Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials.

Background. After stroke, recovery of movement in proximal and distal upper extremity (UE) muscles appears to follow different time courses, suggesting differences in their neural substrates. Objective. We sought to determine if presence or absence of motor evoked potentials (MEPs) differentially influences recovery of volitional contraction and strength in an arm muscle versus an intrinsic hand muscle. We also related MEP status to recovery of proximal and distal interjoint coordination and movement fractionation, as measured by the Fugl-Meyer Assessment (FMA). Methods. In 45 subjects in the year following ischemic stroke, we tracked the relationship between corticospinal tract (CST) integrity and behavioral recovery in the biceps (BIC) and first dorsal interosseous (FDI) muscle. We used transcranial magnetic stimulation to probe CST integrity, indicated by MEPs, in BIC and FDI. We used electromyography, dynamometry, and UE FMA subscores to assess muscle-specific contraction, strength, and inter-joint coordination, respectively. Results. Presence of MEPs resulted in higher likelihood of muscle contraction, greater strength, and higher FMA scores. Without MEPs, BICs could more often volitionally contract, were less weak, and had steeper strength recovery curves than FDIs; in contrast, FMA recovery curves plateaued below normal levels for both the arm and hand. Conclusions. There are shared and separate substrates for paretic UE recovery. CST integrity is necessary for interjoint coordination in both segments and for overall recovery. In its absence, alternative pathways may assist recovery of volitional contraction and strength, particularly in BIC. These findings suggest that more targeted approaches might be needed to optimize UE recovery.

Robotic therapy for chronic stroke: general recovery of impairment or improved task-specific skill?

There is a great need to develop new approaches for rehabilitation of the upper limb after stroke. Robotic therapy is a promising form of neurorehabilitation that can be delivered in higher doses than conventional therapy. Here we sought to determine whether the reported effects of robotic therapy, which have been based on clinical measures of impairment and function, are accompanied by improved motor control. Patients with chronic hemiparesis were trained for 3 wk, 3 days a week, with titrated assistive robotic therapy in two and three dimensions. Motor control improvements (i.e., skill) in both arms were assessed with a separate untrained visually guided reaching task. We devised a novel PCA-based analysis of arm trajectories that is sensitive to changes in the quality of entire movement trajectories without needing to prespecify particular kinematic features. Robotic therapy led to skill improvements in the contralesional arm. These changes were not accompanied by changes in clinical measures of impairment or function. There are two possible interpretations of these results. One is that robotic therapy only leads to small task-specific improvements in motor control via normal skill-learning mechanisms. The other is that kinematic assays are more sensitive than clinical measures to a small general improvement in motor control.

Impact of aging on visual reweighting during locomotion.

OBJECTIVES: The purpose of this study was to investigate the ability of young and old subjects to reweight visual cues while walking at normal and fast speeds. METHODS: Ten young (23.49 ± 4.72) and ten older adults (age 76.22 ± 3.11) were asked to physically walk straight while viewing a virtual scene in a head-mounted display (HMD) unit under three conditions: no visual perturbation, blank (no visual input), and visual perturbation. Subjects performed the tasks walking at two speeds: preferred self-pace and fast. Variables calculated included trajectory, heading angle, and body segment orientations. RESULTS: In the perturbation condition, the older adults walked with higher segmentation and more deviations of the body's centre of mass. Only the young subjects were affected by the walking speed, with an improved performance when walking fast. CONCLUSIONS: Old age affects the ability to re-weight visual information and make postural or locomotor adjustments in real time. The lower errors of the young adults in the fast conditions suggest decreased cortical control of locomotion with increasing speeds. SIGNIFICANCE: Visual information presented in real time can impact on balance and mobility in older adults, and thus should be given serious consideration for the purpose of evaluation and intervention.

Evidence for the use of rotational optic flow cues for locomotor steering in healthy older adults.

Optic flow is a powerful visual cue for the control of locomotion. Considerable research has focused on how healthy young people use and perceive optic flow. However, little is known on how older adults use this type of visual motion to control walking. The purpose of this study is to investigate the ability of young and older adults to adjust their physical walking trajectory in response to a rotation of the optic flow presented in a virtual environment. Ten healthy young adults (mean age 23.49 ± 4.72 yr) and 10 healthy older adults (mean age 76.22 ± 3.11 yr) participated in the study. Subjects were instructed to walk straight in a virtual environment viewed within a head-mounted display unit as they walked overground for 5 m, while the focus of expansion was gradually rotated to the left or the right by 40°. All subjects responded with a similar strategy by rotating their head and body in the direction away from the orientation of the perturbation. The younger subjects achieved almost complete corrections and had very small net heading errors. In contrast, the older adults had delayed and smaller reorientations, particularly in the head, thus showing significantly larger heading errors compared with younger subjects. We conclude that older adults retain the ability to use optic flow to control their walking trajectory, although smaller, delayed head rotations and larger heading errors may indicate an age-dependent effect on sensorimotor coordination.

