Feedback-based training of grip force control in patients with brain damage

doi:10.1016/S0003-9993(95)80635-0

Archives of Physical Medicine and Rehabilitation

Volume 76, Issue 7, July 1995, Pages 653-659

https://doi.org/10.1016/S0003-9993(95)80635-0 Get rights and content

Abstract

Objective: Feedback-based training of grip force control in patients with various brain lesions was evaluated. Design: Patients were instructed to hold a force transducer in a precision grip and to track with their grip force a moving target, which was presented together with the feedback signal on a monitor. Training performance was evaluated during a maximum of 10 sessions. Before and after the training, performance in two transfer tasks, which differed in target characteristics from the training task, was examined. Patients: Ten patients with impaired grip force control, after brain lesions of different origin, were selected on the basis of a clinical examination of hand function. Main Outcome Measures: Tracking accuracy in training tasks and transfer tasks was evaluated by calculating the conventional root-mean-square error. Results: Nine out of the 10 patients reduced their tracking error considerably during a maximum of 10 subsequent sessions (t test, p < 0.05), and most of them reached normal or near-normal performance. In addition, they improved in both transfer tasks (t test, p < 0.05). Detailed analysis showed that impaired initial performance and improvement was not uniform among patients and could be attributed to individual aspects of force control. Conclusions: In view of these results, a feedback-based training of grip force may be a useful enrichment of motor therapy.

