Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children's upper limb motor skills, a randomized controlled trial.

PURPOSE: This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. MATERIALS AND METHODS: Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. RESULTS: Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. CONCLUSIONS: This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions.Incorporating occupational therapy tasks on a vertical surface may increase the control of proximal muscles and ease graphomotor performance.Working on a vertical surface can make activities fun for children and make challenging tasks, like writing, more interesting.Working on a vertical surface during rehabilitation sessions can particularly help children with unilateral cerebral palsy to further develop essential fine, visual, and gross motor skills more than training on horizontal surfaces.

Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study.

This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting.

Comparative analysis of motor skill acquisition in a novel bimanual task: the role of mental representation and sensorimotor feedback.

Introduction: This study investigates the multifaceted nature of motor learning in a complex bimanual task by examining the interplay between mental representation structures, biomechanics, tactile pressure, and performance. We developed a novel maze game requiring participants to maneuver a rolling sphere through a maze, exemplifying complex sequential coordination of vision and haptic control using both hands. A key component of this study is the introduction of cognitive primitives, fundamental units of cognitive and motor actions that represent specific movement patterns and strategies. Methods: Participants were divided into two groups based on initial performance: poor performers (PPG) and good performers (GPG). The experimental setup employed motion capture and innovative tactile sensors to capture a detailed multimodal picture of the interaction process. Our primary aims were to (1) assess the effects of daily practice on task performance, biomechanics, and tactile pressure, (2) examine the relationship between changes in mental representation structures and skill performance, and (3) explore the interplay between biomechanics, tactile pressure, and cognitive representation in motor learning. Results: Performance analysis showed that motor skills improved with practice, with the GPG outperforming the PPG in maze navigation efficiency. Biomechanical analysis revealed that the GPG demonstrated superior movement strategies, as indicated by higher peak velocities and fewer velocity peaks during task execution. Tactile feedback analysis showed that GPG participants applied more precise and focused pressure with their right-hand thumb, suggesting enhanced motor control. Cognitively, both groups refined their mental representation structures over time, but the GPG exhibited a more structured and sophisticated cognitive mapping of the task post-practice. Discussion: The findings highlight the intertwined nature of biomechanical control, tactile feedback, and cognitive processing in motor skill acquisition. The results support established theories, such as the cognitive action architecture approach, emphasizing the role of mental representation in planning and executing motor actions. The integration of cognitive primitives in our analysis provides a theoretical framework that connects observable behaviors to underlying cognitive strategies, enhancing the understanding of motor learning across various contexts. Our study underscores the necessity of a holistic approach to motor learning research, recognizing the complex interaction between cognitive and motor processes in skill acquisition.

Prior coordination solutions shape motor learning and transfer in redundant tasks.

Motor learning does not occur on a 'blank slate', but in the context of prior coordination solutions. The role of prior coordination solutions is likely critical in redundant tasks where there are multiple solutions to achieve the task goal - yet their influence on subsequent learning is currently not well understood. Here we addressed this issue by having human participants learn a redundant virtual shuffleboard task, where they held a bimanual manipulandum and made a discrete throwing motion to slide a virtual puck towards a target. The task was redundant because the distance traveled by the puck was determined by the sum of the left- and right-hand speeds at the time of release. On the first day, 37 participants in different groups practiced symmetric or asymmetric solutions. On the second day, all participants transferred to a common criterion task, which required an asymmetric solution. Results showed that: (i) the symmetry of the practiced solution affected motor variability during practice, with more asymmetric solutions showing higher exploration of the null space, (ii) when transferring to the common criterion task, participants in the symmetric group showed much higher null space exploration, and (iii) when no constraints were placed on the solution, participants tended to return to the symmetric solution regardless of the solution originally practiced. Overall, these results suggest that the stability of prior coordination solutions plays an important role in shaping learning in redundant motor tasks.

Exploring motor skill acquisition in bimanual coordination: insights from navigating a novel maze task.

