Sensorimotor adaptation to destabilizing dynamics in weakly electric fish.

Humans and other animals can readily learn to compensate for changes in the dynamics of movement. Such changes can result from an injury or changes in the weight of carried objects. These changes in dynamics can lead not only to reduced performance but also to dramatic instabilities. We evaluated the impacts of compensatory changes in control policies in relation to stability and robustness in Eigenmannia virescens, a species of weakly electric fish. We discovered that these fish retune their sensorimotor control system in response to experimentally generated destabilizing dynamics. Specifically, we used an augmented reality system to manipulate sensory feedback during an image stabilization task in which a fish maintained its position within a refuge. The augmented reality system measured the fish's movements in real time. These movements were passed through a high-pass filter and multiplied by a gain factor before being fed back to the refuge motion. We adjusted the gain factor to gradually destabilize the fish's sensorimotor loop. The fish retuned their sensorimotor control system to compensate for the experimentally induced destabilizing dynamics. This retuning was partially maintained when the augmented reality feedback was abruptly removed. The compensatory changes in sensorimotor control improved tracking performance as well as control-theoretic measures of robustness, including reduced sensitivity to disturbances and improved phase margins.

How virtual reality is impacting balance: An examination of postural stability.

BACKGROUND: The interest in virtual reality (VR) applications has been on the rise in recent years. However, the impact of VR on postural stability remains unclear. RESEARCH QUESTION: The study has two primary objectives: first, to compare postural stability in a 3D-immersed virtual reality environment (VE) and a real environment (RE), and second, to investigate the effect of positive and negative visual feedback, which are subconditions of VE on postural stability. METHODS: The observational study recruited 20 healthy adults (10 male, 10 female, 22.8 ± 1.8 years) who underwent postural stability assessments in both RE and VE. In VE, participants received visual stimuli in three different ways: without visual feedback, with positive and negative visual feedback that they would consider themselves to be directed towards postural stability outcomes. The RE included two conditions: eyes open (EO) and eyes closed (EC). Postural stability was evaluated with sway velocity, sway area, and perimeter variables obtained from a force platform. RESULTS: All postural stability variables were significantly lower in the RE than in the VE (p < 0.05). There was no significant difference between the VE and EC in terms of sway velocity and sway area (p > 0.05). The visual feedback in the VE did not affect participants' postural stability (p > 0.05). VE may cause an increase in postural sway variables compared to RE and postural requirements may be higher in VE compared to RE. SIGNIFICANCE: This is the first and only study examining the effect of different visual feedback on postural stability in VE.

Daily singing of adult songbirds functions to maintain song performance independently of auditory feedback and age.

Many songbirds learn to produce songs through vocal practice in early life and continue to sing daily throughout their lifetime. While it is well-known that adult songbirds sing as part of their mating rituals, the functions of singing behavior outside of reproductive contexts remain unclear. Here, we investigated this issue in adult male zebra finches by suppressing their daily singing for two weeks and examining the effects on song performance. We found that singing suppression decreased the pitch, amplitude, and duration of songs, and that those song features substantially recovered through subsequent free singing. These reversible song changes were not dependent on auditory feedback or the age of the birds, contrasting with the adult song plasticity that has been reported previously. These results demonstrate that adult song structure is not stable without daily singing, and suggest that adult songbirds maintain song performance by preventing song changes through physical act of daily singing throughout their life. Such daily singing likely functions as vocal training to maintain the song production system in optimal conditions for song performance in reproductive contexts, similar to how human singers and athletes practice daily to maintain their performance.

Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial.

BACKGROUND: Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia. METHODS: In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment. RESULTS: Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group's FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05). CONCLUSION: Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction. CLINICAL TRIAL REGISTRATION INFORMATION: NCT05841108.

Video mirror feedback induces more extensive brain activation compared to the mirror box: an fNIRS study in healthy adults.

