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Edward Taub - One of the best experts on this subject based on the ideXlab platform.
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Relation of white matter hyperintensities and motor deficits in chronic stroke.
Restorative neurology and neuroscience, 2018Co-Authors: Jarrod M Hicks, Edward Taub, Brent Womble, Ameen Barghi, Tyler Rickards, Victor W. Mark, Gitendra UswatteAbstract:Background Infarct size and location account for only a relatively small portion of post-stroke motor impairment, suggesting that other less obvious factors may be involved. Objective Examine the relationship between white matter hyperintensity (WMH) load among other factors and upper extremity motor deficit in patients with mild to moderate chronic stroke. Methods The magnetic resonance images of 28 patients were studied. WMH load was assessed as total WMH volume and WMH overlap with the corticospinal tract in the centrum semiovale. Hemiparetic arm function was measured using the Motor Activity Log (MAL) and Wolf Motor Function Test (WMFT). Results Hierarchical multiple regression models found WMH volume predicted motor deficits in both real-world arm use (MAL;ΔR2 = 0.12, F(1, 22) = 4.73, p = 0.04) and in arm motor capacity as measured by a laboratory motor function test (WMFT;ΔR2 = 0.18, F(1, 22) = 6.32, p = 0.02) over and above age and lesion characteristics. However, these models accounted for less than half of the variance in post-stroke motor deficits. Conclusion The results suggest that WMH may be an important factor to consider in stroke-related upper extremity motor impairment. Nonetheless, the basis of the largest part of the post-stroke motor deficit remains unaccounted for by structural CNS factors. This component may be behavioral or Learned, involving Learned Nonuse.
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Revised Constraint-Induced Aphasia Therapy (CIAT II): Neuroscience Foundations Traced from Basic Laboratory Research to Increased Spontaneous Real-World Speech and Cerebral Cortical Structure (P4.217)
Neurology, 2017Co-Authors: Victor Mark, Edward TaubAbstract:Objective: Trace the course of Constraint-Induced (CI) therapies from basic neuroscience research origins to the current, revised Constraint-Induced Aphasia therapy (CIAT II) effects on spontaneous real-world speech improvement and CNS structural neuroplasticity in post-stroke aphasia. Background: Basic neuroscience research with primates suggested that chronic experimental hemiparesis could be maintained by “Learned Nonuse,” which results from the development of compensatory modes for everyday living activities but which then impedes recovering usage of the more-impaired body part. CI therapies were shown to counter-condition this inhibited use of the more affected part of the body by behavior analysis training methods. The initial trials improved hemiparesis in diverse neurological disorders. The treatment was subsequently adapted for inhibited spontaneous speech in aphasia (CIAT I), and it has recently been substantially modified (CIAT II). We describe pilot results of CIAT II, including structural brain MRI. Design/Methods: Post-stroke aphasic patients with chronically suppressed spontaneous speech ( n =6) underwent 3 weeks of CIAT II, 3.5 hours/day. Outcomes included changes in amount and quality of speech as recorded by the structured Verbal Activity Log (VAL), an instrument validated against an objective quantification of home-based speech by audio recorders. 4 patients also underwent structural brain MRI and subsequent voxel-based morphometry (VBM) of cortical changes. Results: Patients improved immediately after CIAT II on the VAL ( d′ =2.1); at 6 months there was no decrement in retention. In contrast, earlier CIAT I had produced only 10% of the gains from CIAT II. VBM in CIAT II demonstrated increased grey matter in bihemispheric frontotemporal cortices, that was short of significance ( p >0.05) for this pilot sample but in accordance with prediction. Conclusions: CIAT II has promise for promoting enduring increased spontaneous real-world speech as well as brain structure for chronic aphasia, convergent with earlier forms of CI therapies for movement. Further trials are warranted. Study Supported by: NIH grant HD0 53750. Disclosure: Dr. Mark has nothing to disclose. Dr. Taub has nothing to disclose.