In this study, we introduce a novel maze task designed to investigate naturalistic motor learning in bimanual coordination. We developed and validated an extended set of movement primitives tailored to capture the full spectrum of scenarios encountered in a maze game. Over a 3-day training period, we evaluated participants' performance using these primitives and a custom-developed software, enabling precise quantification of performance. Our methodology integrated the primitives with in-depth kinematic analyses and thorough thumb pressure assessments, charting the trajectory of participants' progression from novice to proficient stages. Results demonstrated consistent improvement in maze performance and significant adaptive changes in joint behaviors and strategic recalibrations in thumb pressure distribution. These findings highlight the central nervous system's adaptability in orchestrating sophisticated motor strategies and the crucial role of tactile feedback in precision tasks. The maze platform and setup emerge as a valuable foundation for future experiments, providing a tool for the exploration of motor learning and coordination dynamics. This research underscores the complexity of bimanual motor learning in naturalistic environments, enhancing our understanding of skill acquisition and task efficiency while emphasizing the necessity for further exploration and deeper investigation into these adaptive mechanisms.

Robotic assessment of bilateral and unilateral upper limb functions in adults with cerebral palsy.

BACKGROUND: Children with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study's aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP. METHODS: Nineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks. RESULTS: The majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (rs = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories). CONCLUSIONS: Adults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.

Postmovement Beta Rebound in Real and Imagined Movement.

Movement disorders, such as stroke and amyotrophic lateral sclerosis, result in loss of upper limb function and, hence, severe impairments of bimanual coordination. Although motor imagery is increasingly used to enhance neurorehabilitation, cognitive and neurophysiological parameters that inform effective strategies remain elusive. The aim of the present study is to elucidate the neural dynamics that underlie learning during real and imagined movement using both unimanual and bimanual coordination patterns. The post movement beta rebound (PMBR) has been implicated as a biomarker of motor control and therefore was the focus of this study. Healthy adults (n = 21) learned a visuomotor tracking task in a single session using either one or both hands while brainwaves were captured using electroencephalography. Postmovement beta rebound was evident in the sensorimotor cortex for both unimanual and bimanual conditions. Task-related power of the beta band demonstrated that actual unimanual movement requires greater contralateral activity compared with both actual bimanual movement and imagined movement of either condition. Notably, the PMBR was evident even in imagined movement, although to a lesser extent than real movement. Neurophysiological results support a functional role for beta band in movement. Results of these data may inform neurorehabilitation strategies for patients recovering from movement disorders of the upper limbs.

Effects of repeated unihemispheric concurrent dual-site tDCS and virtual reality games on motor coordination of sedentary adolescent girls.

BACKGROUND: This study investigated the effects of repetitive unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) associated with the use of virtual reality games (VR) on the motor coordination of sedentary adolescent girls. METHODS: Thirty-six inactive adolescent girls were randomly assigned into 3 groups (n = 12 per group): (1) VR + a-tDCSUHCDS, (2) VR + sham-tDCSUHCDS, and (3) Control. The VR + a-tDCSUHCDS and VR + s-tDCSUHCDS groups received the intervention three times a week for four weeks. In each experimental session, participants first received either 20 min of a-tDCSUHCDS (2 mA at each anodal electrode) targeting the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC) or sham and then performed VR for 1 h. The control group received no intervention. Eye-hand coordination (EHC) and bimanual coordination (BC) were measured at baseline, post-intervention, and two weeks later (retention test) using the automatic scoring mirror tracer and continuous two-arm coordination test, respectively. RESULTS: Results showed that the EHC was significantly higher in the VR + a-tDCS and VR + s-tDCS groups at post-intervention (all ps< 0.001) and the retention test (all ps< 0.001) compared to the control group. Moreover, the EHC was significantly higher in the VR + a-tDCS group compared to the VR + s-tDCS group (p = 0.024) at the retention. Similarly, VR + a-tDCS and VR + s-tDCS improved BC compared to the control group at post-intervention (all ps< 0.001) and retention test (all ps< 0.001). In addition, higher BC was observed in the VR + a-tDCS group compared to the VR + s-tDCS group (p< 0.001) at the retention test. CONCLUSIONS: Our results suggest that adding a-tDCSUHCDS to VR over 12 sessions may have an additional effect on VR training for improving and retaining motor coordination in sedentary adolescent girls.

