A novel virtual robotic platform for controlling six degrees of freedom assistive devices with body-machine interfaces.

Body-machine interfaces (BoMIs)-systems that control assistive devices (e.g., a robotic manipulator) with a person's movements-offer a robust and non-invasive alternative to brain-machine interfaces for individuals with neurological injuries. However, commercially-available assistive devices offer more degrees of freedom (DOFs) than can be efficiently controlled with a user's residual motor function. Therefore, BoMIs often rely on nonintuitive mappings between body and device movements. Learning these mappings requires considerable practice time in a lab/clinic, which can be challenging. Virtual environments can potentially address this challenge, but there are limited options for high-DOF assistive devices, and it is unclear if learning with a virtual device is similar to learning with its physical counterpart. We developed a novel virtual robotic platform that replicated a commercially-available 6-DOF robotic manipulator. Participants controlled the physical and virtual robots using four wireless inertial measurement units (IMUs) fixed to the upper torso. Forty-three neurologically unimpaired adults practiced a target-matching task using either the physical (sample size n = 25) or virtual device (sample size n = 18) involving pre-, mid-, and post-tests separated by four training blocks. We found that both groups made similar improvements from pre-test in movement time at mid-test (Δvirtual: 9.9 ± 9.5 s; Δphysical: 11.1 ± 9.9 s) and post-test (Δvirtual: 11.1 ± 9.1 s; Δphysical: 11.8 ± 10.5 s) and in path length at mid-test (Δvirtual: 6.1 ± 6.3 m/m; Δphysical: 3.3 ± 3.5 m/m) and post-test (Δvirtual: 6.6 ± 6.2 m/m; Δphysical: 3.5 ± 4.0 m/m). Our results indicate the feasibility of using virtual environments for learning to control assistive devices. Future work should determine how these findings generalize to clinical populations.

The Effect of an Early Life Motor Skill Intervention on Physical Activity in Growth-Restricted Mice.

INTRODUCTION: Early life growth restriction significantly increases the risk of adulthood physical inactivity and thereby chronic disease incidence. Improvements in motor skill acquisition could result in greater physical activity engagement in the growth-restricted population, thus reducing chronic disease risk. The purpose of this study was to implement an early life motor training intervention to improve physical activity engagement in control and growth-restricted mice. METHODS: Mice were growth restricted in early life utilizing a validated nutritive model or remained fully nourished in early life as a control. All mice were tested throughout early life for various components of motor skill acquisition. On postnatal day 10, mice were randomly assigned to engage in an early life motor skill intervention daily until postnatal day 21 or remained as a sedentary control. All mice were given access to an in-cage running wheel from postnatal days 45-70. RESULTS: Growth-restricted group (PGR) mice had impaired trunk and postural control, coordination/vestibular development, and hindlimb strength in early life compared with control mice. There were no differences in wheel running behavior between the trained and sedentary mice, although control mice ran at a faster average speed compared with PGR mice. Control female mice ran more than PGR female mice during the week 2 dark cycle. CONCLUSIONS: Early life growth restriction reduced motor skill attainment throughout early life, which may be associated with reduced ability to engage in physical activity in adulthood. The early life motor skill intervention did not elicit changes in body weight or physical activity engagement in control or PGR mice, indicating that a more intense/different intervention specifically targeting skeletal muscle may be necessary to counteract the detrimental effects of early life growth restriction.

Proteinase K/Retinoic Acid-Loaded Cationic Liposomes as Multifunctional Anti-Acne Therapy to Disorganize Biofilm and Regulate Keratinocyte Proliferation.

Background: Simultaneous anti-Cutibacterium acnes and anti-inflammatory actions are highly beneficial in treating acne vulgaris. In this study, we present novel anti-acne nanovesicles based on liposomes loaded with proteinase K (PK), retinoic acid (RA), and soyaethyl morpholinium ethosulfate (SME) to achieve an effective and safe treatment. Materials and Methods: This study examined in vitro planktonic and biofilm C. acnes elimination, as well as the keratinocyte proliferation suppression by liposomes. The multifunctional liposomes for treating C. acnes in mice were also evaluated. Results: We acquired multifunctional liposomes with a size of 71 nm and zeta potential of 31 mV. The antimicrobial activity of SME was enhanced after liposomal encapsulation according to the reduction of minimum bactericidal concentration (MBC) by 6-fold. The multifunctional liposomes exhibited a synergistically inhibitory effect on biofilm C. acnes colonization compared with the liposomes containing PK or those containing SME individually. The adhesive bacterial colony in the microplate was lessened by 62% after multifunctional liposome intervention. All liposomal formulations tested here demonstrated no cytotoxicity against the normal keratinocytes but inhibited C. acnes-stimulated cell hyperproliferation. The in vitro scratch assay indicated that the liposomal RA-but not free RA-restrained keratinocyte migration. The animal study showed that free RA combined with SME and multifunctional nanovesicles had a similar effect on diminishing C. acnes colonies in the skin. On the other hand, liposomes exhibited superior performance in recovering the impaired skin barrier function than the free control. We also found that RA-loaded nanovesicles had greater skin tolerability than free RA. Conclusion: The cationic liposomes containing dual PK and RA represented a potential treatment to arrest bacterial infection and associated inflammation in acne.