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Citation Excerpt :
The tracking requires the continuous adjustment of motor actions to visual information, thereby enabling an objective study of visuomotor performance. Tracking tasks are also suitable for the exploration of generalization and transfer effects and have successfully been used in research dealing with the diagnostics and treatment of fine motor disorders, in particular precision grip force impairments (Allgöwer and Hermsdörfer, 2017; Bleton et al., 2014; Kriz et al., 1995; Kurillo et al., 2005; Lindberg et al., 2012). The ability to perform fast force changes reflects a basic motor requirement for the quick adjustment of finger forces during manipulation of objects and has been shown to be a highly sensitive indicator of nervous system disorders (Avarello et al., 1988; Blank and Hermsdörfer, 2009; Hermsdörfer et al., 2003; Prigatano and Wong, 1997).
Writer’s cramp (WC) is a task-specific focal dystonia. WC is characterized by involuntary contractions of muscles of the hand and arm during handwriting, resulting in impaired writing with exaggerated finger forces. The generalization of symptoms to other fine motor tasks is widely discussed. The aim of the study was to determine affected fine motor aspects with an extensive testing battery.
Twelve people with WC and twelve healthy controls were examined. Performance in the Jebsen-Taylor Hand Function Test, Nine-Hole-Peg Test and 2-point discrimination was evaluated. To analyze object manipulation skills, we examined grip forces, temporal measures and other aspects of force control during (1) lifting actions with variations of weight and surface (2) cyclic movements (3) visuomotor tracking (4) fast force changes and (5) grip strength. In addition, correlation between the dependent variables of the fine motor tasks and the handwriting deficits was assessed.
WC patients had impaired performance in the visuomotor tracking task (root mean square error (RMSE), p = 0.03 and time lag, p = 0.05) and the fast force changes (frequency, p = 0.01). There were no statistically significant group differences in the other tasks. We found a correlation between the RMSE of the tracking task and the time needed to write the test sentence (r = 0.643, p = 0.01).
WC patients revealed abnormalities in complex fine motor performance in tasks with high demands on coordination and visual components, specifically in tracking and fast force changes.
This suggests a deficit in visuomotor integration, coordination and cognitive aspects related to movement processing particularly with respect to low forces. These insights may prove useful in the development of targeted training approaches.
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Target force level and actual grip force moved from the left to the right on the screen. The primary motor outcome variables for the force tracking task were time within range (TWR) as the time the participant’s force trace was within a range of five percent above and below the target line as accuracy measure (Kriz et al., 1995) and the relative root mean square error (rRMSE) as a measure of the overall variability of the force tracking performance (cf. (Frankemolle et al., 2010)). Force data were assessed starting from the first time point where the actually produced force met the target force.
Learning new motor skills is important for everyday life and independent living in older age. While studies on motor sequence learning and motor adaptation revealed age differences that are mostly related to frontal decline with increasing age, data for fine finger force modulation are missing.
Twelve young (YA, 18–28 years) and twelve middle-aged older (OA, 55–65 years) adults practiced a force modulation task in precision grip while lying in a 3T MR scanner. Participants followed a sine wave between 5 and 25% of their maximum voluntary contraction (MVC) at a frequency of 0.3 Hz. Ten trials of 30 s were performed to examine learning curves and related changes in Blood Oxygen Level Dependent (BOLD) responses were assessed with functional magnetic resonance imaging (fMRI).
Training slopes were similar for YA and OA, with only a trend for differences in performance level. Both age groups revealed decreasing activations with practice in frontal and parietal regions as well as in the cerebellum. Particularly, the hippocampus was activated in initial trials, but activity immediately decreased with practice. Increase in activation during practice was found only for YA in occipital cortex, cingulate cortex, and thalamus. After practice, OA revealed a pattern similar to the one that YA showed before practice. Described differences between YA and OA in neural activation related to motor practice may indicate compensational mechanisms in OA to enable similar learning slopes as in YA.
Fine motor skills predict performance in the Jebsen Taylor Hand Function Test after stroke
2017, Clinical Neurophysiology
Citation Excerpt :
Visuomotor tracking tasks are suitable for the exploration of generalization and transfer effects. They have successfully been used in research dealing with the diagnostics and treatment of fine motor disorders, in particular precision grip force impairments (Carey et al., 2007; Kriz et al., 1995; Kurillo et al., 2005; Lindberg et al., 2012; Naik et al., 2011). All the individual tasks provide isolated parameters of fine motor performance.
To determine factors characterizing the differences in fine motor performance between stroke patients and controls. To confirm the relevance of the factors by analyzing their predictive power with regard to the Jebsen Taylor Hand Function Test (JTHFT), a common clinical test of fine motor control.
Twenty-two people with slight paresis in an early chronic phase following stroke and twenty-two healthy controls were examined. Performance on the JTHFT, Nine-Hole Peg Test and 2-point discrimination was evaluated. To analyze object manipulation skills, grip forces and temporal measures were examined during (1) lifting actions with variations of weight and surface (2) cyclic movements (3) predictive/reactive catching tasks. Three other aspects of force control included (4) visuomotor tracking (5) fast force changes and (6) grip strength.
Based on 9 parameters which significantly distinguished fine motor performance in the two groups, we identified three principal components (factors): grip force scaling, motor coordination and speed of movement. The three factors are shown to predict JTHFT scores via linear regression (R² = 0.687, p < 0.001).
We revealed a factor structure behind fine motor impairments following stroke and showed that it explains JTHFT results to a large extend.
This result can serve as a basis for improving diagnostics and enabling more targeted therapy.
The Role of Posturography in Assessing the Process of Rehabilitation in Poststroke Patients—A Case Study
2017, Journal of Stroke and Cerebrovascular Diseases
Stroke is one of the most common causes of death and disability both in Poland and around the world. Each year, 250 out of 100,000 people in Europe are diagnosed with a disruption of cerebral perfusion in the form of stroke. In Poland, approximately 65,000-70,000 people are affected each year, with the incidence steadily increasing. Stroke survivors suffer from impaired cognitive and motor functions. Moreover, they exhibit severe gait pattern abnormalities, which together with balance disorders, constitute the main factors increasing the risk of falls in this patient group. Therefore, postural stability and gait assessments in these patients should be an important part of every examination instead of being conducted only for the purposes of physical rehabilitation. Currently, the most common method of postural stability assessment both in the healthy and those affected with a disorder is posturography. The aim of the study was to evaluate selected posturographic parameters in poststroke patients before and after rehabilitation treatment.
Fluctuation amplitude and local synchronization of brain activity in the ultra-low frequency band: An fMRI investigation of continuous feedback of finger force
2015, Brain Research
Functional magnetic resonance imaging (fMRI) studies of motor feedback have suggested that brain activity in the ultra-low frequency band (0–0.01 Hz) may be physiologically significant for various feedback conditions, i.e., real and sham feedback. However, the functional role of the ultra-low frequency band of brain activity during the feedback procedure remains unclear. Here, we carried out an fMRI study of continuous feedback (8 min) of finger force and assessed two important properties of brain activity: the fluctuation amplitude and local synchronization in the ultra-low frequency band. Two intriguing results were obtained: (1) real feedback recruited a stronger fluctuation amplitude and local synchronization in the basal ganglia compared with sham feedback; however, no significant correlation was found between the two properties across subjects; and (2) the behavioral performance was significantly correlated with the fluctuation amplitude but was not correlated with local synchronization in the basal ganglia. These findings contribute to characterization of the functional role of brain activity in the ultra-low frequency band and further suggest that the fluctuation amplitude and local synchronization in the basal ganglia may contribute differently to motor feedback.
Functional connectivity among brain networks in continuous feedback of finger force
2015, Neuroscience
Motor feedback usually engages distinct sensory and cognitive processes based on different feedback conditions, e.g., the real and sham feedbacks. It was thought that these processes may rely on the functional connectivity among the brain networks. However, it remains unclear whether there is a difference in the network connectivity between the two feedback conditions. To address this issue, we carried out a functional magnetic resonance imaging (fMRI) study by employing a new paradigm, i.e., continuous feedback (8 min) of finger force. Using independent component analysis and functional connectivity analysis, we found that as compared with the sham feedback, the real feedback recruited stronger negative connectivity between the executive network (EN) and the posterior default mode network (pDMN). More intriguingly, the left frontal parietal network (lFPN) exhibits positive connectivity with the pDMN in the real feedback while in the sham feedback, the lFPN shows connectivity with the EN. These results suggest that the connectivity among EN, pDMN, lFPN could differ depending on the real and sham feedbacks, and the lFPN may balance the competition between the pDMN and EN, thus supporting the sensory and cognitive processes of the motor feedback.

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ArticleFeedback-based training of grip force control in patients with brain damage

Abstract

Neurosci Letters

J Neurosci Meth

J Neurosci Meth

Neuroscience

Roles of glabrous skin receptors and sensorimotor memory in automatic control of precision grip when lifting rougher or more slippery objects

Exper Brain Res

Somatosensory control of precision grip during unpredictable pulling loads I. Changes in load force amplitude

Exper Brain Res

Modulation of grip force with load force during point-to-point arm movements

Exper Brain Res

Manual tracking performance in patients with cerebellar incoordination: effects of mechanical loading

J Can Sci Neurol

Article
Feedback-based training of grip force control in patients with brain damage