People with mild to moderate intellectual or multiple disabilities may have serious difficulties in accessing leisure events, managing communication exchanges with distant partners, and performing ...functional daily activities. Recently, efforts were made to develop and assess technology-aided programs aimed at supporting people in all three areas (i.e., leisure, communication, and daily activities). This study assessed a new technology-aided program aimed at helping four participants with intellectual and multiple disabilities in the aforementioned areas. The program, which was implemented following a non-concurrent multiple baseline across participants design, relied on the use of a smartphone or tablet connected
via
Bluetooth to a two-switch device. This device served to select leisure and communication events and to control the smartphone or tablet’s delivery of step instructions for the activities scheduled. Data showed that during the baseline phase (with only the smartphone or tablet available), three participants failed in each of the areas (i.e., leisure, communication and functional activities) while one participant managed to access a few leisure events. During the intervention phase (with the support of the technology-aided program), all participants managed to independently access leisure events, make telephone calls, and carry out activities. These results suggest that the program might be a useful tool for helping people with intellectual and multiple disabilities improve their condition in basic areas of daily life.
•Findings extend support for the effectiveness of activity-oriented, as well as body function-oriented approaches when combined with activities.•An important new finding was the evidence of training ...effectiveness when programs were conducted in a small group format and for programs aiming at improved physical fitness.•Data suggest that active computer-assisted training can be a useful adjunct treatment, but the active ingredients are unknown.•Relatively short duration interventions still demonstrated positive treatment effects.•Comparison studies between approaches and groups (age, gender, severity, whether referred or selected and with co-occurring conditions) are needed.
As part of the process of creating an update of the clinical practice guidelines for developmental coordination disorder (DCD) (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012), a systematic review of intervention studies, published since the last guidelines statement was conducted.
The aim of this study was to 1) systematically review the evidence published from January 2012 to February 2017 regarding the effectiveness of motor based interventions in individuals with DCD, 2) quantify treatment effects using a meta-analysis, 3) examine the available information on different aspects of delivery including use of group intervention, duration and frequency of therapy, and 4) identify gaps in the literature and make recommendations for future intervention research.
An electronic search of 5 databases (PubMed, Embase, Pedro, Scopus and Cochrane) was conducted for studies that evaluated motor-based interventions to improve performance for individuals with DCD.
Thirty studies covering 25 datasets were included, 19 of which provided outcomes on standardized measures of motor performance. The overall effect size (Cohen’s d) across intervention studies was large (1.06), but the range was wide: for 11 interventions, the observed effect was large (>0.80), in eight studies moderate (>0.50), and in five it was small or negligible (<0.50). Positive benefits were evident for activity-oriented approaches, body function-oriented combined with activities, active video games, and small group programs.
Results showed that activity-oriented and body function oriented interventions can have a positive effect on motor function and skills. However, given the varied methodological quality and the large confidence intervals of some studies, the results should be interpreted with caution.
Motor impairment is one of the common neurological conditions suffered by stroke patients, where this chronic immobility together with the absence of early limb mobilisation can lead to conditions ...such as joint contracture with spastic limbs. In this study, a soft robotic sock device was developed, which can provide compliant actuation to the ankle joint in the early stage of stroke recovery. The device is fitted with soft extension actuators and when the actuators are inflated, they extend and guide the foot into plantarflexion; upon deflation, the actuators will resume their initial conformations. Each actuator is linked to a pneumatic pump-valve control system that injects pressurised air into or release air from the system. In this study, the design and characterisation of the soft actuators will be presented, where the theoretical and experimental forces generated by the actuators were compared. The performance of the device was also evaluated on healthy subjects and the results had shown that the device was able to move the subjects' ankles into cycles of dorsiflexion-plantarflexion, in the absence of voluntary muscle effort. The findings suggested that the soft wearable robotic device was capable of assisting the subjects in performing repeated cycles of ankle flexion.
