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"Weiss, Mindy"
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Emergence of Virtual Reality as a Tool for Upper Limb Rehabilitation: Incorporation of Motor Control and Motor Learning Principles
The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality–based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback–based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.
Journal Article
ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.
Clinical Trial Registration: URL:
http://www.clinicaltrials.gov
. Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
Journal Article
Isotope evidence for agricultural extensification reveals how the world's first cities were fed
This study sheds light on the agricultural economy that underpinned the emergence of the first urban centres in northern Mesopotamia. Using δ
13
C and δ
15
N values of crop remains from the sites of Tell Sabi Abyad, Tell Zeidan, Hamoukar, Tell Brak and Tell Leilan (6500–2000 cal
bc
), we reveal that labour-intensive practices such as manuring/middening and water management formed an integral part of the agricultural strategy from the seventh millennium
bc
. Increased agricultural production to support growing urban populations was achieved by cultivation of larger areas of land, entailing lower manure/midden inputs per unit area—extensification. Our findings paint a nuanced picture of the role of agricultural production in new forms of political centralization. The shift towards lower-input farming most plausibly developed gradually at a household level, but the increased importance of land-based wealth constituted a key potential source of political power, providing the possibility for greater bureaucratic control and contributing to the wider societal changes that accompanied urbanization.
Carbon and nitrogen isotope measurements of crop remains from archaeological sites in northern Mesopotamia show labour-intensive practices such as manuring and water management forming an integral part of agriculture since the seventh millennium
bc
.
Journal Article