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Constraint-Induced Movement Therapy for Restoration of Upper-Limb Function: Introduction
International Handbook of Occupational Therapy Interventions, 2014Co-Authors: Mary H. Bowman, Victor W. Mark, Edward TaubAbstract:Constraint-induced movement therapy (CIMT) is a research-originated, behavioral approach to neurorehabilitation of limb function after neurologic damage. The intervention utilizes a combination of motor training elements and psychological concepts to facilitate increased use of the affected limb as well as improved movement quality and control. Importantly, CIMT is designed to achieve real-world improvements by behavioral methods, which facilitate the incorporation of regained abilities into the person’s spontaneous behavior. CIMT is composed of four primary elements: (1) repetitive, unilateral training procedures; (2) training by the behavioral technique termed shaping; (3) a set of behavioral techniques, termed the “transfer package,” that promote transfer of therapeutic gains to the life situation; and (4) constraining use of the more-affected hand by one of several techniques including restraint of the less-affected hand, discouragement for exclusive reliance on the less-affected hand for unimanual and bimanual tasks, and purposeful design of the CIMT treatment activities to encourage use of the more-affected hand. Evidence shows that CIMT improves the functional use and occupational performance of the more-affected upper extremity by reversing Learned Nonuse and facilitating use-dependent brain plasticity.
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Implications of CI therapy for visual deficit training
Frontiers in integrative neuroscience, 2014Co-Authors: Edward Taub, Victor W. Mark, Gitendra UswatteAbstract:We address here the question of whether the techniques of CI therapy, a family of treatments that has been employed in the rehabilitation of movement and language after brain damage might apply to the rehabilitation of such visual deficits as unilateral spatial neglect and visual field deficits. CI therapy has been used successfully for the upper and lower extremities after chronic stroke, cerebral palsy (CP), multiple sclerosis (MS), other CNS degenerative conditions, resection of motor areas of the brain, focal hand dystonia, and aphasia. Treatments making use of similar methods have proven efficacious for amblyopia. The CI therapy approach consists of four major components: intensive training, training by shaping, a “transfer package” to facilitate the transfer of gains from the treatment setting to everyday activities, and strong discouragement of compensatory strategies. CI therapy is said to be effective because it overcomes Learned Nonuse, a Learned inhibition of movement that follows injury to the CNS. In addition, CI therapy produces substantial increases in the grey matter of motor areas on both sides of the brain. We propose here that these mechanisms are examples of more general processes: Learned Nonuse being considered parallel to sensory Nonuse following damage to sensory areas of the brain, with both having in common diminished neural connections (DNC) in the nervous system as an underlying mechanism. CI therapy would achieve its therapeutic effect by strengthening the diminished neural connections. Use-dependent cortical reorganization is considered to be an example of the more general neuroplastic mechanism of brain structure repurposing (BSR). If the mechanisms involved in these broader categories are involved in each of the deficits being considered, then it may be the principles underlying efficacious treatment in each case may be similar. The lessons Learned during CI therapy research might then prove useful for the treatment of visual deficits
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doi: 10.3389/fnint.2014.00078 Implications of CI therapy for visual deficit training
2014Co-Authors: Gitendra Uswatte, Victor W. Mark, Olivier Coubard A. Cns-fed, Edward TaubAbstract:Weaddress here the question ofwhether the techniques of Constraint Induced (CI) therapy, a family of treatments that has been employed in the rehabilitation of movement and language after brain damage might apply to the rehabilitation of such visual deficits as unilateral spatial neglect and visual field deficits. CI therapy has been used successfully for the upper and lower extremities after chronic stroke, cerebral palsy (CP), multiple sclerosis (MS), other central nervous system (CNS) degenerative conditions, resection of motor areas of the brain, focal hand dystonia, and aphasia. Treatments making use of similar methods have proven efficacious for amblyopia. The CI therapy approach consists of four major components: intensive training, training by shaping, a “transfer package ” to facilitate the transfer of gains from the treatment setting to everyday activities, and strong discouragement of compensatory strategies. CI therapy is said to be effective because it overcomes Learned Nonuse, a Learned inhibition of movement that follows injury to the CNS. In addition, CI therapy produces substantial increases in the gray matter of motor areas on both sides of the brain. We propose here that these mechanisms are examples of more general processes: Learned Nonuse being considered parallel to sensory nonus
