Learning, Not Adaptation, Characterizes Stroke Motor Recovery: Evidence From Kinematic Changes Induced by Robot-Assisted Therapy in Trained and Untrained Task in the Same Workspace
Identifieur interne : 001A98 ( Pmc/Checkpoint ); précédent : 001A97; suivant : 001A99Learning, Not Adaptation, Characterizes Stroke Motor Recovery: Evidence From Kinematic Changes Induced by Robot-Assisted Therapy in Trained and Untrained Task in the Same Workspace
Auteurs : L. Dipietro ; H. I. Krebs ; B. T. Volpe ; J. Stein ; C. Bever ; S. T. Mernoff ; S. E. Fasoli ; N. HoganSource :
- IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society [ 1534-4320 ] ; 2011.
Abstract
Both the American Heart Association and the VA/DoD endorse upper-extremity robot-mediated rehabilitation therapy for stroke care. However, we do not know yet how to optimize therapy for a particular patient’s needs. Here, we explore whether we must train patients for each functional task that they must perform during their activities of daily living or alternatively capacitate patients to perform a class of tasks and have therapists assist them later in translating the observed gains into activities of daily living. The former implies that motor adaptation is a better model for motor recovery. The latter implies that motor learning (which allows for generalization) is a better model for motor recovery. We quantified trained and untrained movements performed by 158 recovering stroke patients via 13 metrics, including movement smoothness and submovements. Improvements were observed both in trained and untrained movements suggesting that generalization occurred. Our findings suggest that, as motor recovery progresses, an internal representation of the task is rebuilt by the brain in a process that better resembles motor learning than motor adaptation. Our findings highlight possible improvements for therapeutic algorithms design, suggesting sparse-activity-set training should suffice over exhaustive sets of task specific training.
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DOI: 10.1109/TNSRE.2011.2175008
PubMed: 22186963
PubMed Central: 4687974
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<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">101097023</journal-id><journal-id journal-id-type="pubmed-jr-id">22433</journal-id><journal-id journal-id-type="nlm-ta">IEEE Trans Neural Syst Rehabil Eng</journal-id><journal-id journal-id-type="iso-abbrev">IEEE Trans Neural Syst Rehabil Eng</journal-id><journal-title-group><journal-title>IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society</journal-title></journal-title-group><issn pub-type="ppub">1534-4320</issn><issn pub-type="epub">1558-0210</issn></journal-meta><article-meta><article-id pub-id-type="pmid">22186963</article-id><article-id pub-id-type="pmc">4687974</article-id><article-id pub-id-type="doi">10.1109/TNSRE.2011.2175008</article-id><article-id pub-id-type="manuscript">NIHMS744830</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Learning, Not Adaptation, Characterizes Stroke Motor Recovery: Evidence From Kinematic Changes Induced by Robot-Assisted Therapy in Trained and Untrained Task in the Same Workspace</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Dipietro</surname><given-names>L.</given-names></name><aff id="A1">Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA 02139 USA (<email>lauradp@mit.edu</email>)</aff></contrib><contrib contrib-type="author"><name><surname>Krebs</surname><given-names>H. I.</given-names></name><aff id="A2">Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA 02139 USA, and also with the Department of Neurology, University of Maryland, Baltimore, MD 21201 USA</aff></contrib><contrib contrib-type="author"><name><surname>Volpe</surname><given-names>B. T.</given-names></name><aff id="A3">Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030 USA</aff></contrib><contrib contrib-type="author"><name><surname>Stein</surname><given-names>J.</given-names></name><aff id="A4">Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032 USA, and with the Division of Rehabilitation Medicine, Weill Medical College, Cornell University, New York, NY 10065 USA, and also with the New York Presbyterian Hospital, New York, NY 10065 USA</aff></contrib><contrib contrib-type="author"><name><surname>Bever</surname><given-names>C.</given-names></name><aff id="A5">Department of Neurology, University of Maryland, Baltimore, MD 21201 USA, and also with the Baltimore Veterans Administration Medical Center, Baltimore, MD 21201 USA</aff></contrib><contrib contrib-type="author"><name><surname>Mernoff</surname><given-names>S. T.</given-names></name><aff id="A6">Providence Veterans Administration Medical Center, Providence, RI 02908 USA, and also with the Alpert Medical School, Brown University, Providence, RI 02912 USA</aff></contrib><contrib contrib-type="author"><name><surname>Fasoli</surname><given-names>S. E.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Hogan</surname><given-names>N.</given-names></name><aff id="A7">Mechanical Engineering and Brain and Cognitive Sciences Departments, Massachusetts Institute of Technology, Cambridge, MA 02139 USA</aff></contrib></contrib-group><pub-date pub-type="nihms-submitted"><day>16</day><month>12</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>16</day><month>12</month><year>2011</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>22</day><month>12</month><year>2015</year></pub-date><volume>20</volume><issue>1</issue><fpage>48</fpage><lpage>57</lpage><pmc-comment>elocation-id from pubmed: 10.1109/TNSRE.2011.2175008</pmc-comment>
<abstract><p id="P1">Both the American Heart Association and the VA/DoD endorse upper-extremity robot-mediated rehabilitation therapy for stroke care. However, we do not know yet how to optimize therapy for a particular patient’s needs. Here, we explore whether we must train patients for each functional task that they must perform during their activities of daily living or alternatively capacitate patients to perform a class of tasks and have therapists assist them later in translating the observed gains into activities of daily living. The former implies that motor adaptation is a better model for motor recovery. The latter implies that motor learning (which allows for generalization) is a better model for motor recovery. We quantified trained and untrained movements performed by 158 recovering stroke patients via 13 metrics, including movement smoothness and submovements. Improvements were observed both in trained and untrained movements suggesting that generalization occurred. Our findings suggest that, as motor recovery progresses, an internal representation of the task is rebuilt by the brain in a process that better resembles motor learning than motor adaptation. Our findings highlight possible improvements for therapeutic algorithms design, suggesting sparse-activity-set training should suffice over exhaustive sets of task specific training.</p></abstract><kwd-group><title>Index Terms</title><kwd>Kinematics</kwd><kwd>motor adaptation</kwd><kwd>motor learning</kwd><kwd>rehabilitation robotics</kwd><kwd>stroke</kwd></kwd-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Bever, C" sort="Bever, C" uniqKey="Bever C" first="C." last="Bever">C. Bever</name><name sortKey="Dipietro, L" sort="Dipietro, L" uniqKey="Dipietro L" first="L." last="Dipietro">L. Dipietro</name><name sortKey="Fasoli, S E" sort="Fasoli, S E" uniqKey="Fasoli S" first="S. E." last="Fasoli">S. E. Fasoli</name><name sortKey="Hogan, N" sort="Hogan, N" uniqKey="Hogan N" first="N." last="Hogan">N. Hogan</name><name sortKey="Krebs, H I" sort="Krebs, H I" uniqKey="Krebs H" first="H. I." last="Krebs">H. I. Krebs</name><name sortKey="Mernoff, S T" sort="Mernoff, S T" uniqKey="Mernoff S" first="S. T." last="Mernoff">S. T. Mernoff</name><name sortKey="Stein, J" sort="Stein, J" uniqKey="Stein J" first="J." last="Stein">J. Stein</name><name sortKey="Volpe, B T" sort="Volpe, B T" uniqKey="Volpe B" first="B. T." last="Volpe">B. T. Volpe</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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