer score (0–30) increased in the control group from 1.25 to 2.75 (ns) and 0.75 to 6.75 in the treatment group (p < .05). Median Modified Ashworth score increased 0/5 to 2/5 in the control group, but not in the treatment group, 0 to 0. Only one patient, in the treatment group, regained function of the affected hand. No side effects occurred. Conclusion: Treatment with the Finger Trainer was well tolerated in sub-acute & chronic stroke patients, whose abnormal muscle tone improved. In sub-acute stroke patients, the Finger Trainer group showed small improvements in active movement and avoided the increase in tone seen in the control group. This series was too small to demonstrate any effect on functional outcome however.

Background: It has been suggested that there is a dose-response relationship between the amount of therapy and functional recovery in post-acute rehabilitation care. To this day, only the total time of therapy has been investigated as a potential determinant of this dose-response relationship because of methodological and measurement challenges. The primary objective of this study was to compare time and motion measures during real life physical therapy with estimates of active time (i.e. the time during which a patient is active physically) obtained with a wireless body area network (WBAN) of 3D accelerometer modules positioned at the hip, wrist and ankle. The secondary objective was to assess the differences in estimates of active time when using a single accelerometer module positioned at the hip. Methods: Five patients (77.4 ± 5.2 y) with 4 different admission diagnoses (stroke, lower limb fracture, amputation and immobilization syndrome) were recruited in a post-acute rehabilitation center and observed during their physical therapy sessions throughout their stay. Active time was recorded by a trained observer using a continuous time and motion analysis program running on a Tablet-PC. Two WBAN configurations were used: 1) three accelerometer modules located at the hip, wrist and ankle (M3) and 2) one accelerometer located at the hip (M1). Acceleration signals from the WBANs were synchronized with the observations. Estimates of active time were computed based on the temporal density of the acceleration signals. Results: A total of 62 physical therapy sessions were observed. Strong associations were found between WBANs estimates of active time and time and motion measures of active time. For the combined sessions, the intraclass correlation coefficient (ICC) was 0.93 (P ≤ 0.001) for M3 and 0.79 (P ≤ 0.001) for M1. The mean percentage of differences between observation measures and estimates from the WBAN of active time was -8.7% ± 2.0% using data from M3 and -16.4% ± 10.4% using data from M1. Conclusion: WBANs estimates of active time compare favorably with results from observation-based time and motion measures. While the investigation on the association between active time and outcomes of rehabilitation needs to be studied in a larger scale study, the use of an accelerometer-based WBAN to measure active time is a promising approach that offers a better overall precision than methods relying on work sampling. Depending on the accuracy needed, the use of a single accelerometer module positioned on the hip may still be an interesting alternative to using multiple modules.

Background: It is well documented that individuals with chronic stroke often exhibit considerable gait impairments that significantly impact their quality of life. While stroke subjects often walk asymmetrically, we sought to investigate whether prescribing near normal physiological gait patterns with the use of the Lokomat robotic gait-orthosis could help ameliorate asymmetries in gait, specifically, promote similar ankle, knee, and hip joint torques in both lower extremities. We hypothesized that hemiparetic stroke subjects would demonstrate significant differences in total joint torques in both the frontal and sagittal planes compared to non-disabled subjects despite walking under normal gait kinematic trajectories. Methods: A motion analysis system was used to track the kinematic patterns of the pelvis and legs of 10 chronic hemiparetic stroke subjects and 5 age matched controls as they walked in the Lokomat. The subject's legs were attached to the Lokomat using instrumented shank and thigh cuffs while instrumented footlifters were applied to the impaired foot of stroke subjects to aid with foot clearance during swing. With minimal body-weight support, subjects walked at 2.5 km/hr on an instrumented treadmill capable of measuring ground reaction forces. Through a custom inverse dynamics model, the ankle, knee, and hip joint torques were calculated in both the frontal and sagittal planes. A single factor ANOVA was used to investigate differences in joint torques between control, unimpaired, and impaired legs at various points in the gait cycle. Results: While the kinematic patterns of the stroke subjects were quite similar to those of the control subjects, the kinetic patterns were very different. During stance phase, the unimpaired limb of stroke subjects produced greater hip extension and knee flexion torques than the control group. At pre-swing, stroke subjects inappropriately extended their impaired knee, while during swing they tended to abduct their impaired leg, both being typical abnormal torque synergy patterns common to stroke gait. Conclusion: Despite the Lokomat guiding stroke subjects through physiologically symmetric kinematic gait patterns, abnormal asymmetric joint torque patterns are still generated. These differences from the control group are characteristic of the hip hike and circumduction strategy employed by stroke subjects.