Y. Matsuoka - One of the best experts on this subject based on the ideXlab platform.
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The Robotics Institute,
2011Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. Matsuoka, Department Of PsychologyAbstract:Abstract—We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion
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Visual feedback distortion in a robotic environment for hand rehabilitation
Brain research bulletin, 2008Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:Robotic therapy offers a means of enhancing rehabilitation for individuals with chronic stroke or traumatic brain injury. The present research targets members of this population who demonstrate Learned Nonuse, a tendency to use affected limbs below the level of the individual’s true capability. These individuals may not strive for difficult goals in therapy, which ultimately hampers their progress and the outcome of rehabilitation. Our research uses a paradigm called visual feedback distortion in which the visual feedback corresponding to force or distance is gradually changed by an imperceptible amount to encourage improved performance. Our first set of experiments was designed to assess the limits of imperceptible distortion for visual feedback concerning the force exerted or the distance moved by the index finger. A second set of experiments used these limits to gradually distort visual feedback in order to manipulate a subject’s force or distance response. Based on this work, we designed a paradigm applying visual feedback distortion to the rehabilitation of individuals with chronic stroke and traumatic brain injury. Initial tests are reported for two subjects who participated in a six-week rehabilitation protocol. Each patient followed visual feedback distortion to levels of performance above that predicted by her performance during an initial assessment. Both patients showed functional improvements after participating in the study. Visual feedback distortion may provide a way to help a patient move beyond his or her self-assessed “best” performance, improving the outcome
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Feedback Distortion to Increase Strength and Mobility
2003Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:A method for using visual distortion to overcome Learned Nonuse in stroke victims is described, and results from a preliminary experiment on unimpaired subjects are presented. A visual display was used to present increasingly distorted feedback about the force exerted by a subject. Visual distortion encouraged unimpaired subjects to increase their force production by more than 30%. In addition, the effects of different amounts of distortion on force production were analyzed; visual feedback distortions of up to 28.8% linearly increased the force exerted by subjects.
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Feedback distortion to overcome Learned Nonuse: a system overview
Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439), 1Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion.
Gitendra Uswatte - One of the best experts on this subject based on the ideXlab platform.
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Relation of white matter hyperintensities and motor deficits in chronic stroke.
Restorative neurology and neuroscience, 2018Co-Authors: Jarrod M Hicks, Edward Taub, Brent Womble, Ameen Barghi, Tyler Rickards, Victor W. Mark, Gitendra UswatteAbstract:Background Infarct size and location account for only a relatively small portion of post-stroke motor impairment, suggesting that other less obvious factors may be involved. Objective Examine the relationship between white matter hyperintensity (WMH) load among other factors and upper extremity motor deficit in patients with mild to moderate chronic stroke. Methods The magnetic resonance images of 28 patients were studied. WMH load was assessed as total WMH volume and WMH overlap with the corticospinal tract in the centrum semiovale. Hemiparetic arm function was measured using the Motor Activity Log (MAL) and Wolf Motor Function Test (WMFT). Results Hierarchical multiple regression models found WMH volume predicted motor deficits in both real-world arm use (MAL;ΔR2 = 0.12, F(1, 22) = 4.73, p = 0.04) and in arm motor capacity as measured by a laboratory motor function test (WMFT;ΔR2 = 0.18, F(1, 22) = 6.32, p = 0.02) over and above age and lesion characteristics. However, these models accounted for less than half of the variance in post-stroke motor deficits. Conclusion The results suggest that WMH may be an important factor to consider in stroke-related upper extremity motor impairment. Nonetheless, the basis of the largest part of the post-stroke motor deficit remains unaccounted for by structural CNS factors. This component may be behavioral or Learned, involving Learned Nonuse.