Do Combined Oculomotor and Bimanual Coordination Exercises Instantly Stabilize Balance in Athletes?

Purpose: This study examined the immediate effects of oculomotor and bimanual coordination exercises, as well as a combination of the two, on stability of balance in athletes. Patients and Methods: Changes in center-of-gravity sway were measured in 30 college student athletes before and after the following three exercise conditions: 1) oculomotor exercises, 2) bimanual coordination exercises, and 3) a combination of oculomotor and bimanual coordination exercises (1+2). The order of these exercises was counterbalanced. Results: The combination of exercises (condition 3) reduced large swaying during balancing and immediately increased postural stability. Moreover, the oculomotor and bimanual coordination exercises (conditions 1 and 2) immediately reduced large sway during balancing when performed independently. Thus, the present study revealed that the combination of oculomotor and bimanual coordination exercises immediately reduced accidental swaying during balancing and also improved postural stability. Conclusion: This combination could be effective as an immediate balance adjustment method for athletes.

Bimanual Coordination in Children with Bilateral Cerebral Palsy: A Cross-Sectional Study.

AIM: To compare bimanual coordination in children with bilateral cerebral palsy (BCP) with that of children with typical development (TD) and correlate bimanual coordination with clinical measures of hand function. METHODS: 3-D kinematic data were collected from 14 children with BCP (mean age 13 years 1 month; range 7.3-17.2 years, 5 females) and 14 age-matched children with TD (mean age 13 years 1 month, range 7.0-16.0 years, 7 females) as they opened a drawer with one hand and activated a switch inside it with the other hand at self-paced and as-fast-as-possible speeds. Hand roles varied in each condition. Participants' hand function levels were classified using the Manual Ability Classification System. Unimanual dexterity and bimanual performance were evaluated using the Box and Blocks Test and Both Hands Assessment respectively. RESULTS: Participants with BCP performed the bimanual task more slowly (p < 0.001) and sequentially, as evidenced by greater time differences between the two hands achieving the end goal (p = 0.01). Faster speeds, particularly when the less affected hand opened the drawer, facilitated time-related measures of bimanual coordination (p < 0.05). Bimanual coordination correlated with all clinical measures of hand function (p < 0.05). CONCLUSION: For children with BCP, speed and hand used for each subcomponent of the task influence bimanual coordination. Better bimanual coordination is associated with less impairment of both hands.

The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy.

BACKGROUND: Accurate visual information is needed to guide and perform efficient movements in daily life. AIMS: To investigate the relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy (uCP). METHODS AND PROCEDURES: In 49 children with uCP (7-15 y), we investigated the relation between stereoacuity (Titmus Stereo Fly test), visual perception (Test of Visual Perceptual Skills), visuomotor integration (Beery Buktenica Test of Visual-Motor Integration) and functional vision (Flemish cerebral visual impairment questionnaire) with bimanual dexterity (Tyneside Pegboard Test), bimanual coordination (Kinarm exoskeleton robot, Box opening task), and functional hand use (Children's Hand-use Experience Questionnaire; Assisting Hand Assessment) using correlations (rs) and elastic-net regularized regressions (d). OUTCOMES AND RESULTS: Visual perception correlated with bimanual coordination (rs=0.407-0.436) and functional hand use (rs=0.380-0.533). Stereoacuity (rs=-0.404), visual perception (rs=-0.391 to -0.620), and visuomotor integration (rs=-0.377) correlated with bimanual dexterity. Functional vision correlated with functional hand use (rs=-0.441 to -0.458). Visual perception predicted bimanual dexterity (d=0.001-0.315), bimanual coordination (d=0.004-0.176), and functional hand use (d=0.001-0.345), whereas functional vision mainly predicted functional hand use (d=0.001-0.201). CONCLUSIONS AND IMPLICATIONS: Visual functions and functional vision are related to bimanual function in children with uCP highlighting the importance of performing extensive visual assessment to better understand children's difficulties in performing bimanual tasks. WHAT THIS PAPER ADDS: Previous findings showed that up to 62 % of children with unilateral cerebral palsy (uCP) present with visual impairment, which can further compromise their motor performance. However, the relation between visual and motor function has hardly been investigated in this population. This study makes a significant contribution to the literature by comprehensively investigating the multi-level relation between the heterogenous spectrum of visual abilities and bimanual function in children with uCP. We found that mainly decreased visual perception was related to decreased bimanual dexterity, bimanual coordination, and functional hand use while impairments in functional vision were only related to decreased functional hand use. Additionally, elastic-net regression models showed that visual assessments can predict bimanual function in children with uCP, however, effect sizes were only tiny to small. With our study, we demonstrated a relation between visual functions and bimanual function in children with uCP. These findings suggest the relevance of thoroughly examining visual functions in children with uCP to identify the presence of visual impairments that may further compromise their bimanual function.

