Use Of Audio Motor Learning For The Rehabilitation Of Upper Limb Reaching In Hemiparetic Subjects.

Use of audio motor learning for the rehabilitation of upper limb reaching in hemiparetic subjects. Robertson, J. 1, 2, Hoellinger, Hoellinger, T. 1, Hanneton, Hanneton, S. 1 and RobyRoby-Brami, Brami, A. 1, 2 1 Laboratoire de Neurophysique et Physiologie, Université Paris Descartes, CNRS UMR 8119, 45 Rue des St Pères, Paris 75006. 2 Service MPR, Laboratoire d’Analyse du Mouvement, Hôpital Raymond Poincaré, Garches, 92380.

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0,5

1,0

1,5

seg me nta tio

0,6 0,5 0,4 0,2 0,1 0,0 0,0

0,4

Time (sec)

0,8

1,2

Time (sec)

Excessive trunk motion

Segmented tangential velocity curves of hand trajectory

OBJECTIVES OF PRELIMINARY STUDY

10

0 0 10 20 30 40 50 60 70

Elbow Ang Vel (deg/sec)

Non-linear relationship between elbow and shoulder velocity

Elbow Shoulder

80 60 40 20

0 0,0 0,2 0,4 0,6 0,8 1,0 1,2

Time (sec)

Non-synchronous timing of elbow and shoulder angular velocity peaks

RESULTS

Sensors positioned on trunk, acromion, arm and hand record translation and orientation (Euler’s angles) at 30 Hz.

FEEDBACK 3D spatialised sound produced using Open Al. ‘Listener’ corresponds to the hand sensor allowing hand motion to influence perceived sound (see Hoellinger et al. poster). volume increases towards

Simple feedback

varies according to hand distance from target.

Spatialised feedback

also varies according to hand orientation relative to target.

1,15

Curve Ratio

3D ‘on line’ recording of movement with electromagnetic motion tracking system: POLHEMUS

37 36 35 34

None

Simple Spatialised Feedback

1,14

1,13

1,12

None

Simple Spatialised Feedback

Increased smoothness with feedback (decreased number of velocity peaks and decreased jerk metric). * * * * * 4,0 * 5 Jerk Metric

MATERIALS

Length of hand path (cm)

¾ To compare the effect of simple feedback with spatialised feedback.

Significant improvements in spatial characteristics of hand trajectory (length and curvature). * * * * *

Number of Vel Peaks

¾ To assess the effect of auditory feedback on kinematic movement parameters during reaching movements of the hemiparetic upper limb.

‘Buzzing’ sound accompanies movements target.

n

0,3

20

Angular Velocity (deg/sec)

Auditory feedback on kinematic parameters of movement could enhance performance in the hemiparetic upper limb (Maulucci, 2001).

12 ° forward lean

Shoulder Ang Vel (deg/sec)

Studies show that feedback is an essential component of motor learning. (Schmidt, 2004).

98 96 94 92 90 88 86 84 0,0

Hand Velocity (m/s)

Temperospatial parameters are frequently altered during reaching movements (Roby-Brami, 2003, Cirstea 2003).

Trunk Flexion Angle (deg)

< 50% of stroke patients recover functional ability in the upper limb. Recovery of reaching movements in the hemiparetic upper limb is a rehabilitation problem.

INTRODUCTION Typical kinematic deficits in hemiparetic pointing movements

3,5

3,0

4 3 2 1

None

Simple Spatialised Feedback

None

Simple Spatialised Feedback

Effects significantly greater with spatialised feedback than simple feedback.

Subjects

90% arm length

Design

Task

* Statistically significant difference (p<0.05).

METHODS 6 hemiparetic patients (1 left, 5 right) 1 female, 5 males Mean age = 46 years Dominant hand affected = 3 Barthel = 70 –100 / 100 ARAT = 28-57 / 57

DISCUSSION / CONCLUSION / PERSPECTIVES Auditory feedback appears to improve spatial parameters of movement. Spatialised feedback appears to have a particular effect on parameters relating to smoothness.

30° 20 cm

2 sessions (randomised) ¾ No feedback

simple feedback

¾ No feedback

spatialised feedback

Subject

3 consecutive reaching movements to 9 targets (random): ¾ 3 close (60% arm length) ¾ 3 far (90% arm length) ¾ 3 far + high (17cm)

REFERENCES

More subjects are required, however, in order to confirm these preliminary findings. We wish to explore the effects simple and spatialised auditory feedback on inter-joint coordination and trunk motion. Following this, we aim to develop different types of auditory feedback, using positive and negative reinforcement in order to improve inter-joint coordination and decrease use of trunk motion. Our long-term aim is to develop a ‘tool-box’ of sensory motor activities for reaching and grasping using auditory feedback. Each activity will be specific to a particular temperospatial deficit and will be adaptable for each patient. Our hypothesis is that improvements at the impairment level will positively affect function.

Roby-Brami, A., Feydy, A. et al. (2003). "Motor compensation and recovery for reaching in stroke patients." Acta Neurol Scand 107(5): 369-81. Cirstea, M. C., Mitnitski, A.B. et al. (2003). "Interjoint coordination dynamics during reaching in stroke." Exp Brain Res 151(3): 289-300. Schmidt, R., and Wrisberg, C. (2004) Motor learning and performance.Human Kinetics, Leeds, UK. Maulucci, R. A. and R. H. Eckhouse (2001). "Retraining reaching in chronic stroke with real-time auditory feedback." NeuroRehabilitation 16(3): 171-82.