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Implications of CI therapy for visual deficit training
Frontiers in integrative neuroscience, 2014Co-Authors: Edward Taub, Victor W. Mark, Gitendra UswatteAbstract:We address here the question of whether the techniques of CI therapy, a family of treatments that has been employed in the rehabilitation of movement and language after brain damage might apply to the rehabilitation of such visual deficits as unilateral spatial neglect and visual field deficits. CI therapy has been used successfully for the upper and lower extremities after chronic stroke, cerebral palsy (CP), multiple sclerosis (MS), other CNS degenerative conditions, resection of motor areas of the brain, focal hand dystonia, and aphasia. Treatments making use of similar methods have proven efficacious for amblyopia. The CI therapy approach consists of four major components: intensive training, training by shaping, a “transfer package” to facilitate the transfer of gains from the treatment setting to everyday activities, and strong discouragement of compensatory strategies. CI therapy is said to be effective because it overcomes Learned Nonuse, a Learned inhibition of movement that follows injury to the CNS. In addition, CI therapy produces substantial increases in the grey matter of motor areas on both sides of the brain. We propose here that these mechanisms are examples of more general processes: Learned Nonuse being considered parallel to sensory Nonuse following damage to sensory areas of the brain, with both having in common diminished neural connections (DNC) in the nervous system as an underlying mechanism. CI therapy would achieve its therapeutic effect by strengthening the diminished neural connections. Use-dependent cortical reorganization is considered to be an example of the more general neuroplastic mechanism of brain structure repurposing (BSR). If the mechanisms involved in these broader categories are involved in each of the deficits being considered, then it may be the principles underlying efficacious treatment in each case may be similar. The lessons Learned during CI therapy research might then prove useful for the treatment of visual deficits
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doi: 10.3389/fnint.2014.00078 Implications of CI therapy for visual deficit training
2014Co-Authors: Gitendra Uswatte, Victor W. Mark, Olivier Coubard A. Cns-fed, Edward TaubAbstract:Weaddress here the question ofwhether the techniques of Constraint Induced (CI) therapy, a family of treatments that has been employed in the rehabilitation of movement and language after brain damage might apply to the rehabilitation of such visual deficits as unilateral spatial neglect and visual field deficits. CI therapy has been used successfully for the upper and lower extremities after chronic stroke, cerebral palsy (CP), multiple sclerosis (MS), other central nervous system (CNS) degenerative conditions, resection of motor areas of the brain, focal hand dystonia, and aphasia. Treatments making use of similar methods have proven efficacious for amblyopia. The CI therapy approach consists of four major components: intensive training, training by shaping, a “transfer package ” to facilitate the transfer of gains from the treatment setting to everyday activities, and strong discouragement of compensatory strategies. CI therapy is said to be effective because it overcomes Learned Nonuse, a Learned inhibition of movement that follows injury to the CNS. In addition, CI therapy produces substantial increases in the gray matter of motor areas on both sides of the brain. We propose here that these mechanisms are examples of more general processes: Learned Nonuse being considered parallel to sensory nonus
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The Pediatric Motor Activity Log-Revised: Assessing Real-world Arm Use in Children with Cerebral Palsy
Rehabilitation psychology, 2012Co-Authors: Gitendra Uswatte, Edward Taub, Angi Griffin, Laura K. Vogtle, Jan Rowe, Joydip BarmanAbstract:Approximately one-third of children with cerebral palsy (CP) exhibit motor deficits in their more-affected arm (Hagberg, Hagberg, Beckung, & Uvebrant, 2001). Although measures of upper-extremity function in the laboratory or clinic have been available (Gilmore, Sakzewski, & Boyd, 2010), no instruments existed until recently that assess how much such children actually use their more-affected arm in daily life. To address this gap, Taub and co-workers modified a structured interview developed for measuring real-world more-affected arm activity in adults after stroke (Taub, Ramey, DeLuca, & Echols, 2004). In