Intraoperative challenges and management of fibrovascular membrane with tractional retinoschisis in proliferative diabetic retinopathy.

BACKGROUND: In severe Proliferative Diabetic Retinopathy (PDR), fibrovascular membrane (FVM) causes macular tractional retinal detachment (MTRD) which threatens vision and eventually leads to blindness. Here we present a case of separation between the inner and outer retina in tractional retinoschisis, induced during intraoperative FVM delamination. CASE PRESENTATION: A 68-year-old woman presented with PDR in the right eye, characterized by a combined FVM and retinal detachment, for which a vitrectomy was performed. Multiple holes, large retinal detachment extending to all quadrants, and white-lined blood vessels with FVM were found during the procedure. When membrane delamination was performed, it strayed into the space between the inner and outer retinal layers without being noticed due to retinoschisis and multiple retinal holes. After removing the FVM and detaching the separated inner retina, fluid-gas and photocoagulation were performed. Retinal reattachment was successfully achieved after surgery, and the postoperative visual acuity was improved and maintained for 26 months postoperatively. CONCLUSIONS: When tractional retinoschisis due to FVM is combined with retinal holes in tractional retinal detachment (TRD), care must be taken to prevent delamination from straying into retinoschisis during separation.

Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia.

AIM: Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). METHODS: We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions. RESULTS: We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. CONCLUSIONS: Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.

Hierarchical Organization and Adjustment of Force Coordination in Response to Self-Triggered and External-Triggered Cues in Simulated Archery Performance.

The purpose of this study was to investigate the hierarchical organization of digit force production and its effect on stability and performance during the simulated archery task. The simulated archery shooting task required the production of a prescribed level of force in virtual space with the left hand and an equivalent force with all 4 fingers of right hand. A single trial had 2 phases, including static force production as aiming in archery and quick force release to shoot the virtual arrow. The timing of the force release was determined by the participant's choice or response to the external cue. The coordination indices, that is, the synergy index, of force stabilization were quantified in 2 hierarchies by decomposing the variance components. The accuracy and precision of the hit position of the virtual arrow were calculated as performance-related indices. The results confirmed that the precision, that is, reproducibility, of the performance was greater when the force release time was determined by the self-selected time, suggesting the beneficial effect of the anticipatory mechanism. There was a distinct synergistic organization of digit forces for the stabilization of net forces in both bimanual and multifinger levels, which was especially correlated with the precision of performance.

Head movements induced by voluntary neck flexion stabilize sensorimotor synchronization of the finger to syncopated auditory rhythms.

