Augmented feedback modes during functional grasp training with an intelligent glove and virtual reality for persons with traumatic brain injury.

Introduction: Physical therapy is crucial to rehabilitating hand function needed for activities of daily living after neurological traumas such as traumatic brain injury (TBI). Virtual reality (VR) can motivate participation in motor rehabilitation therapies. This study examines how multimodal feedback in VR to train grasp-and-place function will impact the neurological and motor responses in TBI participants (n = 7) compared to neurotypicals (n = 13). Methods: We newly incorporated VR with our existing intelligent glove system to seamlessly enhance the augmented visual and audio feedback to inform participants about grasp security. We then assessed how multimodal feedback (audio plus visual cues) impacted electroencephalography (EEG) power, grasp-and-place task performance (motion pathlength, completion time), and electromyography (EMG) measures. Results: After training with multimodal feedback, electroencephalography (EEG) alpha power significantly increased for TBI and neurotypical groups. However, only the TBI group demonstrated significantly improved performance or significant shifts in EMG activity. Discussion: These results suggest that the effectiveness of motor training with augmented sensory feedback will depend on the nature of the feedback and the presence of neurological dysfunction. Specifically, adding sensory cues may better consolidate early motor learning when neurological dysfunction is present. Computerized interfaces such as virtual reality offer a powerful platform to personalize rehabilitative training and improve functional outcomes based on neuropathology.

Hand dominance in the performance and perceptions of virtual reach control.

PURPOSE: Efforts to optimize human-computer interactions are becoming increasingly prevalent, especially with virtual reality (VR) rehabilitation paradigms that utilize engaging interfaces. We hypothesized that motor and perceptional behaviors within a virtual environment are modulated uniquely through different modes of control of a hand avatar depending on limb dominance. This study investigated the effects of limb dominance on performance and concurrent changes in perceptions, such as time-based measures for intentional binding, during virtual reach-to-grasp. METHODS: Participants (n = 16, healthy) controlled a virtual hand through their own hand motions with control adaptations in speed, noise, and automation. RESULTS: A significant (p < 0.01) positive relationship between performance (reaching pathlength) and binding (time-interval estimation of beep-sound after grasp contact) was observed for the dominant hand. Unique changes in performance (p < 0.0001) and binding (p < 0.0001) were observed depending on handedness and which control mode was applied. CONCLUSIONS: Developers of VR paradigms should consider limb dominance to optimize settings that facilitate better performance and perceptional engagement. Adapting VR rehabilitation for handedness may particularly benefit unilateral impairments, like hemiparesis or single-limb amputation.

Concurrent Continuous Versus Bandwidth Visual Feedback With Varying Body Representation for the 2-Legged Squat Exercise.

CONTEXT: Continuous visual feedback (VF) can improve abilities to achieve desired movements and maximize rehabilitation outcomes by displaying actual versus target body positions in real time. Bandwidth VF reduces the reliance on feedback by displaying movement cues only when performance errors exceed specified thresholds. As such, bandwidth VF may better train independent movement abilities through greater development of intrinsic body control. In this study, continuous and bandwidth VF were investigated across modes of display (abstract and representative) that differed in body-discernibility. OBJECTIVE: To compare the performance of the 2-legged squat during training with concurrent feedback (real-time VF) and short-term retention (immediately after training, VF removed). DESIGN: Cross-sectional. SETTING: University research laboratory. PARTICIPANTS: Eighteen healthy individuals. METHODS: Marker-based motion capture displayed real-time position. MAIN OUTCOME MEASURES: Four VF cases (continuous-abstract, bandwidth-abstract, continuous-representative, and bandwidth-representative) were evaluated for accuracy and consistency to a target trajectory and target depth. RESULTS: During training, both continuous VF cases showed significantly (P < .05) higher accuracy and consistency to the target trajectory compared with both bandwidth VF cases. Bandwidth VF resulted in greater potential learning (retention performance relative to a training baseline) compared with continuous-abstract. CONCLUSIONS: Continuous-representative may offer unique performance benefits in both training and retention of multisegment movement tasks. Bandwidth VF showed greater potential for learning. For long-term learning, an optimal VF paradigm should consider continuous-representative with bandwidth features.