Ten guidelines for designing motor learning studies.

Motor learning is a central focus of several disciplines including kinesiology, neuroscience and rehabilitation. However, given the different traditions of these fields, this interdisciplinarity can be a challenge when trying to interpret evidence and claims from motor learning experiments. To address this issue, we offer a set of ten guidelines for designing motor learning experiments starting from task selection to data analysis, primarily from the viewpoint of running lab-based experiments. The guidelines are not intended to serve as rigid rules, but instead to raise awareness about key issues in motor learning. We believe that addressing these issues can increase the robustness of work in the field and its relevance to the real-world.

Children are suboptimal in adapting motor exploration to task dimensionality during motor learning.

Motor learning in novel tasks requires exploration to find the appropriate coordination patterns to perform the task. Prior work has shown that compared to adults, children show limited exploration when learning a task that required using upper body movements to control a 2D cursor on a screen. Here, by changing the task dimensionality to 1D, we examined two competing hypotheses: whether children show limited exploration as a general strategy, or whether children are suboptimal in adapting their exploration to task dimensionality. Two groups of children (9- and 12-year olds), and one group of adults learned a virtual task that involved learning to control a cursor on the screen using movements of the upper body. Participants practiced the task for a single session with a total of 232 reaching movements. Results showed that 9-year olds show worse task performance relative to adults, as indicated by higher movement times and path lengths. Analysis of the coordination strategies indicated that both groups of children showed lower variance along the first principal component, suggesting that they had greater exploration than adults which was suboptimal for the 1D task. These results suggest that motor learning in children is characterized not by limited exploration per se, but by a limited adaptability in matching motor exploration to task dimensionality.

Motor Variability Prior to Learning does not Facilitate the Ability to Adopt new Movement Solutions.

Many contexts in motor learning require a learner to change from an existing movement solution to a novel movement solution to perform the same task. Recent evidence has pointed to motor variability prior to learning as a potential marker for predicting individual differences in motor learning. However, it is not known if this variability is predictive of the ability to adopt a new movement solution for the same task. Here, we examined this question in the context of a redundant precision task requiring control of motor variability. Fifty young adults learned a precision task that involved throwing a virtual puck toward a target using both hands. Because the speed of the puck depended on the sum of speeds of both hands, this task could be achieved using multiple solutions. Participants initially performed a baseline task where there was no constraint on the movement solution, and then performed a novel task where they were constrained to adopt a specific movement solution requiring asymmetric left and right hand speeds. Results showed that participants were able to learn the new solution, and this change was associated with changes in both the amount and structure of variability. However, increased baseline motor variability did not facilitate initial or final task performance when using the new solution - in fact, greater variability was associated with higher errors. These results suggest that motor variability is not necessarily indicative of flexibility and highlight the role of the task context in determining the relation between motor variability and learning.

Repetition Without Repetition: Challenges in Understanding Behavioral Flexibility in Motor Skill.

A hallmark of skilled motor performance is behavioral flexibility - i.e., experts can not only produce a movement pattern to reliably and efficiently achieve a given task outcome, but also possess the ability to change that movement pattern to fit a new context. In this perspective article, we briefly highlight the factors that are critical to understanding behavioral flexibility, and its connection to movement variability, stability, and learning. We then address how practice strategies should be developed from a motor learning standpoint to enhance behavioral flexibility. Finally, we highlight some important future avenues of work that are needed to advance our understanding of behavioral flexibility. We use examples from sport as a context to highlight these issues, especially in regard to elite performance and development.

Controlling a robotic arm for functional tasks using a wireless head-joystick: A case study of a child with congenital absence of upper and lower limbs.