Aging affects the ability to use optic flow in the control of heading during locomotion.

Perceived self-motion from optic flow is implicated in the control of locomotion. Aging, which affects visual perception and sensorimotor integration, may result in an inability to use optic flow to guide heading while walking. The purpose of this study was to examine whether advanced age could impact on the steering of locomotion, when changing optic flow directions were presented in an immersive virtual environment (VE). Nine young adults (21.56 +/- 3.20 years) and nine older adults (66.11 +/- 3.95 years) participated in the study. Subjects were asked to walk while viewing a VE through a head-mounted display unit (Kaiser). The VE viewed by the subjects was a large room displayed as an expanding translational optic flow, with the focus of expansion (FOE) located at neutral, 20 degrees or 40 degrees to the right or left. Their task was to walk straight with respect to the VE. Kinematic data in 3D were collected, from which the body's centre of mass (CoM) position and heading direction were calculated. Young subjects were able to make proper heading adjustments in the VE, with respect to FOE shifts, but not older individuals. Young subjects altered their CoM trajectory so that it was oriented in the direction opposite to the FOE in the physical environment and resulted in small deviation in the VE. The older adults did not adjust their locomotor patterns in response to the different flows presented and maintained similar walking trajectories across all trials. Advanced age results in an altered control of steering of locomotion in response to changing directions of optic flow. This may be related to an impaired perception and/or use of the optic flow, or due to inherent problems in sensorimotor integration.

Steering behaviour can be modulated by different optic flows during walking.

Optic flow is a typical pattern of visual motion that can be used to control locomotion. While the ability to discriminate translational or rotational optic flows have been extensively studied, how these flows control steering during locomotion is not known. The goal of this study was to compare the steering behaviour of subjects subjected to rotational, translational, or combined (rotational added to translational) optic flows with a focus of expansion (FOE) located to the right, left, or straight ahead. Ten healthy young subjects were instructed to walk straight in a virtual room viewed through a helmet mounted display while the location of the FOE was randomly offset. Horizontal trajectory of the body's centre of mass (CoM), as well as rotations of the head, trunk and foot were recorded in coordinates of both the physical and virtual worlds. Results show that subjects experienced a mediolateral shift in CoM opposite to the FOE location, with larger corrections being observed at more eccentric FOE locations. Head and body segment reorientations were only observed for optic flows containing a rotational component. CoM trajectory corrections in the physical world were also of small magnitude, leading to deviation errors in the virtual world. Altogether, these results suggest a profound influence of vision, especially due to the pattern of visual motion, on steering behaviours during locomotion.

Characteristics of single and double obstacle avoidance strategies: a comparison between adults and children.

Activities of daily living often require us to negotiate several obstacles in the travel path. To date, there is little work investigating how adults accomplish such tasks, and there is even less known about multiple obstacle avoidance strategies used by children. The current work will expand our knowledge about the role of vision in adults and children when avoiding two obstacles placed in their travel path under altered ambient lighting. Healthy 7-year old children (n=10; aged 7.51+/-0.2 years) and adults (n=10; aged 22.76+/-1.7 years) were instrumented with infrared markers (Optotrak, NDI) placed on anatomical landmarks and asked to walk along a ten meter path under three conditions: unobstructed, single obstacle, or double obstacle. These trials were performed under two lighting conditions: Full (simulating standard office lighting) and Low (simulating a dark hallway lit by nightlights). Data analyses included lead and trail clearance values, step length, step width and step velocity, take-off distance and Horizontal toe Displacement at Apex (HDA) which was defined as the distance between the horizontal position of the toe to the leading edge of the obstacle when the toe reaches its peak height. Adults were able to maintain consistent behaviour regardless of the number of obstacles in the travel path. Children, however, adjusted their foot placement for the second obstacle. This indicates that having multiple obstacles in the travel path is a more challenging task for 7-year old, and suggests that children at this age may not have fully developed anticipatory locomotor strategies. Children had larger clearance values than adults for the lead foot crossing the obstacle under all obstacle and lighting conditions, and consistently used larger HDA values than adults. Together, these findings suggest that children adopt more cautious strategies than adults in complex environments. Additionally, children decreased walking velocity, increased step width and decreased their step length in a Low light environment. These changes are all indicators of a more careful avoidance strategy, which implies that children at this age rely heavily on visual information to guide foot placements in a complex environment.