Training with Agency-Inspired Feedback from an Instrumented Glove to Improve Functional Grasp Performance.

Sensory feedback from wearables can be effective to learn better movement through enhanced information and engagement. Facilitating greater user cognition during movement practice is critical to accelerate gains in motor function during rehabilitation following brain or spinal cord trauma. This preliminary study presents an approach using an instrumented glove to leverage sense of agency, or perception of control, to provide training feedback for functional grasp. Seventeen able-bodied subjects underwent training and testing with a custom-built sensor glove prototype from our laboratory. The glove utilizes onboard force and flex sensors to provide inputs to an artificial neural network that predicts achievement of "secure" grasp. Onboard visual and audio feedback was provided during training with progressively shorter time delay to induce greater agency by intentional binding, or perceived compression in time between an action (grasp) and sensory consequence (feedback). After training, subjects demonstrated a significant reduction (p < 0.05) in movement pathlength and completion time for a functional task involving grasp-move-place of a small object. Future work will include a model-based algorithm to compute secure grasp, virtual reality immersion, and testing with clinical populations.

Effects of Visual Feedback Complexity on the Performance of a Movement Task for Rehabilitation.

This study investigated the effects of visual feedback (VF) complexity on movement performance to potentially optimize the design of VF-based rehabilitation. We evaluated the effects of VF complexity on performance of the two-legged squat during training with concurrent (real-time) VF and short-term retention with no VF. Four VF cases were employed to train spatial positioning of the thigh segment in unique combinations of complexity (simple, complex) and representation of body-discernibility (abstract, representative). Eighteen able-bodied subjects attempted to minimize the error between individual body segment positions and a target trajectory during concurrent VF and short-term retention tests. Complex-representative VF demonstrated greater potential for training with increased performance consistency in both motion and muscle activity patterns.

Agency and Performance of Reach-to-Grasp With Modified Control of a Virtual Hand: Implications for Rehabilitation.

This study investigated how modified control of a virtual hand executing reach-to-grasp affects functional performance and agency (perception of control). The objective of this work was to demonstrate positive relationships between reaching performance and grasping agency and motivate greater consideration of agency in movement rehabilitation. We hypothesized that agency and performance have positive correlation across varying control modes of the virtual hand. In this study, each participant controlled motion of a virtual hand through motion of his or her own hand. Control of the virtual hand was modified according to a specific control mode. Each mode involved the virtual hand moving at a modified speed, having noise, or including a level of automation. These specific modes represent potential control features to adapt for a rehabilitation device such as a prosthetic arm and hand. In this study, significant changes in agency and performance were observed across the control modes. Overall, a significant positive relationship (p < 0.001) was observed between the primary performance metric of reach (tracking a minimum path length trajectory) and an implicit measurement of agency (intentional binding). Intentional binding was assessed through participant perceptions of time-intervals between grasp contact and a sound event. Other notable findings include improved movement efficiency (increased smoothness, reduced acceleration) during expression of higher agency and shift toward greater implicit versus explicit agency with higher control speed. Positively relating performance and agency incentivizes control adaptation of powered movement devices, such as prostheses or exoskeletons, to maximize both user engagement and functional performance. Agency-based approaches may foster user-device integration at a cognitive level and facilitate greater clinical retention of the device. Future work should identify robust and automated methods to adapt device control for increased agency. Objectives include how virtual reality (VR) may identify optimal control of real-world devices and assessing real-time agency from neurophysiological signals.

Control Modification of Grasp Force Covaries Agency and Performance on Rigid and Compliant Surfaces.