BACKGROUND: Mirror therapy (MT) has been shown to be effective for motor recovery of the upper limb after a stroke. The cerebral mechanisms of mirror therapy involve the precuneus, premotor cortex and primary motor cortex. Activation of the precuneus could be a marker of this effectiveness. MT has some limitations and video therapy (VT) tools are being developed to optimise MT. While the clinical superiority of these new tools remains to be demonstrated, comparing the cerebral mechanisms of these different modalities will provide a better understanding of the related neuroplasticity mechanisms. METHODS: Thirty-three right-handed healthy individuals were included in this study. Participants were equipped with a near-infrared spectroscopy headset covering the precuneus, the premotor cortex and the primary motor cortex of each hemisphere. Each participant performed 3 tasks: a MT task (right hand movement and left visual feedback), a VT task (left visual feedback only) and a control task (right hand movement only). Perception of illusion was rated for MT and VT by asking participants to rate the intensity using a visual analogue scale. The aim of this study was to compare brain activation during MT and VT. We also evaluated the correlation between the precuneus activation and the illusion quality of the visual mirrored feedback. RESULTS: We found a greater activation of the precuneus contralateral to the visual feedback during VT than during MT. We also showed that activation of primary motor cortex and premotor cortex contralateral to visual feedback was more extensive in VT than in MT. Illusion perception was not correlated with precuneus activation. CONCLUSION: VT led to greater activation of a parieto-frontal network than MT. This could result from a greater focus on visual feedback and a reduction in interhemispheric inhibition in VT because of the absence of an associated motor task. These results suggest that VT could promote neuroplasticity mechanisms in people with brain lesions more efficiently than MT. CLINICAL TRIAL REGISTRATION: NCT04738851.

Influence of visual feedback and cognitive challenge on the age-related changes in force steadiness.

Force steadiness can be influenced by visual feedback as well as presence of a cognitive tasks and potentially differs with age and sex. This study determined the impact of altered visual feedback on force steadiness in the presence of a difficult cognitive challenge in young and older men and women. Forty-nine young (19-30 yr; 25 women, 24 men) and 25 older (60-85 yr; 15 women; 10 men) performed low force (5% of maximum) static contractions with the elbow flexor muscles in the presence and absence of a cognitive challenge (counting backwards by 13) either with low or high visual feedback gain. The cognitive challenge reduced force steadiness (increased force fluctuation amplitude) particularly in women (cognitive challenge × sex: P < 0.05) and older individuals (cognitive challenge × age: P < 0.05). Force steadiness improved with high-gain visual feedback compared with low-gain visual feedback (P < 0.01) for all groups (all interactions: P > 0.05). Manipulation of visual feedback had no influence on the reduced force steadiness in presence of the cognitive challenge for all groups (all P > 0.05). These findings indicate that older individuals and women have greater risk of impaired motor performance of the upper extremity if steadiness is required during a low-force static contraction. Manipulation of visual feedback had minimal effects on the reduced force steadiness in presence of a difficult cognitive challenge.

Prediction error in implicit adaptation during visually- and memory-guided reaching tasks.

Human movements are adjusted by motor adaptation in order to maintain their accuracy. There are two systems in motor adaptation, referred to as explicit or implicit adaptation. It has been suggested that the implicit adaptation is based on the prediction error and has been used in a number of motor adaptation studies. This study aimed to examine the effect of visual memory on prediction error in implicit visuomotor adaptation by comparing visually- and memory-guided reaching tasks. The visually-guided task is thought to be implicit learning based on prediction error, whereas the memory-guided task requires more cognitive processes. We observed the adaptation to visuomotor rotation feedback that is gradually rotated. We found that the adaptation and retention rates were higher in the visually-guided task than in the memory-guided task. Furthermore, the delta-band power obtained by electroencephalography (EEG) in the visually-guided task was increased immediately following the visual feedback, which indicates that the prediction error was larger in the visually-guided task. Our results show that the visuomotor adaptation is enhanced in the visually-guided task because the prediction error, which contributes update of the internal model, was more reliable than in the memory-guided task. Therefore, we suggest that the processing of the prediction error is affected by the task-type, which in turn affects the rate of the visuomotor adaptation.