Predictive processing, a crucial aspect of human cognition, is also relevant for language comprehension. In everyday situations, we exploit various sources of information to anticipate and therefore ...facilitate processing of upcoming linguistic input. In the literature, there are a variety of models that aim at accounting for such ability. One group of models propose a strict relationship between prediction and language production mechanisms. In this review, we first introduce very briefly the concept of predictive processing during language comprehension. Secondly, we focus on models that attribute a prominent role to language production and sensorimotor processing in language prediction (“prediction-by-production” models). Contextually, we provide a summary of studies that investigated the role of speech production and auditory perception on language comprehension/prediction tasks in healthy, typical participants. Then, we provide an overview of the limited existing literature on specific atypical/clinical populations that may represent suitable testing ground for such models–i.e., populations with impaired speech production and auditory perception mechanisms. Ultimately, we suggest a more widely and in-depth testing of prediction-by-production accounts, and the involvement of atypical populations both for model testing and as targets for possible novel speech/language treatment approaches.
Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for ...Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children's social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke. Children with ischemic stroke demonstrated elevated parent-reported social skills problems (observed = 20.51%, expected = 14.00%) and clinically elevated social withdrawal (observed = 11.21%, expected = 2.00%). Attentional problems significantly contributed to reduced social skills,
(3,164) = 30.68,
< 0.01, while attentional problems and neurological impairments accounted for increased withdrawal behavior,
(2, 164) = 7.47,
< 0.01. The presence of a motor impairment was associated with higher social withdrawal compared to individuals with no motor impairment diagnosis,
(307.73) = 2.25,
< .025,
= 0.25, 95% CI 0.42, 6.21. The current study demonstrates that children with stroke who experience motor impairments, attentional problems, reduced functional communication skills, and neurological impairments can experience deficits in their social skills and withdrawal behavior.
Over the past two decades, several functional neuroimaging experiments demonstrated changes in neural activity in stroke patients with motor deficits. Conclusions from single experiments are usually ...constrained by small sample sizes and high variability across studies. Here, we used coordinate-based activation likelihood estimation meta-analyses to provide a quantitative synthesis of the current literature on motor-related neural activity after stroke. Of over 1000 PubMed search results through January 2011, 36 studies reported standardized whole-brain group coordinates. Meta-analyses were performed on 54 experimental contrasts for movements of the paretic upper limb (472 patients, 452 activation foci) and on 20 experiments comparing activation between patients and healthy controls (177 patients, 113 activation foci). We computed voxelwise correlations between activation likelihood and motor impairment, time post-stroke, and task difficulty across samples. Patients showed higher activation likelihood in contralesional primary motor cortex (M1), bilateral ventral premotor cortex and supplementary motor area (SMA) relative to healthy subjects. Activity in contralesional areas was more likely found for active than for passive tasks. Better motor performance was associated with greater activation likelihood in ipsilesional M1, pre-SMA, contralesional premotor cortex and cerebellum. Over time post-stroke, activation likelihood in bilateral premotor areas and medial M1 hand knob decreased. This meta-analysis shows that increased activation in contralesional M1 and bilateral premotor areas is a highly consistent finding after stroke despite high inter-study variance resulting from different fMRI tasks and motor impairment levels. However, a good functional outcome relies on the recruitment of the original functional network rather than on contralesional activity.
► Quantitative synthesis of motor-related neural activity after stroke. ► Contralesional M1 and bilateral PMC activity differentiates patients and controls. ► Recruitment of original activation sites indicates better clinical outcome. ► No consistent relationship between contralesional M1 activity and clinical deficit.
Objective. Several training programs have been developed in the past to restore motor functions after stroke. Their efficacy strongly relies on the possibility to assess individual levels of ...impairment and recovery rate. However, commonly used clinical scales rely mainly on subjective functional assessments and are not able to provide a complete description of patients' neuro-biomechanical status. Therefore, current clinical tests should be integrated with specific physiological measurements, i.e. kinematic, muscular, and brain activities, to obtain a deep understanding of patients' condition and of its evolution through time and rehabilitative intervention. Approach. We proposed a multivariate approach for motor control assessment that simultaneously measures kinematic, muscle and brain activity and combines the main physiological variables extracted from these signals using principal component analysis (PCA). We tested it in a group of six sub-acute stroke subjects evaluated extensively before and after a four-week training, using an upper-limb exoskeleton while performing a reaching task, along with brain and muscle measurements. Main results. After training, all subjects exhibited clinical improvements correlating with changes in kinematics, muscle synergies, and spinal maps. Movements were smoother and faster, while muscle synergies increased in numbers and became more similar to those of the healthy controls. These findings were coupled with changes in cortical oscillations depicted by EEG-topographies. When combining these physiological variables using PCA, we found that (i) patients' kinematic and spinal maps parameters improved continuously during the four assessments; (ii) muscle coordination augmented mainly during treatment, and (iii) brain oscillations recovered mostly pre-treatment as a consequence of short-term subacute changes. Significance. Although these are preliminary results, the proposed approach has the potential of identifying significant biomarkers for patient stratification as well as for the design of more effective rehabilitation protocols.