Children with movement impairments needing assistive devices for activities of daily living often require novel methods for controlling these devices. Body-machine interfaces, which rely on body movements, are particularly well-suited for children as they are non-invasive and have high signal-to-noise ratios. Here, we examined the use of a head-joystick to enable a child with congenital absence of all four limbs to control a seven degree-of-freedom robotic arm. Head movements were measured with a wireless inertial measurement unit and used to control a robotic arm to perform two functional tasks-a drinking task and a block stacking task. The child practiced these tasks over multiple sessions; a control participant performed the same tasks with a manual joystick. Our results showed that the child was able to successfully perform both tasks, with movement times decreasing by ~40-50% over 6-8 sessions of training. The child's performance with the head-joystick was also comparable to the control participant using a manual joystick. These results demonstrate the potential of using head movements for the control of high degree-of-freedom tasks in children with limited movement repertoire.

Self-controlled practice and nudging during structural learning of a novel control interface.

Self-controlled practice schedules have been shown to enhance motor learning in several contexts, but their effectiveness in structural learning tasks, where the goal is to eventually learn an underlying structure or rule, is not well known. Here we examined the use of self-controlled practice in a novel control interface requiring structural learning. In addition, we examined the effect of 'nudging'-i.e., whether altering task difficulty could influence self-selected strategies, and hence facilitate learning. Participants wore four inertial measurement units (IMUs) on their upper body and the goal was to use motions of the upper body to move a screen cursor to different targets presented on the screen. The structure in this task that had to be learned was based on the fact that the signals from the IMUs were linearly mapped to the x- and y- position of the cursor. Participants (N = 62) were split into 3 groups (random, self-selected, nudge) based on whether they had control over the sequence in which they could practice the targets. To test whether participants learned the underlying structure, participants were tested both on the trained targets, as well as novel targets that were not practiced during training. Results showed that during training, the self-selected group showed shorter movement times relative to the random group, and both self-selected and nudge groups adopted a strategy of tending to repeat targets. However, in the test phase, we found no significant differences in task performance between groups, indicating that structural learning was not reliably affected by the type of practice. In addition, nudging participants by adjusting task difficulty did not show any significant benefits to overall learning. These results suggest that although self-controlled practice influenced practice structure and facilitated learning, it did not provide any additional benefits relative to practicing on a random schedule in this task.

A novel two-body sensor system to study spontaneous movements in infants during caregiver physical contact.

Spontaneous movements, which refer to repetitive limb movements in the absence of any external stimulus, have been found to be reflective of neurodevelopmental status during infancy. These movements are modulated by both individual and environmental factors, including physical contact (holding) with the caregiver. However, it is a challenge to measure spontaneous movements during physical contact because infant-generated movements become coupled with caregiver-generated movements in such contexts. Here, we propose the use of a novel two-body sensor system to distinguish infant-generated movements in the presence of physical contact with the caregiver. Data from seven typically developing infants and their caregivers were recorded during different simulated home activities, which involved different combinations of physical interaction, caregiver's movement and infant positions. The two-body sensor system consisted of two wearable accelerometers - one placed on the infant's arm and one on the caregiver's arm, and we developed a Kalman-filter based algorithm to isolate the infant-generated movements. In addition, video was recorded for qualitative analysis. Results indicated that spontaneous movement activity was higher when there was no physical contact with caregiver. When there was physical contact, spontaneous movements were increased when the caregiver was still and when the infant was held horizontally. These results show that the novel two-body sensor system and the associated algorithms were able to isolate infant-generated movements during physical contact with the caregiver. This approach holds promise for the automated long-term tracking of spontaneous movements in infants, which may provide critical insight into developmental disorders.

Online and offline contributions to motor learning change with practice, but are similar across development.

Children show motor learning deficits relative to adults across a diverse range of tasks. One mechanism that has been proposed to underlie these differences is the contribution of online and offline components to overall learning; however, these tasks have almost focused exclusively on sequence learning paradigms which are characterized by performance gains in the offline phase. Here, we examined the role of online and offline learning in a novel motor task which was characterized by warm-up decrement, i.e., a performance loss, during the offline phase. In particular, using a relatively extended practice period, we examined if differences between children and adults persist across relatively long practice periods, and if the contribution of online and offline learning is affected by age and by practice itself. Two groups of children, 8-10 years and 11-13 years old, and one group of young adults (N = 30, n = 10/group) learned a novel task that required control of upper body movements to control a cursor on a screen. Participants learned the task over 5 days and we measured movement time as the primary task performance variable. Consistent with prior results, we found that 8-10 year olds had longer movement times compared to both 11-13 year olds and adults. We also found distinct changes in online and offline learning with practice; the amount of online learning decreased with practice, whereas offline learning was relatively stable across practice. However, there was no detectable effect of age group on either online or offline learning. These results suggest that age-related differences in learning among children 8-10 years old are persistent even after extended practice but are not necessarily accounted for by differences in online and offline learning.