Head movements that are synchronized with musical rhythms often emerge during musical activities, such as hip hop dance. Although such movements are known to affect the meter and pulse perception of complex auditory rhythms, no studies have investigated their contribution to the performance of sensorimotor synchronization (SMS). In the present study, participants listened to syncopated auditory rhythms and flexed their dominant hand index finger in time with the perceived pulses (4/4 meters). In the first experiment (Exp. 1), the participants moved their heads via voluntary neck flexion to the pulses in parallel with finger SMS (Nodding condition, ND). This performance was compared with finger SMS without nodding (Without Nodding condition, WN). In the second experiment (Exp. 2), we investigated the specificity of the effect of head SMS on finger SMS confirmed in Exp. 1 by asking participants to flex their bilateral index fingers to the pulses (Bimanual condition, BM). We compared the performance of dominant hand finger SMS between the BM and ND conditions. In Exp. 1, we found that dominant hand finger SMS was significantly more stable (smaller standard deviation of asynchrony) in the ND versus WN condition (p < 0.001). In Exp. 2, dominant hand finger SMS was significantly more accurate (smaller absolute value of asynchrony) in the ND versus BM condition (p = 0.037). In addition, the stability of dominant hand finger SMS was significantly correlated with the index of phase locking between the pulses and head SMS across participants in the ND condition (r = -0.85, p < 0.001). In contrast, the stability of dominant hand finger SMS was not significantly correlated with the index of phase locking between pulses and non-dominant hand finger SMS in the BM condition (r = -0.25, p = 0.86 after multiple comparison correction). These findings suggest that SMS modulation depends on the motor effectors simultaneously involved in synchronization: simultaneous head SMS stabilizes the timing of dominant hand finger SMS, while simultaneous non-dominant hand finger SMS deteriorates the timing accuracy of dominant hand finger SMS. The present study emphasizes the unique and crucial role of head movements in rhythmic behavior.

Peripheral and bimanual reaching in a stroke survivor with left visual neglect and extinction.

Whether attentional deficits are accompanied by visuomotor impairments following posterior parietal lesions has been debated for quite some time. This single-case study investigated reaching in a stroke survivor (E.B.) with left visual neglect and visual extinction following right temporo-parietal-frontal strokes. Unlike most neglect patients, E.B. did not present left hemiparesis, homonymous hemianopia nor show evidence of motor neglect or extinction allowing us to examine, for the first time, if lateralised attentional deficits co-occur with deficits in peripheral and bimanual reaching. First, we found a classic optic ataxia field effect: E.B.'s accuracy was impaired when reaching to peripheral targets in her neglected left visual field (regardless of the hand used). Second, we found a larger bimanual cost for movement time in E.B. than controls when both hands reached to incongruent locations. E.B.'s visuomotor profile is similar to the one of patients with optic ataxia showing that attentional deficits are accompanied by visuomotor deficits in the affected field.

[Outcomes of bimanual vitreoretinal surgery in the treatment of diabetic retinopathy complications]. / Rezul'taty bimanual'noi vitreoretinal'noi khirurgii v lechenii oslozhnenii diabeticheskoi retinopatii.

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems. PURPOSE: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. MATERIAL AND METHODS: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. RESULTS: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. CONCLUSION: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.

Through the looking-glass: Mirror feedback modulates temporal and spatial aspects of bimanual coordination.

Mirror therapy has become an effective and recommended intervention for a range of conditions affecting the upper limb (e.g. hemiparesis following stroke). However, little is known about how mirror feedback affects the control of bimanual movements (as performed during mirror therapy). In this study, in preparation for future clinical investigations, we examined the kinematics of bimanual circle drawing in unimpaired participants both with (Experiment 1) and without (Experiment 2) a visual template to guide movement. In both experiments, 15 unimpaired right-handed participants performed self-paced continuous bimanual circle-drawing movements with a mirror/symmetrical coordination pattern. For the mirror condition, vision was directed towards the mirror in order to monitor the reflected limb. In the no mirror condition, the direction of vision was unchanged, but the mirror was replaced with an opaque screen. Movements of both hands were recorded using motion capture apparatus. In both experiments, the most striking feature of movements was that the hand behind the mirror drifted spatially during the course of individual trials. Participants appeared to be largely unaware of this marked positional change of their unseen hand, which was most pronounced when a template to guide movement was visible (Experiment 1). Temporal asynchrony between the limbs was also affected by mirror feedback in both experiments; in the mirror condition, illusory vision of the unseen hand led to a relative phase lead for that limb. Our data highlight the remarkable impact that the introduction of a simple mirror can have on bimanual coordination. Modulation of spatial and temporal features is consistent with the mirror inducing a rapid and powerful visual illusion, the latter appearing to override proprioceptive signals.

