Factors Used by Mobile Applications to Predict Female Fertility Status and Their Reported Effectiveness: A Scoping Review.

Family planning, whether for pregnancy prevention or conception, is of pivotal importance to women of reproductive age. As hormonally driven methods, such as oral contraceptive pills, are widely used but have numerous side effects, women often seek alternative non-hormonal, non-invasive options, including fertility-tracking mobile applications (apps). However, the effectiveness of these apps as a method of contraception and conception planning has not been extensively vetted. The goal of this scoping review is to identify the various factors used by apps marketed as a method of contraception and/or family planning to predict a woman's fertility status, as well as their documented effectiveness. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a literature search was performed in CINAHL, MEDLINE, and Alt HealthWatch databases for articles published between October 1, 2017, and October 4, 2022. Quality assessment of eligible full-text articles was conducted using the Joanna Briggs Institute critical appraisal tools. A total of 629 articles were screened. Overall, 596 articles were excluded and the remaining 33 articles underwent full-text review. Seven articles were included in the final analysis, yielding data on the following five apps: Natural Cycles, Ava Fertility, Clearblue Connected, Ovia Fertility, and Dynamic Optimal Timing (DOT). Data supporting the effectiveness of these apps is limited. All apps provided predictions on fertility status throughout a woman's menstrual cycle using proprietary algorithms, biometric data, and self-reported menstrual cycle data. Further research, particularly independent research following a randomized controlled design, on the efficacy of these apps is needed to produce more robust results.

A rare case of deafferentation reveals an essential role of proprioception in bilateral coordination.

Loss of proprioception has been shown to produce deficits in intralimb coordination and in the ability to stabilize limb posture in the absence of visual feedback. However, the role of proprioceptive signals in the feedforward and feedback control of interlimb coordination remains unclear. To address this issue, we examined bimanual coordination in a deafferented participant (DP) with large-fiber sensory neuropathy, which resulted in the loss of proprioception and touch in both arms, and in age-matched control participants. The task required participants to move a single virtual bar with both hands to a rectangular target with horizontal orientation. The participants received visual feedback of the virtual bar, but not of the hand positions along the bar-axis. Although the task required symmetrical movement between the arms, there were significant differences in the trajectories of the dominant and non-dominant hands in the deafferented participant, and thus more final errors and impaired coordination compared to controls. Deafferentation was also associated with an asymmetric deficit in stabilizing the hand at the end of motion, where the dominant arm showed more drift than the non-dominant arm. While the findings with DP may reflect a unique adaptation to deafferentation, they suggest that 1) Bilateral coordination depends on proprioceptive feedback, and 2) Postural stability at the end of motion can be specified through feedforward mechanisms, in the absence of proprioceptive feedback, but this process appears to be asymmetric, with better stability in the non-dominant arm.

Interlimb Responses to Perturbations of Bilateral Movements are Asymmetric.

Previous research has revealed rapid feedback mediated responses in one arm to mechanical perturbations applied to the other arm during shared bimanual tasks. We now ask whether these interlimb responses are expressed symmetrically. We tested this question in a virtual reality environment: a cursor representing each hand was used to 'pick up' each end of a virtual bar and place it into a target trough. Near the onset of occasional, unpredictable trials, one arm was perturbed. Regardless of which arm was perturbed, ipsilateral responses were significant during the perturbation. However, responses in the arm contralateral to the perturbation were asymmetric. While the non-dominant arm showed a significant kinematic response to correct the bar orientation when the dominant arm was mechanically perturbed, the dominant arm did not respond when the non-dominant arm was perturbed. We also saw an asymmetric response in early EMG activity, in which only the non-dominant anterior deltoid showed a significant reflex response within 100 milliseconds of perturbation onset in response to dominant arm. This response was consistent with correcting the bar position, but not with correcting its orientation. We conclude that responses to perturbations during bilateral movements are expressed asymmetrically, such that non-dominant arm responses to perturbations to the dominant arm are stronger than dominant arm responses to non-dominant arm perturbations.

Left hemisphere damage produces deficits in predictive control of bilateral coordination.

Previous research has demonstrated hemisphere-specific motor deficits in ipsilesional and contralesional unimanual movements in patients with hemiparetic stroke due to MCA infarct. Due to the importance of bilateral motor actions on activities of daily living, we now examine how bilateral coordination may be differentially affected by right or left hemisphere stroke. To avoid the caveat of simply adding unimanual deficits in assessing bimanual coordination, we designed a unique task that requires spatiotemporal coordination features that do not exist in unimanual movements. Participants with unilateral left (LHD) or right hemisphere damage (RHD) and age-matched controls moved a virtual rectangle (bar) from a midline start position to a midline target. Movement along the long axis of the bar was redundant to the task, such that the bar remained in the center of and parallel to an imaginary line connecting each hand. Thus, to maintain midline position of the bar, movements of one hand closer to or further away from the bar midline required simultaneous, but oppositely directed displacements with the other hand. Our findings indicate that left (LHD), but not right (RHD) hemisphere-damaged patients showed poor interlimb coordination, reflected by significantly lower correlations between displacements of each hand along the bar axis. These left hemisphere-specific deficits were only apparent prior to peak velocity, likely reflecting predictive control of interlimb coordination. In contrast, the RHD group bilateral coordination was not significantly different than that of the control group. We conclude that predictive mechanisms that govern bilateral coordination are dependent on left hemisphere mechanisms. These findings indicate that assessment and training in cooperative bimanual tasks should be considered as part of an intervention framework for post-stroke physical rehabilitation.

Interlimb differences in coordination of unsupported reaching movements.

Previous research suggests that interlimb differences in coordination associated with handedness might result from specialized control mechanisms that are subserved by different cerebral hemispheres. Based largely on the results of horizontal plane reaching studies, we have proposed that the hemisphere contralateral to the dominant arm is specialized for predictive control of limb dynamics, while the non-dominant hemisphere is specialized for controlling limb impedance. The current study explores interlimb differences in control of 3-D unsupported reaching movements. While the task was presented in the horizontal plane, participant's arms were unsupported and free to move within a range of the vertical axis, which was redundant to the task plane. Results indicated significant dominant arm advantages for both initial direction accuracy and final position accuracy. The dominant arm showed greater excursion along a redundant axis that was perpendicular to the task, and parallel to gravitational forces. In contrast, the non-dominant arm better impeded motion out of the task-plane. Nevertheless, non-dominant arm task errors varied substantially more with shoulder rotation excursion than did dominant arm task errors. These findings suggest that the dominant arm controller was able to take advantage of the redundant degrees of freedom of the task, while non-dominant task errors appeared enslaved to motion along the redundant axis. These findings are consistent with a dominant controller that is specialized for intersegmental coordination, and a non-dominant controller that is specialized for impedance control. However, the findings are inconsistent with previously documented conclusions from planar tasks, in which non-dominant control leads to greater final position accuracy.