Age-related deficits in motor learning are associated with altered motor exploration strategies.

How is motor learning affected by aging? Although several experimental paradigms have been used to address this question, there has been limited focus on the early phase of motor learning, which involves motor exploration and the need to coordinate multiple degrees of freedom in the body. Here, we examined motor learning in a body-machine interface where we measured both age-related differences in task performance as well as the coordination strategies underlying this performance. Participants (N = 65; age range 18-72 years) wore wireless inertial measurement units on the upper body, and learned to control a cursor on a screen, which was controlled by motions of the trunk. Results showed that, consistent with prior studies, there was an age-related effect on movement time, with middle-aged and older adults taking longer to perform the task than young adults. However, we also found that these changes were associated with limited exploration in older adults. Moreover, when considering data across a majority of the lifespan (including children), longer movement times were associated with greater inefficiency of the coordination pattern, producing more task-irrelevant motion. These results suggest exploration behaviors during motor learning are affected with aging, and highlight the need for different practice strategies with aging.

Age-dependent differences in learning to control a robot arm using a body-machine interface.

Body-machine interfaces, i.e. interfaces that rely on body movements to control external assistive devices, have been proposed as a safe and robust means of achieving movement and mobility; however, how children learn these novel interfaces is poorly understood. Here we characterized the learning of a body-machine interface in young unimpaired adults, two groups of typically developing children (9-year and 12-year olds), and one child with congenital limb deficiency. Participants had to control the end-effector of a robot arm in 2D using movements of the shoulder and torso. Results showed a striking effect of age - children had much greater difficulty in learning the task compared to adults, with a majority of the 9-year old group unable to even complete the task. The 12-year olds also showed poorer task performance compared to adults (as measured by longer movement times and greater path lengths), which were associated with less effective search strategies. The child with congenital limb deficiency showed superior task performance compared to age-matched children, but had qualitatively distinct coordination strategies from the adults. Taken together, these results imply that children have difficulty learning non-intuitive interfaces and that the design of body-machine interfaces should account for these differences in pediatric populations.

Social adjustment experiences of adolescents with Tourette syndrome.

AIMS AND OBJECTIVES: To explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan. BACKGROUND: Although Tourette syndrome is a non-life-threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long-term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self-adjust and maintain harmonious social interaction with others. DESIGN: Descriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour. METHODS: Sixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one-on-one interviews were performed from March 2014-April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60-90 min. Data were analysed with Giorgi's phenomenological method for data analysis. RESULTS: Three themes were identified from the adolescent' interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes. CONCLUSIONS: Adolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome. RELEVANCE TO CLINICAL PRACTICE: The experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome.

Children show limited movement repertoire when learning a novel motor skill.

Examining age differences in motor learning using real-world tasks is often problematic due to task novelty and biomechanical confounds. Here, we investigated how children and adults acquire a novel motor skill in a virtual environment. Participants of three different age groups (9-year-olds, 12-year-olds, and adults) learned to use their upper body movements to control a cursor on a computer screen. Results showed that 9-year-old and 12-year-old children showed poorer ability to control the cursor at the end of practice. Critically, when we investigated the movement coordination, we found that the lower task performance of children was associated with limited exploration of their movement repertoire. These results reveal the critical role of motor exploration in understanding developmental differences in motor learning.

Body-Machine Interface Enables People With Cervical Spinal Cord Injury to Control Devices With Available Body Movements: Proof of Concept.

This study tested the use of a customized body-machine interface (BoMI) for enhancing functional capabilities in persons with cervical spinal cord injury (cSCI). The interface allows people with cSCI to operate external devices by reorganizing their residual movements. This was a proof-of-concept phase 0 interventional nonrandomized clinical trial. Eight cSCI participants wore a custom-made garment with motion sensors placed on the shoulders. Signals derived from the sensors controlled a computer cursor. A standard algorithm extracted the combinations of sensor signals that best captured each participant's capacity for controlling a computer cursor. Participants practiced with the BoMI for 24 sessions over 12 weeks performing 3 tasks: reaching, typing, and game playing. Learning and performance were evaluated by the evolution of movement time, errors, smoothness, and performance metrics specific to each task. Through practice, participants were able to reduce the movement time and the distance from the target at the 1-second mark in the reaching task. They also made straighter and smoother movements while reaching to different targets. All participants became faster in the typing task and more skilled in game playing, as the pong hit rate increased significantly with practice. The results provide proof-of-concept for the customized BoMI as a means for people with absent or severely impaired hand movements to control assistive devices that otherwise would be manually operated.

