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23 pages, 990 KiB

Open AccessArticle

Error Enhancement for Upper Limb Rehabilitation in the Chronic Phase after Stroke: A 5-Day Pre-Post Intervention Study

by Marjan Coremans, Eli Carmeli, Ineke De Bauw, Bea Essers, Robin Lemmens and Geert Verheyden

Sensors 2024, 24(2), 471; https://doi.org/10.3390/s24020471 - 12 Jan 2024

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A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1–Q3)) in (1) UL Fugl–Meyer assessment (1.0 (0.8–3.0), p < 0.001) and action research arm test (2.0 (0.8–2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0–0.3), p < 0.001) and quality of use (0.1 (0.1–0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (−0.45 (−0.81–0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training. Full article

(This article belongs to the Special Issue Advanced Sensors in Biomechanics and Rehabilitation)

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12 pages, 3582 KiB

Open AccessFeature PaperArticle

The Relationship between Retained Primitive Reflexes and Hemispheric Connectivity in Autism Spectrum Disorders

by Robert Melillo, Gerry Leisman, Calixto Machado, Yanin Machado-Ferrer, Mauricio Chinchilla-Acosta, Ty Melillo and Eli Carmeli

Brain Sci. 2023, 13(8), 1147; https://doi.org/10.3390/brainsci13081147 - 30 Jul 2023

Cited by 3 | Viewed by 8862

Abstract

Background: Autism Spectrum Disorder (ASD) can be identified by a general tendency toward a reduction in the expression of low-band, widely dispersed integrative activities, which is made up for by an increase in localized, high-frequency, regionally dispersed activity. The study assessed ASD children and adults all possessing retained primitive reflexes (RPRs) compared with a control group that did not attempt to reduce or remove those RPRs and then examined the effects on qEEG and brain network connectivity. Methods: Analysis of qEEG spectral and functional connectivity was performed, to identify associations with the presence or absence of retained primitive reflexes (RPRs), before and after an intervention based on TENS unilateral stimulation. Results: The results point to abnormal lateralization in ASD, including long-range underconnectivity, a greater left-over-right qEEG functional connectivity ratio, and short-range overconnectivity in ASD. Conclusions: Clinical improvement and the absence of RPRs may be linked to variations in qEEG frequency bands and more optimized brain networks, resulting in more developmentally appropriate long-range connectivity links, primarily in the right hemisphere. Full article

(This article belongs to the Collection New Advances in Autism)

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23 pages, 424 KiB

Open AccessFeature PaperArticle

Taking Sides: Asymmetries in the Evolution of Human Brain Development in Better Understanding Autism Spectrum Disorder

by Gerry Leisman, Robert Melillo, Ty Melillo, Calixto Machado, Yanin Machado-Ferrer, Mauricio Chinchilla and Eli Carmeli

Symmetry 2022, 14(12), 2689; https://doi.org/10.3390/sym14122689 - 19 Dec 2022

Cited by 5 | Viewed by 8359

Abstract

Confirmation from structural, functional, and behavioral studies agree and suggest a configuration of atypical lateralization in individuals with autistic spectrum disorders (ASD). It is suggested that patterns of cortical and behavioral atypicality are evident in individuals with ASDs with atypical lateralization being common in individuals with ASDs. The paper endeavors to better understand the relationship between alterations in typical cortical asymmetries and functional lateralization in ASD in evolutionary terms. We have proposed that both early genetic and/or environmental influences can alter the developmental process of cortical lateralization. There invariably is a “chicken or egg” issue that arises whether atypical cortical anatomy associated with abnormal function, or alternatively whether functional atypicality generates abnormal structure. Full article

(This article belongs to the Special Issue Symmetry and Biology Section: Feature Papers in Neuroscience and Behavior)

