Search Results (11)

Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen–Taylor Hand Function Test (JTHFT) (SMD = −0.62; 95% CI = (−1.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = −0.38; 95% CI = (−1;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = −0.42; 95% CI = (−0.78–0.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed. Full article

Arm and hand function play a critical role in the successful completion of everyday tasks. Lost function due to neurological impairment impacts millions of lives worldwide. Despite improvements in the ability to assess and rehabilitate arm deficits, knowledge about underlying sources of impairment and related sequela remains limited. The comprehensive assessment of function requires the measurement of both biomechanics and neuromuscular contributors to performance during the completion of tasks that often use multiple joints and span three-dimensional workspaces. To our knowledge, the complexity of movement and diversity of measures required are beyond the capabilities of existing assessment systems. To bridge current gaps in assessment capability, a new exoskeleton instrument is developed with comprehensive bilateral assessment in mind. The development of the BiLateral Upper-limb Exoskeleton for Simultaneous Assessment of Biomechanical and Neuromuscular Output (BLUE SABINO) expands on prior iterations toward full-arm assessment during reach-and-grasp tasks through the development of a dual-arm and dual-hand system, with 9 active degrees of freedom per arm and 12 degrees of freedom (six active, six passive) per hand. Joints are powered by electric motors driven by a real-time control system with input from force and force/torque sensors located at all attachment points between the user and exoskeleton. Biosignals from electromyography and electroencephalography can be simultaneously measured to provide insight into neurological performance during unimanual or bimanual tasks involving arm reach and grasp. Design trade-offs achieve near-human performance in exoskeleton speed and strength, with positional measurement at the wrist having an error of less than 2 mm and supporting a range of motion approximately equivalent to the 50th-percentile human. The system adjustability in seat height, shoulder width, arm length, and orthosis width accommodate subjects from approximately the 5th-percentile female to the 95th-percentile male. Integration between precision actuation, human–robot-interaction force-torque sensing, and biosignal acquisition systems successfully provide the simultaneous measurement of human movement and neurological function. The bilateral design enables use with left- or right-side impairments as well as intra-subject performance comparisons. With the resulting instrument, the authors plan to investigate underlying neural and physiological correlates of arm function, impairment, learning, and recovery. Full article

The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20–30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP. Full article

Long-term motor training can cause functional and structural changes in the human brain. Assessing how the training of specific movements affects specific parts of the neural circuitry is essential to understand better the underlying mechanisms of motor training-induced plasticity in the human brain. We report a single-case neuroimaging study that investigated functional and structural properties in a professional athlete of wheelchair racing. As wheelchair racing requires bilateral synchronization of upper limb movements, we hypothesized that functional and structural properties of interhemispheric interactions in the central motor system might differ between the professional athlete and controls. Functional and diffusion magnetic resonance imaging (fMRI and dMRI) data were obtained from a top Paralympian (P1) in wheelchair racing. With 23 years of wheelchair racing training starting at age eight, she holds an exceptional competitive record. Furthermore, fMRI and dMRI data were collected from three other paraplegic participants (P2-P4) with long-term wheelchair sports training other than wheelchair racing and 37 able-bodied control volunteers. Based on the fMRI data analyses, P1 showed activation in the bilateral precentral hand sections and greater functional connectivity between these sections during a right-hand unimanual task. In contrast, other paraplegic participants and controls showed activation in the contralateral hemisphere and deactivation in the ipsilateral hemisphere. Moreover, dMRI data analysis revealed that P1 exhibited significantly lower mean diffusivity along the transcallosal pathway connecting the bilateral precentral motor regions than control participants, which was not observed in the other paraplegic participants. These results suggest that long-term training with bilaterally synchronized upper-limb movements may promote bilateral recruitment of the precentral hand sections. Such recruitment may affect the structural circuitry involved in the interhemispheric interaction between the bilateral precentral regions. This study provides valuable evidence of the extreme adaptability of the human brain. Full article