Parkinson’s disease (PD) is a chronic, progressive and second most prevalent neurological disorder affecting the motor system. Cardinal motor impairment and α-synucleinopathy are the characteristic ...features of PD. Recently, it has been identified that the gut-brain axis is substantially regulated by the gut microbiome (GM) through an immunological, neuroendocrine, and neural mechanism. However, disturbance in the gut-microbiome-brain axis in PD might proceed to gastrointestinal manifestations intermittently leading to the motor system and the PD pathogenesis itself. The gut microbial toxins may induce the production of α-synuclein (α-syn) aggregates in the enteric nervous system (ENS), which may proliferate and propagate in a prion-like-manner through the vagus nerve to the central nervous system (CNS); supporting the hypothesis that, GM might play a pivotal role in PD pathogenesis. Overstimulated innate immune system due to intestinal bacterial overgrowth or gut dysbiosis and the enhanced intestinal permeability may persuade systemic inflammation, while the activation of enteric glial cells and enteric neurons may contribute to α-synucleinopathy. Gut microbiota can bear a significant impact on neurological outcomes such as learning, memory and cognition. In this review paper, we summarize how the alterations in gut microbiota and ENS inflammation are associated with PD pathogenesis. The evidence supporting the causative role played by gut-associated dysbiosis and microbial byproducts, in the onset of PD is also discussed. We have highlighted the landmark discoveries in the field of PD particularly focusing on the gut-brain axis. A better comprehension of the interaction between the gut-brain axis, gut microbiota, and PD can usher in novel therapeutic and diagnostic approaches.
Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the post-stroke patients with ...moderate to severe upper limb paresis due to the poor accomplishment of the complex tasks.
27 post-stroke individuals and 20 non-disabled people participated in the study. The trunk and upper limb movements during the Hand-to-mouth task were captured by the motion capture system and upper extremity kinematic analysis software automatically. The subgroup analysis within stroke group were conducted layering by the Fugl-Meyer Assessment for Upper Extremity scores (severe: 16–31; moderate: 32–50).
The paretic upper limbs in the stroke group tended to use more trunk and shoulder compensatory strategies to offset the impact of spasticity and weakness compared with non-disabled controls. The less-affected limbs in the stroke group also showed abnormal kinematic data. There were significant differences between the kinematic metrics of severe and moderate subgroups.
The Hand-to-mouth task is a good and feasible option for kinematic analysis of these patients. It is essential to layer the severity of the paresis and put more emphasis on trunk movements in the future kinematic studies.
•Both upper limbs in the stroke group showed significant kinematic abnormalities.•The dominant and non-dominant limbs in the non-disabled group performed highly similar.•The two subgroups within the stroke group showed different kinematic characteristics.
Purpose:
Cross-cultural adaptation of the Pediatric Balance Scale (PBS) into Greek.
Methods:
The PBS was forward-back translated and evaluated for content equivalence. The Greek PBS (PBS
GR
) was ...administered to children with movement impairments by 2 pediatric physical therapists. The scale was readministered to the same children after 3 weeks (test-retest reliability) and to children with typical development for discriminant validity. The 1-minute walk test was administered to test the scale's concurrent validity.
Results:
Psychometric testing was completed on 26 children with movement impairments. The scale had excellent interrater and test-retest reliability and internal consistency. Moderate correlation was observed between PBS
GR
and 1-minute walk. Children with movement impairment had significantly lower PBS
GR
scores than children with typical development.
Conclusions:
Acceptable reliability, concurrent validity, and discriminant validity were observed for the PBS
GR
.
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