A Holistic Approach for Physiotherapy Rehabilitation of Girdlestone Arthroplasty With Infection and Concomitant Contralateral Spastic Hemiplegic Cerebral Palsy: A Case Report.

Girdlestone arthroplasty is a traditional approach for complicated infections occurring with contralateral spastic hemiplegic cerebral palsy, which presents intricate challenges in rehabilitation. In this case report, an 18-year-old girl came to a multispecialty hospital with a history of falls. She was an identified case of femoral head dislocation with acute osteomyelitis and a history of spastic hemiplegic cerebral palsy. She underwent girdlestone arthroplasty with additional upper tibial and ankle pin traction. After that, she was referred to physiotherapy management. To further aid recovery, rehabilitation protocol included a combination of static exercises, ankle pumps on the affected side, and stretching, bimanual hand-arm training with lower limb training on the unaffected side to reduce spasticity. Once the stitches were removed and traction discontinued, the focus shifted to improving mobility through basic activities like rolling and transitioning to sitting, gradually progressing to standing with the assistance of a walker and bimanual hand-arm training with lower limb training for spasticity. Outcome measures like functional independence measure, numerical pain rating scale, range of motion, and manual ability classification system were used to record patient progress during rehabilitation. This case report serves the crucial role physiotherapy plays in the treatment of orthopedic and neurological conditions in younger patients, with the ultimate goal of regaining functional independence and enhancing overall quality of life.

Symmetry and synchrony of bimanual movements are not predicated on interlimb control coupling.

Previous studies suggest that bimanual coordination recruits neural mechanisms that explicitly couple control of the arms, resulting in symmetric kinematics. However, the higher symmetry for actions that require congruous joint motions compared with noncongruous joint motions calls into question the concept of control coupling as a general policy. An alternative view proposes that codependence might emerge from an optimal feedback controller that minimizes control effort and costs in task performance. Support for this view comes from studies comparing conditions in which both hands move a shared or independent virtual objects. Because these studies have mainly focused on congruous bimanual movements, it remains unclear if kinematic symmetry emerges from such control policies. We now examine movements with congruous or noncongruous joint motions (inertially symmetric or asymmetric, respectively) under shared or independent cursors conditions. We reasoned that if a control policy minimizes kinematic differences between limbs, spatiotemporal symmetry should remain relatively unaffected by inertial asymmetries. As shared tasks reportedly elicit greater interlimb codependence, these conditions should elicit higher bilateral covariance regardless of inertial asymmetries. Our results indicate a robust spatiotemporal symmetry only under inertially symmetric conditions, regardless of cursor condition. We simulated bimanual reaching using an optimal feedback controller with and without explicit costs of kinematic asymmetry, finding that only the latter mirrored our empirical data. Our findings support the hypothesis that bimanual control policies do not include kinematic asymmetry as a cost when it is not demanded by task constraints suggesting that kinematic symmetry depends critically on mechanical movement conditions.NEW & NOTEWORTHY Previously, the control coupling hypothesis and task-dependent control hypothesis have been shown to be robust in the bimanually symmetrical movement, but whether the same policy remains robust in the bimanually asymmetrical movement remains unclear. Here, with evidence from empirical and simulation data, we show that a spatiotemporal symmetry between the arms is not predicated on control coupling, but instead it is predicated on the symmetry of mechanical conditions (e.g. limb inertia) between the arms.