Patients after stroke need to re-learn functional movements required for independent living throughout the rehabilitation process. In the study, we used a wearable sensory system for monitoring the movement of the upper limbs while performing activities of daily living. We implemented time-based and path-based segmentation of movement trajectories and muscle activity to quantify the activities of the unaffected and the affected upper limbs. While time-based segmentation splits the trajectory in quants of equal duration, path-based segmentation isolates completed movements. We analyzed the hand movement path and forearm muscle activity and introduced a bimanual movement parameter, which enables differentiation between unimanual and bimanual activities. The approach was validated in a study that included a healthy subject and seven patients after stroke with different levels of disabilities. Path-based segmentation provides a more detailed and comprehensive evaluation of upper limb activities, while time-based segmentation is more suitable for real-time assessment and providing feedback to patients. Bimanual movement parameter effectively differentiates between different levels of upper limb involvement and is a clear indicator of the activity of the affected limb relative to the unaffected limb. Full article

An asymmetry in the prevalence of left-handedness vs. right-handedness in society has supposedly resulted in negative frequency-dependent advantages for left-handers in interactive sports. The aim of this study was to test whether these advantages apply to handball by examining whether being left-handed is beneficial when executing 7 m shots, a highly unimanual movement. All 1,625 7 m shots at the men’s 2016–2022 European championships were analyzed using a Bayesian two-level analysis. While the results did not indicate that left-handers were more likely to score from any single 7 m shot, left-handers were overrepresented among the designated shooters compared to both the population as a whole (38% vs. 11.6%) and left-handers on any given handball team (38% vs. 25%). The implication here was that handedness plays no role in the outcome of 7 m shots at the world-class level, but handedness does appear to play a role in who becomes a world-class 7 m shooter. Full article

Both static and dynamic ambiguous stimuli representing human bodies that perform unimanual or unipedal movements are usually interpreted as right-limbed rather than left-limbed, suggesting that human observers attend to the right side of others more than the left one. Moreover, such a bias is stronger when static human silhouettes are presented in the RVF (right visual field) than in the LVF (left visual field), which might represent a particular instance of embodiment. On the other hand, hemispheric-specific rotational biases, combined with the well-known bias to perceive forward-facing figures, could represent a confounding factor when accounting for such findings. Therefore, we investigated whether the lateralized presentation of an ambiguous rotating human body would affect its perceived handedness/footedness (implying a role of motor representations), its perceived spinning direction (implying a role of visual representations), or both. To this aim, we required participants to indicate the perceived spinning direction (which also unveils the perceived handedness/footedness) of ambiguous stimuli depicting humans with an arm or a leg outstretched. Results indicated that the lateralized presentation of the stimuli affected both their perceived limb laterality (a larger number of figures being interpreted as right-limbed in the RVF than in the LVF) and their perceived spinning direction (a larger number of figures being interpreted as spinning clockwise in the LVF than in the RVF). However, the hemifield of presentation showed a larger effect size on the perceived spinning direction than on the perceived limb laterality. Therefore, as we already proposed, the implicit representation of others’ handedness seems to be affected more by visual than by motor processes during the perception of ambiguous human silhouettes. Full article

Children with hemiplegia have lower spontaneous use and quality of movement in the affected upper limb. The modified constraint-induced movement therapy (mCIMT) is applied to improve the affected upper limb function. The objective of this study was to study the efficacy of unaffected hand containment to obtain changes in the function of the affected upper limb after applying two unimanual therapies. A randomized controlled pilot study was performed with 16 children diagnosed with congenital infantile hemiplegia, with eight children randomized in each group (average age: 5.54 years; SD: 1.55). mCIMT and unimanual therapy without containment (UTWC) were applied, with a total of 50 h distributed in five weeks (two h/per day). Two assessments were performed (pre- and post-treatment) to evaluate the affected upper limb spontaneous use, measured with the Shiners Hospital Upper Extremity Evaluation (SHUEE), and the quality of movement, measured with the Quality of Upper Extremity Skills Test (QUEST scale). The progression of the variables was different in both groups. The results are expressed in the median of the improvement percent and interquartile range (IQR). The spontaneous use analysis showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the UTWC group. The quality of movement increased in the mCIMT and UTWC groups, 24.21 (IQR: 13.44, 50.39), 1.34 (IQR: 0.00, 4.75), respectively and the greatest increase was obtained in the grasp variable for both groups. The use of unaffected hand containment in mCIMT would produce improvements in the affected upper limb functionality in children with hemiplegia (4–8 years old) compared to the same protocol without containment (UTWC). Full article