Multiple processes of vocal sensory-motor interaction in primate auditory cortex.

Sensory-motor interactions in the auditory system play an important role in vocal self-monitoring and control. These result from top-down corollary discharges, relaying predictions about vocal timing and acoustics. Recent evidence suggests such signals may be two distinct processes, one suppressing neural activity during vocalization and another enhancing sensitivity to sensory feedback, rather than a single mechanism. Single-neuron recordings have been unable to disambiguate due to overlap of motor signals with sensory inputs. Here, we sought to disentangle these processes in marmoset auditory cortex during production of multi-phrased 'twitter' vocalizations. Temporal responses revealed two timescales of vocal suppression: temporally-precise phasic suppression during phrases and sustained tonic suppression. Both components were present within individual neurons, however, phasic suppression presented broadly regardless of frequency tuning (gating), while tonic was selective for vocal frequencies and feedback (prediction). This suggests that auditory cortex is modulated by concurrent corollary discharges during vocalization, with different computational mechanisms.

Visual feedback improves propulsive force generation during treadmill walking in people with Parkinson disease.

Persons with Parkinson's disease experience gait alterations, such as reduced step length. Gait dysfunction is a significant research priority as the current treatments targeting gait impairment are limited. This study aimed to investigate the effects of visual biofeedback on propulsive force during treadmill walking in persons with Parkinson's. Sixteen ambulatory persons with Parkinson's participated in the study. They received real-time biofeedback of anterior ground reaction force during treadmill walking at a constant speed. Peak propulsive force values were measured and normalized to body weight. Spatiotemporal parameters were also assessed, including stride length and double support percent. Persons with Parkinson's significantly increased peak propulsive force during biofeedback compared to baseline (p <.0001, Cohen's dz = 1.69). Variability in peak anterior ground reaction force decreased across repeated trials (p <.0001, dz = 1.51). While spatiotemporal parameters did not show significant changes individually, stride length and double support percent improved marginally during biofeedback trials. Persons with Parkinson's can increase propulsive force with visual biofeedback, suggesting the presence of a propulsive reserve. Though stride length did not significantly change, clinically meaningful improvements were observed. Targeting push-off force through visual biofeedback may offer a potential rehabilitation technique to enhance gait performance in Persons with Parkinson's. Future studies could explore the long-term efficacy of this intervention and investigate additional strategies to improve gait in Parkinson's disease.

The effects of visual information deprivation and feedback balance training on balance in patients with stroke.

BACKGROUND: Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE: The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS: The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS: The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION: The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Augmenting locomotor perception by remapping tactile foot sensation to the back.