This study investigated how modifications in the display of a computer trace under user control of grasp forces can co-modulate agency (perception of control) and performance of grasp on rigid and compliant surfaces. We observed positive correlation (p < 0.01) between implicit agency, measured from time-interval estimation for intentional binding, and grasp performance, measured by force-tracking error, across varying control modes for each surface type. The implications of this work are design directives for cognition-centered device interfaces for rehabilitation of grasp after neurotraumas such as spinal cord and brain injuries while considering if grasp interaction is rigid or compliant. These device interfaces should increase user integration to virtual reality training and powered assistive devices such as exoskeletons and prostheses. The modifications in control modes for this study included changes in force magnitude, addition of mild noise, and a measure of automation. Significant differences (p < 0.001) were observed for each surface type across control modes with metrics for implicit agency, performance, and grasp control efficiency. Explicit agency, measured from user survey responses, did not exhibit significant variations in this study, suggesting implicit measures of agency are needed for identifying co-modulation with grasp performance. Grasp on the compliant surface resulted in greater dependence of performance on agency and increases in agency and performance with the addition of mild noise. Noise in conjunction with perceived freedom at a flexible surface may have amplified visual feedback responses. Introducing automation in control decreased agency and performance for both surfaces, suggesting the value in continuous user control of grasp. In conclusion, agency and performance of grasp can be co-modulated across varying modes of control, especially for compliant grasp actions. Future studies should consider reliable measures of implicit agency, including physiological recordings, to automatically adapt rehabilitation interfaces for better cognitive engagement and to accelerate functional outcomes.

Surface shear viscosity as a macroscopic probe of amyloid fibril formation at a fluid interface.

Amyloidogenesis of proteins is of wide interest because amyloid structures are associated with many diseases, including Alzheimer's and type II diabetes. Dozens of different proteins of various sizes are known to form amyloid fibrils. While there are numerous studies on the fibrillization of insulin induced by various perturbations, shearing at fluid interfaces has not received as much attention. Here, we present a study of human insulin fibrillization at room temperature using a deep-channel surface viscometer. The hydrodynamics of the bulk flow equilibrates in just over a minute, but the proteins at the air-water interface exhibit a very slow development during which the surface (excess) shear viscosity deduced from a Newtonian surface model increases slightly over a period of a day and a half. Then, there is a very rapid increase in the surface shear viscosity to effectively unbounded levels as the interface becomes immobilized. Atomic force microscopy shows that fibrils appear at the interface after it becomes immobilized. Fibrillization in the bulk does not occur until much later. This has been verified by concurrent atomic force microscopy and circular dichroism spectroscopy of samples from the bulk. The immobilized interface has zero in-plane shear rate, however due to the bulk flow, there is an increase in the strength of the normal component of the shear rate at the interface, implicating this component of shear in the fibrillization process ultimately resulting in a thick weave of fibrils on the interface. Real-time detection of fibrillization via interfacial rheology may find utility in other studies of proteins at sheared interfaces.

Shear-induced amyloid fibrillization: the role of inertia.

Agitation of protein is known to induce deleterious effects on protein stability and structure, with extreme agitation sometimes resulting in complete aggregation into amyloid fibrils. Many mechanisms have been proposed to explain how protein becomes unstable when subjected to flow, including alignment of protein species, shear-induced unfolding, simple mixing, or fragmentation of existing fibrils to create new seeds. Here a shearing flow was imposed on a solution of monomeric human insulin via a rotating Couette device with a small hydrophobic fluid interface. The results indicate that even very low levels of shear are capable of accelerating amyloid fibril formation. Simulations of the flow suggest that the shear enhances fibrillization kinetics when flow inertia is non-negligible and the resulting meridional circulation allows for advection of bulk protein to the hydrophobic interface.

Comparison of Human and Bovine Insulin Amyloidogenesis under Uniform Shear.

A diverse range of proteins can assemble into amyloid fibrils, a process that generally results in a loss of function and an increase in toxicity. The occurrence and rate of conversion is strongly dependent on several factors including molecular structure and exposure to hydrodynamic forces. To investigate the origins of shear-induced enhancement in the rate of fibrillization, a stable rotating Couette flow was used to evaluate the kinetics of amyloid formation under uniform shear for two similar insulin species (human and bovine) that demonstrate unique fibrillization kinetics. The presence of shear-induced nuclei predicted by previous studies is supported by observations of a lag between the consumption of soluble insulin and the precipitation of amyloid aggregates. The apparent fibrillization rate generally increases with shear. However, a two-parameter kinetic model revealed that the nucleation rate has a maximum value at intermediate shear rates. The fibril elongation rate increases monotonically with shear and is similar for both insulin variants, suggesting that increased elongation rates are related to mixing. Differences between human and bovine insulin kinetics under shear are attributable to the nucleation step.