Background and Objective. Many studies have suggested that each hand has a different special talent; however, there is a lack of data in the area of goal-directed bimanual hand coordination and its dependence on gender. The aim of this paper was to investigate gender-dependent bimanual speed-accuracy task performance.
Material and Methods. Twelve healthy young males and twelve healthy young females (all righthanded) performed protractile movements with both arms simultaneously by pushing joysticks toward two targets as quickly and accurately as possible.
Results. Though no significant difference was observed in the reaction time during a unimanual speed-accuracy task between the left and right hands as well as men and women, during a bimanual task, the reaction time of both the hands was significantly longer in women than men. There was no significant difference in the velocity of both the hands during a bimanual speed-accuracy task between men and women, while the accuracy of the left hand was significantly greater in men than women. There was no significant difference in intraindividual variability in the reaction time, maximal velocity, and path of movement between men and women as well as the left and right hands, but variability in the average velocity of the right hand both in women and men was significantly greater compared with their left hand.
Conclusions. Whereas people typically look at the target location for a reaching movement, it is possible that two objects are simultaneously fixated. Full article

Previous functional MRI and brain electrophysiology studies have studied the left-right differences during the tapping tasks and found that the activation of left hemisphere was more significant than that of right hemisphere. In this study, we wanted to delineate this lateralization phenomenon not only in the execution phase but also in other processing phases, such as early visual, pre-executive and post-executive phases. We have designed a finger-tapping task to delineate the left-right differences of event related potentials (ERPs) to right finger movement in sixteen right handed college students. The mean amplitudes of ERPs were analyzed to examine the left-right dominance of cortical activity in the phase of early visual process (75-120ms), pre-execution (175-260ms), execution (310-420ms) and post-execution (420-620ms). In the execution phase, ERPs at the left electrodes were significantly more pronounced than those at the right electrodes (F3 > F4, C3 > C4, P3 > P4, O1 > O2) under the situation without comparing the central electrodes (Fz, Cz, Pz, and Oz). No difference was found between left and right electrodes in other three phases except the C3 electrode still showed more dominant than C4 in the pre- and post-execution phase. In conclusion, the phenomenon of brain lateralization occur major in the execution phase. The central area also showed the lateralization in the pre- and post-execution to demonstrate its unique lateralized contributions to unilateral simple finger movements. Full article

Previous brain electrophysiological research has studied the interregionalconnectivity during the tapping task and found that inter-hemispheric alpha coherence wasmore significant under bimanual task conditions than that under unilateral conditions, butthe interregional connectivity situation in the unilateral tapping condition was not exploredclearly. We have designed a unilateral repetitive finger-tapping task to delineate the anteriorand posterior cortex contributions to unilateral finger movement. Sixteen right handedcollege students participated in this study. Event related potentials (ERPs) and the strengthof event related coherence (ERCoh) were analyzed to examine the antero-posterodominance of cortical activity in the phase of early visual process (75-120ms), pre-execution(175-260ms), execution (310-420ms) and post-execution (420-620ms). Results showed thatthe occipital (Oz, O1 and O2), frontal (Fz, F3, and F4), fronto-central (Fz, Cz, F3 and C3),and parietal regions were the most pronounced in the early visual, pre-execution, execution,and post-execution phases, respectively. Moreover, among four inter-hemispheric pairs onlythe Coh (C3 and C4) was significantly correlated to reaction time (RT) of tapping in theexecution phase. In conclusion, the aforementioned variability of electrophysiological data(ERPs and coherence) and the change of antero-postero regional dominance with timereflect the relative importance of different mechanisms in different phases. The mechanismsof visual processing, motor planning, motor execution and feedback reward wereoperational, respectively. Full article