BACKGROUND: Sensory reafferents are crucial to correct our posture and movements, both reflexively and in a cognitively driven manner. They are also integral to developing and maintaining a sense of agency for our actions. In cases of compromised reafferents, such as for persons with amputated or congenitally missing limbs, or diseases of the peripheral and central nervous systems, augmented sensory feedback therefore has the potential for a strong, neurorehabilitative impact. We here developed an untethered vibrotactile garment that provides walking-related sensory feedback remapped non-invasively to the wearer's back. Using the so-called FeetBack system, we investigated if healthy individuals perceive synchronous remapped feedback as corresponding to their own movement (motor awareness) and how temporal delays in tactile locomotor feedback affect both motor awareness and walking characteristics (adaptation). METHODS: We designed the system to remap somatosensory information from the foot-soles of healthy participants (N = 29), using vibrotactile apparent movement, to two linear arrays of vibrators mounted ipsilaterally on the back. This mimics the translation of the centre-of-mass over each foot during stance-phase. The intervention included trials with real-time or delayed feedback, resulting in a total of 120 trials and approximately 750 step-cycles, i.e. 1500 steps, per participant. Based on previous work, experimental delays ranged from 0ms to 1500ms to include up to a full step-cycle (baseline stride-time: µ = 1144 ± 9ms, range 986-1379ms). After each trial participants were asked to report their motor awareness. RESULTS: Participants reported high correspondence between their movement and the remapped feedback for real-time trials (85 ± 3%, µ ± σ), and lowest correspondence for trials with left-right reversed feedback (22 ± 6% at 600ms delay). Participants further reported high correspondence of trials delayed by a full gait-cycle (78 ± 4% at 1200ms delay), such that the modulation of motor awareness is best expressed as a sinusoidal relationship reflecting the phase-shifts between actual and remapped tactile feedback (cos model: 38% reduction of residual sum of squares (RSS) compared to linear fit, p < 0.001). The temporal delay systematically but only moderately modulated participant stride-time in a sinusoidal fashion (3% reduction of RSS compared a linear fit, p < 0.01). CONCLUSIONS: We here demonstrate that lateralized, remapped haptic feedback modulates motor awareness in a systematic, gait-cycle dependent manner. Based on this approach, the FeetBack system was used to provide augmented sensory information pertinent to the user's on-going movement such that they reported high motor awareness for (re)synchronized feedback of their movements. While motor adaptation was limited in the current cohort of healthy participants, the next step will be to evaluate if individuals with a compromised peripheral nervous system, as well as those with conditions of the central nervous system such as Parkinson's Disease, may benefit from the FeetBack system, both for maintaining a sense of agency over their movements as well as for systematic gait-adaptation in response to the remapped, self-paced, rhythmic feedback.

Precise cortical contributions to sensorimotor feedback control during reactive balance.

The role of the cortex in shaping automatic whole-body motor behaviors such as walking and balance is poorly understood. Gait and balance are typically mediated through subcortical circuits, with the cortex becoming engaged as needed on an individual basis by task difficulty and complexity. However, we lack a mechanistic understanding of how increased cortical contribution to whole-body movements shapes motor output. Here we use reactive balance recovery as a paradigm to identify relationships between hierarchical control mechanisms and their engagement across balance tasks of increasing difficulty in young adults. We hypothesize that parallel sensorimotor feedback loops engaging subcortical and cortical circuits contribute to balance-correcting muscle activity, and that the involvement of cortical circuits increases with balance challenge. We decomposed balance-correcting muscle activity based on hypothesized subcortically- and cortically-mediated feedback components driven by similar sensory information, but with different loop delays. The initial balance-correcting muscle activity was engaged at all levels of balance difficulty. Its onset latency was consistent with subcortical sensorimotor loops observed in the lower limb. An even later, presumed, cortically-mediated burst of muscle activity became additionally engaged as balance task difficulty increased, at latencies consistent with longer transcortical sensorimotor loops. We further demonstrate that evoked cortical activity in central midline areas measured using electroencephalography (EEG) can be explained by a similar sensory transformation as muscle activity but at a delay consistent with its role in a transcortical loop driving later cortical contributions to balance-correcting muscle activity. These results demonstrate that a neuromechanical model of muscle activity can be used to infer cortical contributions to muscle activity without recording brain activity. Our model may provide a useful framework for evaluating changes in cortical contributions to balance that are associated with falls in older adults and in neurological disorders such as Parkinson's disease.

Implicit Adaptation Is Modulated by the Relevance of Feedback.

Given that informative and relevant feedback in the real world is often intertwined with distracting and irrelevant feedback, we asked how the relevancy of visual feedback impacts implicit sensorimotor adaptation. To tackle this question, we presented multiple cursors as visual feedback in a center-out reaching task and varied the task relevance of these cursors. In other words, participants were instructed to hit a target with a specific task-relevant cursor, while ignoring the other cursors. In Experiment 1, we found that reach aftereffects were attenuated by the mere presence of distracting cursors, compared with reach aftereffects in response to a single task-relevant cursor. The degree of attenuation did not depend on the position of the distracting cursors. In Experiment 2, we examined the interaction between task relevance and attention. Participants were asked to adapt to a task-relevant cursor/target pair, while ignoring the task-irrelevant cursor/target pair. Critically, we jittered the location of the relevant and irrelevant target in an uncorrelated manner, allowing us to index attention via how well participants tracked the position of target. We found that participants who were better at tracking the task-relevant target/cursor pair showed greater aftereffects, and interestingly, the same correlation applied to the task-irrelevant target/cursor pair. Together, these results highlight a novel role of task relevancy on modulating implicit adaptation, perhaps by giving greater attention to informative sources of feedback, increasing the saliency of the sensory prediction error.