9 pages, 1766 KiB

Open AccessArticle

Measuring Dynamic Leg Length during Normal Gait

by Sam Khamis, Shmuel Springer, Dror Ovadia, Sima Krimus and Eli Carmeli

Sensors 2018, 18(12), 4191; https://doi.org/10.3390/s18124191 - 29 Nov 2018

Cited by 4 | Viewed by 4481

Abstract

Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement that is measured by the distance from the hip to the heel, ankle, and forefoot during the gait cycle. The aim of this study was to present DLL measurement during normal gait. Forty healthy participants underwent a gait evaluation using a motion analysis system. The average DLLs were compared between sides during the gait cycle using the paired t-test at 51 sample points. Time of maximal and minimal DLLs and the ratio between maximal and minimal DLLs during the gait cycle were calculated. DLLs were found to be consistent, indicated by a within standard deviation of <6.65 mm and by being symmetrical with no significant differences between sides [p > 0.103]. DLL patterns and time of maximal and minimal DLLs were established. The ratio between maximal DLLs during the stance phase and minimal DLLs during the swing phase was also defined and found to be symmetrical. Normative data of DLL measures were set with respect to magnitude and pattern during the gait cycle. These data might serve as a reference for abnormal gait deviation reflected by abnormal DLLs, thus promoting a new perspective in gait analysis. Full article

(This article belongs to the Section Biosensors)

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11 pages, 3332 KiB

Open AccessArticle

Correlation between Gait Asymmetry and Leg Length Discrepancy—What Is the Role of Clinical Abnormalities?

by Sam Khamis, Barry Danino, Dror Ovadia and Eli Carmeli

Appl. Sci. 2018, 8(10), 1979; https://doi.org/10.3390/app8101979 - 18 Oct 2018

Cited by 9 | Viewed by 4769

Abstract

Reducing the effect of leg length discrepancy (LLD) on gait abnormalities while other abnormal conditions such as spasticity, joint contractures or weak muscle strength are exhibited is challenging. This study aimed to evaluate the impact of mild LLD on lower limb biomechanics, on participants with anatomic LLD with and without other clinical abnormalities. A motion capture system was utilized on 32 participants to measure lower limb kinematics and dynamic leg length (DLL) throughout the gait cycle, calculated as the absolute distance from the hip joint center, either to the heel, ankle joint center, or forefoot. The Pearson correlation coefficient found that LLD was associated with 5 kinematic variables only when LLD appeared with no other clinical abnormalities present (r = 0.574 – 0.846, p < 0.05). When clinical abnormalities were present, the random forest classification accuracy was lower (64% versus 80%), implying that the used kinematics are low predictors for anatomic LLD, revealing a higher asymmetrical clearance index (the difference between the maximal stance phase and the minimal contra-lateral swing phase DLL) and a different kinematic variable importance index. Clinical abnormalities in pathological gait will in all probability significantly affect gait deviations, affirming mild anatomic LLD as inconsequential. A functional measurement can offer a better estimate as to the side and extent of the functional discrepancy. Full article

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8 pages, 837 KiB

Open AccessArticle

Detecting Anatomical Leg Length Discrepancy Using the Plug-in-Gait Model

by Sam Khamis, Barry Danino, Shmuel Springer, Dror Ovadia and Eli Carmeli

Appl. Sci. 2017, 7(9), 926; https://doi.org/10.3390/app7090926 - 8 Sep 2017

Cited by 6 | Viewed by 7913

Abstract

Leg length discrepancy (LLD) is a significant factor influencing several pathological conditions. Gait analysis is based on biomechanical gait models calculating joint kinematics; however, no previous study has validated its ability to detect anatomical LLD. The aim of the present study was to compare the validity of the Vicon^® Plug-in-Gait-model (PGM) in measuring femur and tibia segmental length discrepancy with measurements attained by X-ray. Fifteen participants with suspected leg length discrepancies underwent a lower limb X-ray and a standing calibration trial using a motion analysis system (Vicon^®, Oxford Metrics, UK). Femur and tibia segment lengths were deducted from both measurements. No differences were found when measuring the discrepancies between sides for the femur (p = 0.3) and tibia (p = 0.45) segmental length. A high correlation was found between methods (r = 0.808–0.962, p < 0.001), however, a significant difference was observed when measuring the femur and tibia length (p < 0.0001). PGM was found to be a valid model in detecting segmental length discrepancy when based on the location of the joint centers compared to X-ray. A variance was noted in the femur and tibial segmental length. The impact of this inconsistency in segmental length on kinematics and kinetics should be further evaluated. Full article

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