the adult version, termed the Motor Activity Log (MAL), patients rate how they use their more-affected arm for 30 upper-extremity activities in daily life over a specified period (e.g., the past week; Taub et al., 1993; Uswatte & Taub, 2005; Uswatte, E. Taub, D. Morris, K. Light, & P. Thompson, 2006; Uswatte, Taub, Morris, Vignolo, & McCulloch, 2005). In the version for young children, the Pediatric Motor Activity Log (PMAL), primary family caregivers report on their child with upper-extremity hemiparesis (Taub, Ramey, DeLuca, & Echols, 2004). In adult neurorehabilitation, four developments have contributed to the generation of methods for assessing activity of an impaired upper extremity in daily life (Uswatte & Taub, 2005). First, randomized controlled trials (RCTs) supporting the efficacy of Constraint-Induced Movement therapy (CIMT; Taub et al., 1993; Taub et al., 2006; Wolf et al., 2006) for rehabilitating real-world arm use after stroke (reviewed in Langhorne, Coupar, & Pollack, 2009), along with evidence of substantial brain plasticity after this treatment (reviewed in Taub & Uswatte, 2009) have led to a greater emphasis on ameliorating more-affected arm use, as opposed to teaching compensatory strategies (Morris & Taub, 2001; Uswatte, Taub, Morris, Vignolo, & McCulloch, 2005). Second, there has been growing acceptance of the Learned Nonuse formulation (Taub, 1977, 1980; Taub, Uswatte, Mark, & Morris, 2006), which predicts that after neurological injury the degree of motor recovery measured by laboratory performance tests will frequently overestimate how much an impaired extremity is actually used in daily life. Third, the World Health Organization model of disability has promoted measuring impairment and activity separately (World Health Organization, 2001). Fourth, the rigor with which outcomes are measured has received increasing attention in the rehabilitation sciences (Callahan & Barisa, 2005). Similar considerations in pediatric neurorehabilitation have inspired a parallel interest in measuring more-affected arm activity in children with upper-extremity hemiparesis. In 2009, Wallen, Bundy, Pont, and Ziviani examined the psychometric characteristics of the original version of the PMAL (Taub, Ramey, DeLuca, & Echols, 2004) for measuring this parameter in children with CP between 6 months and 8 years (Wallen, Bundy, Pont, & Ziviani, 2009) when the PMAL was administered as a paper-and-pencil parent report. Wallen and coworkers conducted a Rasch analysis that found the rating scale structure of the PMAL was disordered. Hence, they collapsed the number of PMAL rating scale steps from the original six to three. After re-scoring the PMAL using the 3-step scale, Wallen and coworkers found that, as predicted, children with low levels of manual ability in daily life, as measured by the Manual Abilities Classification System (MACS; Eliasson et al., 2006), had lower PMAL scores than children with high levels. This paper examines the test-retest reliability, convergent validity, and other psychometric characteristics of a revised version of the PMAL in young children with upper-extremity hemiparesis due to CP. The method here departs from the Wallen et al. study by (a) administering the PMAL-R as a structured interview, as originally designed, rather than a correspondent report; (b) scoring the PMAL-R using both the original 6-step and modified 3-step scales; and (c) validating the PMAL-R against an index of everyday activity specific to the more-affected arm rather than a categorization system whose scoring scheme does not take into account which arm is employed, i.e., the MACS.
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Handbook of Neuroscience for the Behavioral Sciences - Constraint‐Induced Movement Therapy: A Paradigm for Translating Advances in Behavioral Neuroscience into Rehabilitation Treatments
Handbook of Neuroscience for the Behavioral Sciences, 2009Co-Authors: Edward Taub, Gitendra UswatteAbstract:1 Behavioral Plasticity After Somatosensory Deafferentation in Monkeys 2 A Linked, but Independent, Mechanism: Use-Dependent Plastic Brain Reorganization 3 Application of the Learned Nonuse Model to Humans After Stroke 4 Application of CI Therapy to the Treatment of Other Neurological and Orthopedic Disorders 5 An Impending Paradigm Shift Keywords: neuroplasticity; neurorehabilitation; CI therapy; Constraint-Induced Movement therapy; movement; stroke; traumatic brain injury; cerebral palsy; multiple sclerosis; intensive training; shaping; transfer package; treatment; translational research
B.r. Brewer - One of the best experts on this subject based on the ideXlab platform.