Force matching: motor effects that are not reported by the actor.

We explored unintentional drifts of finger forces during force production and matching task. Based on earlier studies, we predicted that force matching with the other hand would reduce or stop the force drift in instructed fingers while uninstructed (enslaved) fingers remain unaffected. Twelve young, healthy, right-handed participants performed two types of tasks with both hands (task hand and match hand). The task hand produced constant force at 20% of MVC level with the Index and Ring fingers pressing in parallel on strain gauge force sensors. The Middle finger force wasn't instructed, and its enslaved force was recorded. Visual feedback on the total force by the instructed fingers was either present throughout the trial or only during the first 5 s (no-feedback condition). The other hand matched the perceived force level of the task hand starting at either 4, 8, or 15 s from the trial initiation. No feedback was ever provided for the match hand force. After the visual feedback was removed, the task hand showed a consistent drift to lower magnitudes of total force. Contrary to our prediction, over all conditions, force matching caused a brief acceleration of force drift in the task hand, which then reached a plateau. There was no effect of matching on drifts in enslaved finger force. We interpret the force drifts within the theory of control with spatial referent coordinates as consequences of drifts in the command (referent coordinate) to the antagonist muscles. This command is not adequately incorporated into force perception.

Resist-as-Needed ADL Training With SPINDLE for Patients With Tremor.

Individuals with neurological disorders often exhibit altered manual dexterity and muscle weakness in their upper limbs. These motor impairments with tremor lead to severe difficulties in performing Activities of Daily Living (ADL). There is a critical need for ADL-focused robotic training that improves individual's strength when engaging with dexterous ADL tasks. This research introduces a new approach to training ADLs by employing a novel robotic rehabilitation system, Spherical Parallel INstrument for Daily Living Emulation (SPINDLE), which incorporates Virtual Reality (VR) to simulate ADL tasks. The study results present the feasibility of training individuals with movements similar to ADLs while interacting with the SPINDLE. A new game-based robotic training paradigm is suggested to perform ADL tasks at various intensity levels of resistance as needed. The proposed system can facilitate the training of various ADLs requiring 3-dimensional rotational movements by providing optimal resistance and visual feedback. We envision this system can be utilized as a table-top home device by restoring the impaired motor function of individuals with tremor and muscle weakness, guiding to improved ADL performance and quality of life.

Improving walking via real-time visual feedback after stroke in treadmill training (RE-VISIT): a protocol for randomized controlled trial / Melhorando a caminhada por meio de feedback visual em tempo real após acidente vascular cerebral em treinamento em esteira (RE-VISIT): um protocolo para ensaio clínico randomizado

