RESUMEN
Wearable sensors can measure movement in daily life, an outcome that is salient to patients, and have been critical to accelerating progress in rehabilitation research and practice. However, collecting and processing sensor data is burdensome, leaving many scientists with limited access to such data. To address these challenges, we present a harmonized, wearable sensor dataset that combines 2,885 recording days of sensor data from the upper and lower limbs from eight studies. The dataset includes 790 individuals ages 0 - 90, nearly equal sex proportions (53% male, 47% female), and representation from a range of demographic backgrounds (69.4% White, 24.9% Black, 1.8% Asian) and clinical conditions (46% neurotypical, 31% stroke, 7% Parkinson's disease, 6% orthopedic conditions, and others). The dataset is publicly available and accompanied by open source code and an app that allows for interaction with the data. This dataset will facilitate the use of sensor data to advance rehabilitation research and practice, improve the reproducibility and replicability of wearable sensor studies, and minimize costs and duplicated scientific efforts.
RESUMEN
Background: An essential component of childhood development is increasing motor competence. Poor motor learning is often thought to underlie impaired motor competence, but this link is unclear in previous studies. Aims: Our aim was to test the relationship between motor competence and motor learning in the acquisition phase. Both reinforcement learning (RL) and error-based learning (EBL) were tested. We hypothesized that slower RL and slower EBL acquisition rates would relate to lower motor competence. Methods and procedures: Eighty-six participants ages 6-12 performed a target throwing task under RL and EBL conditions. The Movement Assessment Battery for Children - 2nd edition (MABC-2) provided a measure of motor competence. We assessed EBL and RL acquisition rates, baseline variability, and baseline bias from the throwing task. Outcomes and results: In a multiple linear regression model, baseline variability (ß = -0.49, p = <0.001) and the EBL acquisition rate (ß = -0.24, p = 0.018) significantly explained the MABC-2 score. Participants with higher baseline variability and slower EBL acquisition had lower motor competence scores. The RL acquisition rate was independent of MABC-2 score suggesting that RL may be less of a contributor to poor motor competence. Conclusions and implications: Children with slower EBL acquisition had lower motor competence scores but RL acquisition was unrelated to the level of motor competence. Emphasizing the unrelated reinforcement mechanisms over error-based mechanisms during motor skill interventions may help children with poor motor competence better acquire new motor skills.
RESUMEN
[This corrects the article DOI: 10.3389/fped.2024.1361757.].
RESUMEN
BACKGROUND: Despite the promise of wearable sensors for both rehabilitation research and clinical care, these technologies pose significant burden on data collectors and analysts. Investigations of factors that may influence the wearable sensor data processing pipeline are needed to support continued use of these technologies in rehabilitation research and integration into clinical care settings. The purpose of this study was to investigate the effect of one such factor, sleep, on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment and across a two-day wearing period. METHODS: This was a secondary analysis of data collected during a prospective, longitudinal cohort study (n = 127 individuals, 62 with upper limb impairment and 65 without). Participants wore a wearable sensor on each wrist for 48 h. Five upper limb sensor variables were calculated over the full wear period (sleep included) and with sleep time removed (sleep excluded): preferred time, non-preferred time, use ratio, non-preferred magnitude and its standard deviation. Linear mixed effects regression was used to quantify the effect of sleep on each sensor variable and determine if the effect differed between people with and without upper limb impairment and across a two-day wearing period. RESULTS: There were significant differences between sleep included and excluded for the variables preferred time (p < 0.001), non-preferred time (p < 0.001), and non-preferred magnitude standard deviation (p = 0.001). The effect of sleep was significantly different between people with and without upper limb impairment for one variable, non-preferred magnitude (p = 0.02). The effect of sleep was not substantially different across wearing days for any of the variables. CONCLUSIONS: Overall, the effects of sleep on sensor-derived variables of upper limb accelerometry are small, similar between people with and without upper limb impairment and across a two-day wearing period, and can likely be ignored in most contexts. Ignoring the effect of sleep would simplify the data processing pipeline, facilitating the use of wearable sensors in both research and clinical practice.