Emergence Profile Index Implant Surgical Guide.

INTRODUCTION: This case series presents an innovative approach to fabricating an implant surgical guide to facilitate ideal implant placement. CASE SERIES: Three healthy, non-smoking patients with a partially edentulous ridge presented to a private practice. Informed consent for dental implant placement was attained from patients. Sequential three-dimensional (3D) surgical guides were fabricated before implant surgery using light-polymerizing material. These guides provided information to the surgeons on implant position in the bucco-lingual, mesio-distal, and apico-coronal directions. CONCLUSION: With assistance of the proposed surgical guide, ideal 3D implant placement can be achieved so that future peri-implant complications can be minimized.

The development of tool use: Planning for end-state comfort.

Some grips on the handle of a tool can be planned on the basis of information directly available in the scene. Other grips, however, must be planned on the basis of the final position of the hand. "End-state comfort" grips require an awkward or uncomfortable initial grip so as to later implement the action comfortably and efficiently. From a cognitive perspective, planning for end-state comfort requires a consistent representation of the entire action sequence, including the latter part, which is not based on information directly available in the scene. Many investigators have found that young children fail to demonstrate planning for end-state comfort and that adultlike performance does not appear until about 12 years of age. In 2 experiments, we used a hammering task that engaged children in a goal-directed action with multiple steps. We assessed end-state-comfort planning in novel ways by measuring children's hand choice, grip choice, and tool implementation over multiple trials. The hammering task also uniquely allowed us to assess the efficiency of implementation. We replicated the previous developmental trend in 4-, 8-, and 12-year-old children with our novel task. Most important, our data revealed that 4-year-olds are in a transitional stage during which several competing strategies were exhibited during a single session. Preschoolers changed their grip within trials and across trials, indicating awareness of errors and a willingness to sacrifice speed for more efficient implementation. The end-state-comfort grip initially competes as one grip type among many but gradually displaces all others. Children's sensitivity to costs and drive for efficiency may motivate this change. (PsycINFO Database Record

Body-machine interface for control of a screen cursor for a child with congenital absence of upper and lower limbs: a case report.

BACKGROUND: There has been a recent interest in the development of body-machine interfaces which allow individuals with motor impairments to control assistive devices using body movements. METHODS: In this case study, we report findings in the context of the development of such an interface for a 10-year old child with congenital absence of upper and lower limbs. The interface consisted of 4 wireless inertial measurement units (IMUs), which we used to map movements of the upper body to the position of a cursor on a screen. We examined the learning of a task in which the child had to move the cursor to specified targets on the screen as quickly as possible. In addition, we also determined the robustness of the interface by evaluating the child's performance in two different body postures. RESULTS: We found that the child was not only able to learn the task rapidly, but also showed superior performance when compared to typically developing children in the same age range. Moreover, task performance was comparable for the two different body postures, suggesting that the child was able to control the device in different postures without the need for interface recalibration. CONCLUSIONS: These results clearly establish the viability and robustness of the proposed non-invasive body-machine interface for pediatric populations with severe motor limitations.

Upper Body-Based Power Wheelchair Control Interface for Individuals With Tetraplegia.

Many power wheelchair control interfaces are not sufficient for individuals with severely limited upper limb mobility. The majority of controllers that do not rely on coordinated arm and hand movements provide users a limited vocabulary of commands and often do not take advantage of the user's residual motion. We developed a body-machine interface (BMI) that leverages the flexibility and customizability of redundant control by using high dimensional changes in shoulder kinematics to generate proportional control commands for a power wheelchair. In this study, three individuals with cervical spinal cord injuries were able to control a power wheelchair safely and accurately using only small shoulder movements. With the BMI, participants were able to achieve their desired trajectories and, after five sessions driving, were able to achieve smoothness that was similar to the smoothness with their current joystick. All participants were twice as slow using the BMI however improved with practice. Importantly, users were able to generalize training controlling a computer to driving a power wheelchair, and employed similar strategies when controlling both devices. Overall, this work suggests that the BMI can be an effective wheelchair control interface for individuals with high-level spinal cord injuries who have limited arm and hand control.