BACKGROUND: After a stroke, most patients often suffer reduced walking ability and balance. Restoring walking ability and improving balance are major goals of stroke rehabilitation. Treadmills are often used in clinical setups to achieve these goals. Adding dimensions to the visual feedback in addition to the mirror for real-time frontal view is proven to enhance the gait. It is, therefore, important to design additional real-time visual feedback in treadmill training, in particular for the sagittal view involved side. OBJECTIVE: The objective of this study is to test if the real-time sagittal visual feedback during treadmill training is superior to the conventional mirror feedback treadmill training program of equivalent intensity in improving walking speed and balance after stroke. METHODS/DESIGN: The RE-VISIT trial (Real-time Visual feedback after Stroke in Treadmill training) is registered in the Clinical Trial Registry of India (CTRI/2023/10/058299). In this two-arm randomized control trial, which will be a single-blinded study, 42 eligible stroke survivors undergoing rehabilitation will be randomly allocated (1:1 ratio) to either real-time visual sagittal feedback along with front mirror (experimental) group or only front mirror treadmill training (control) group, all the participants will receive 15 sessions of treadmill training for up to 15 min at a safe self-selected speed over 5-6 weeks. The RE-VISIT (experimental) group will receive real-time, visual sagittal view feedback of the involved lower limb trajectory along with the routine front mirror view during treadmill training and will be asked to modify their gait pattern. The control group will receive treadmill walking training only with the routine front mirror view feedback. Clinical and gait assessments will be conducted at the baseline, immediately following the final session of training, and at the 9th week during follow-up. The outcome measures of interest are walking speed (primary) and balance (secondary), which will be measured prior to baseline, post 15 sessions of training, and at the 9th week following training. DISCUSSION: This REVISIT trial will provide insight and contribute to the existing innovation and modifications of incorporating realtime visual feedback during treadmill training in post-stroke gait rehabilitation. The findings will help the better designing of a gait rehabilitation program with a treadmill for post-stroke subjects to improve walking speed, and balance for those who have greater difficulties in community ambulation. We anticipate that those in the REVISIT training will demonstrate improved walking ability.

CONTEXTO: Após o acidente vascular cerebral, a maioria dos pacientes frequentemente sofre redução da capacidade de caminhar e do equilíbrio. Restaurar a capacidade de caminhar e melhorar o equilíbrio são os principais objetivos da reabilitação do AVC. As esteiras são frequentemente usadas em ambientes clínicos para atingir esses objetivos. Está comprovado que adicionar dimensões ao feedback visual, além do espelho para visão frontal em tempo real, melhora a marcha. É, portanto, importante projetar feedbacks visuais adicionais em tempo real no treinamento em esteira, em particular para o lado envolvido na visão sagital. OBJETIVO: O objetivo deste estudo é testar se o feedback visual sagital em tempo real durante o treinamento em esteira é superior ao programa de treinamento em esteira com feedback de espelho convencional de intensidade equivalente na melhoria da velocidade de caminhada e equilíbrio após acidente vascular cerebral. MÉTODOS/ DESENHO: O ensaio RE-VISIT (feedback visual em tempo real após acidente vascular cerebral no treinamento em esteira) está registrado no Registro de Ensaios Clínicos da Índia (CTRI/2023/10/058299). Neste ensaio de controle randomizado de dois braços, que será um estudo cego, 42 sobreviventes de AVC elegíveis em reabilitação serão alocados aleatoriamente (proporção de 1:1) para feedback sagital visual em tempo real junto com grupo de espelho frontal (experimental) ou apenas Grupo de treinamento em esteira com espelho frontal (controle), todos os participantes receberão 15 sessões de treinamento em esteira por até 15 minutos em uma velocidade segura e autosselecionada durante 5-6 semanas. O grupo RE-VISIT (experimental) receberá feedback visual em tempo real da visão sagital da trajetória dos membros inferiores envolvidos, juntamente com a visão rotineira do espelho frontal durante o treinamento em esteira e será solicitado a modificar seu padrão de marcha. O grupo de controle receberá treinamento de caminhada em esteira apenas com o feedback rotineiro da visão do espelho frontal. Avaliações clínicas e de marcha serão realizadas no início do estudo, imediatamente após a sessão final de treinamento e na 9ª semana durante o acompanhamento. As medidas de resultados de interesse são a velocidade de caminhada (primária) e o equilíbrio (secundário), que serão medidos antes da linha de base, após a 15ª sessão de treinamento e na 9ª semana após o treinamento. DISCUSSÃO: este ensaio REVISIT fornecerá insights e contribuirá para a inovação e modificações existentes na incorporação de feedbacks visuais em tempo real durante o treinamento em esteira na reabilitação da marcha pós-AVC. As descobertas ajudarão no melhor desenho de um programa de reabilitação da marcha com esteira para indivíduos pós-AVC para melhorar a velocidade de caminhada e o equilíbrio para aqueles que têm maiores dificuldades na deambulação comunitária. Prevemos que aqueles no treinamento REVISIT demonstrarão melhor capacidade de caminhada.