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The Robotics Institute,
2011Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. Matsuoka, Department Of PsychologyAbstract:Abstract—We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion
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Visual feedback distortion in a robotic environment for hand rehabilitation
Brain research bulletin, 2008Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:Robotic therapy offers a means of enhancing rehabilitation for individuals with chronic stroke or traumatic brain injury. The present research targets members of this population who demonstrate Learned Nonuse, a tendency to use affected limbs below the level of the individual’s true capability. These individuals may not strive for difficult goals in therapy, which ultimately hampers their progress and the outcome of rehabilitation. Our research uses a paradigm called visual feedback distortion in which the visual feedback corresponding to force or distance is gradually changed by an imperceptible amount to encourage improved performance. Our first set of experiments was designed to assess the limits of imperceptible distortion for visual feedback concerning the force exerted or the distance moved by the index finger. A second set of experiments used these limits to gradually distort visual feedback in order to manipulate a subject’s force or distance response. Based on this work, we designed a paradigm applying visual feedback distortion to the rehabilitation of individuals with chronic stroke and traumatic brain injury. Initial tests are reported for two subjects who participated in a six-week rehabilitation protocol. Each patient followed visual feedback distortion to levels of performance above that predicted by her performance during an initial assessment. Both patients showed functional improvements after participating in the study. Visual feedback distortion may provide a way to help a patient move beyond his or her self-assessed “best” performance, improving the outcome
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Feedback Distortion to Increase Strength and Mobility
2003Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:A method for using visual distortion to overcome Learned Nonuse in stroke victims is described, and results from a preliminary experiment on unimpaired subjects are presented. A visual display was used to present increasingly distorted feedback about the force exerted by a subject. Visual distortion encouraged unimpaired subjects to increase their force production by more than 30%. In addition, the effects of different amounts of distortion on force production were analyzed; visual feedback distortions of up to 28.8% linearly increased the force exerted by subjects.
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Feedback distortion to overcome Learned Nonuse: a system overview
Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439), 1Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion.
Roberta L. Klatzky - One of the best experts on this subject based on the ideXlab platform.
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The Robotics Institute,
2011Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. Matsuoka, Department Of PsychologyAbstract:Abstract—We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion
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Visual feedback distortion in a robotic environment for hand rehabilitation
Brain research bulletin, 2008Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:Robotic therapy offers a means of enhancing rehabilitation for individuals with chronic stroke or traumatic brain injury. The present research targets members of this population who demonstrate Learned Nonuse, a tendency to use affected limbs below the level of the individual’s true capability. These individuals may not strive for difficult goals in therapy, which ultimately hampers their progress and the outcome of rehabilitation. Our research uses a paradigm called visual feedback distortion in which the visual feedback corresponding to force or distance is gradually changed by an imperceptible amount to encourage improved performance. Our first set of experiments was designed to assess the limits of imperceptible distortion for visual feedback concerning the force exerted or the distance moved by the index finger. A second set of experiments used these limits to gradually distort visual feedback in order to manipulate a subject’s force or distance response. Based on this work, we designed a paradigm applying visual feedback distortion to the rehabilitation of individuals with chronic stroke and traumatic brain injury. Initial tests are reported for two subjects who participated in a six-week rehabilitation protocol. Each patient followed visual feedback distortion to levels of performance above that predicted by her performance during an initial assessment. Both patients showed functional improvements after participating in the study. Visual feedback distortion may provide a way to help a patient move beyond his or her self-assessed “best” performance, improving the outcome
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Feedback Distortion to Increase Strength and Mobility
2003Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:A method for using visual distortion to overcome Learned Nonuse in stroke victims is described, and results from a preliminary experiment on unimpaired subjects are presented. A visual display was used to present increasingly distorted feedback about the force exerted by a subject. Visual distortion encouraged unimpaired subjects to increase their force production by more than 30%. In addition, the effects of different amounts of distortion on force production were analyzed; visual feedback distortions of up to 28.8% linearly increased the force exerted by subjects.
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Feedback distortion to overcome Learned Nonuse: a system overview
Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439), 1Co-Authors: B.r. Brewer, Roberta L. Klatzky, Y. MatsuokaAbstract:We constructed a virtual environment that is designed to use visual feedback distortion to address Learned Nonuse in stroke patients. The system is intended to rehabilitate finger movements, and it includes haptic and visual displays. The virtual environment includes custom-made hardware and software that allow the force feedback to adapt to different individuals and to movement changes over time for a single individual. Using this environment, we conducted a preliminary experiment with unimpaired subjects to show that it is possible to extend the range and strength of movements without subjects recognizing the visual feedback distortion.