Optimal reaching subject to computational and physical constraints reveals structure of the sensorimotor control system.

Optimal feedback control provides an abstract framework describing the architecture of the sensorimotor system without prescribing implementation details such as what coordinate system to use, how feedback is incorporated, or how to accommodate changing task complexity. We investigate how such details are determined by computational and physical constraints by creating a model of the upper limb sensorimotor system in which all connection weights between neurons, feedback, and muscles are unknown. By optimizing these parameters with respect to an objective function, we find that the model exhibits a preference for an intrinsic (joint angle) coordinate representation of inputs and feedback and learns to calculate a weighted feedforward and feedback error. We further show that complex reaches around obstacles can be achieved by augmenting our model with a path-planner based on via points. The path-planner revealed "avoidance" neurons that encode directions to reach around obstacles and "placement" neurons that make fine-tuned adjustments to via point placement. Our results demonstrate the surprising capability of computationally constrained systems and highlight interesting characteristics of the sensorimotor system.

Exploring Bimanual Haptic Feedback for Spatial Search in Virtual Reality.

Spatial search tasks are common and crucial in many Virtual Reality (VR) applications. Traditional methods to enhance the performance of spatial search often employ sensory cues such as visual, auditory, or haptic feedback. However, the design and use of bimanual haptic feedback with two VR controllers for spatial search in VR remains largely unexplored. In this work, we explored bimanual haptic feedback with various combinations of haptic properties, where four types of bimanual haptic feedback were designed, for spatial search tasks in VR. Two experiments were designed to evaluate the effectiveness of bimanual haptic feedback on spatial direction guidance and search in VR. The results from the first experiment reveal that our proposed bimanual haptic schemes significantly enhanced the recognition of spatial directions in terms of accuracy and speed compared to spatial audio feedback. The second experiment's findings suggest that the performance of bimanual haptic feedback was comparable to or even better than the visual arrow, especially in reducing the angle of head movement and enhancing searching targets behind the participants, which was supported by subjective feedback as well. Based on these findings, we have derived a set of design recommendations for spatial search using bimanual haptic feedback in VR.

Effect of sensor location for modifying center of pressure during gait using haptic feedback in people with chronic ankle instability.

BACKGROUND: Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). RESEARCH QUESTIONS: Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? METHODS: In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. RESULTS: Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). SIGNIFICANCE: A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI.

The interplay of sensory feedback, arousal, and action tremor amplitude in essential tremor.

Essential tremor (ET) amplitude is modulated by visual feedback during target driven movements and in a grip force task. It has not been examined yet whether visual feedback exclusively modulates target force tremor amplitude or if other afferent inputs like auditory sensation has a modulatory effect on tremor amplitude as well. Also, it is unknown whether the enhanced sensory feedback causes an increase of arousal in persons with ET (p-ET). We hypothesized that (1) amplitude of tremor is modulated by variation of auditory feedback in the absence of visual feedback in a force tremor paradigm; (2) increase of tremor amplitude coincides with pupillary size as a measure of arousal. 14 p-ET and 14 matched healthy controls (HC) conducted a computer-based experiment in which they were asked to match a target force on a force sensor using their thumb and index finger. The force-induced movement was fed back to the participant visually, auditory or by a combination of both. Results showed a comparable deviation from the target force (RMSE) during the experiment during all three sensory feedback modalities. The ANOVA revealed an effect of the high vs. low feedback condition on the tremor severity (Power 4-12 Hz) for the visual- and also for the auditory feedback condition in p-ET. Pupillometry showed a significantly increased pupil diameter during the auditory involved high feedback conditions compared to the low feedback conditions in p-ET. Our findings suggest that action tremor in ET is firstly modulated not only by visual feedback but also by auditory feedback in a comparable manner. Therefore, tremor modulation seems to be modality independent. Secondly, high feedback was associated with a significant pupil dilation, possibly mirroring an increased arousal/perceived effort.