Asunto(s)
Acelerometría , Sueño , Extremidad Superior , Dispositivos Electrónicos Vestibles , Humanos , Acelerometría/instrumentación , Extremidad Superior/fisiología , Masculino , Femenino , Persona de Mediana Edad , Sueño/fisiología , Adulto , Anciano , Estudios Prospectivos , Estudios LongitudinalesRESUMEN
Transcranial direct current stimulation (tDCS) can be used to non-invasively augment cognitive training. However, the benefits of tDCS may be due in part to placebo effects, which have not been well-characterized. The purpose of this study was to determine whether tDCS can have a measurable placebo effect on cognitive training and to identify potential sources of this effect. Eighty-three right-handed adults were randomly assigned to one of three groups: control (no exposure to tDCS), sham tDCS, or active tDCS. The sham and active tDCS groups were double-blinded. Each group performed 20 min of an adapted Corsi Block Tapping Task (CBTT), a visuospatial working memory task. Anodal or sham tDCS was applied during CBTT training in a right parietal-left supraorbital montage. After training, active and sham tDCS groups were surveyed on expectations about tDCS efficacy. Linear mixed effects models showed that the tDCS groups (active and sham combined) improved more on the CBTT with training than the control group, suggesting a placebo effect of tDCS. Participants' tDCS expectations were significantly related to the placebo effect, as was the belief of receiving active stimulation. This placebo effect shows that the benefits of tDCS on cognitive training can occur even in absence of active stimulation. Future tDCS studies should consider how treatment expectations may be a source of the placebo effect in tDCS research, and identify ways to potentially leverage them to maximize treatment benefit.
Asunto(s)
Memoria a Corto Plazo , Estimulación Transcraneal de Corriente Directa , Adulto , Humanos , Memoria a Corto Plazo/fisiología , Efecto Placebo , Mano , Corteza Prefrontal/fisiología , Método Doble CiegoRESUMEN
Aim: The rise of wearable sensing technology shows promise for addressing the challenges of measuring motor behavior in pediatric populations. The current pediatric wearable sensing literature is highly variable with respect to the number of sensors used, sensor placement, wearing time, and how data extracted from the sensors are analyzed. Many studies derive conceptually similar variables via different calculation methods, making it hard to compare across studies and clinical populations. In hopes of moving the field forward, this report provides referent upper limb wearable sensor data from accelerometers on 25 variables in typically-developing children, ages 3-17 years. Methods: This is a secondary analysis of data from three pediatric cohorts of children 3-17 years of age. Participants (n = 222) in the cohorts wore bilateral wrist accelerometers for 2-4 days for a total of 622 recording days. Accelerometer data were reprocessed to compute 25 variables that quantified upper limb movement duration, intensity, symmetry, and complexity. Analyses examined the influence of hand dominance, age, gender, reliability, day-to-day stability, and the relationships between variables. Results: The majority of variables were similar on the dominant and non-dominant sides, declined slightly with age, and were not different between boys and girls. ICC values were moderate to excellent. Variation within individuals across days generally ranged from 3% to 32%. A web-based R shiny object is available for data viewing. Interpretation: With the use of wearable movement sensors increasing rapidly, these data provide key, referent information for researchers as they design studies, and analyze and interpret data from neurodevelopmental and other pediatric clinical populations. These data may be of particularly high value for pediatric rare diseases.
RESUMEN
BACKGROUND: Navigating your environment requires both straight-line gait as well as turning. Gait speed normative values are well established and utilized in determining a person's functional status, however, it has limitations. This study sought to examine whether turning speed declines with age and how it compared to gait speed age-related decline. METHODS: A secondary analysis was performed on 275 community dwelling adults between the ages of 18-88 that performed a timed walking test with an inertial measurement unit on their lumbar spine. Turning speed and walking speed were extracted for each participant. A series of mixed models were compared, and Akaike's Information Criterion was used to determine the best fit model between age and turning speed and age and gait speed. FINDINGS: Turning speed and gait speed normative values were reported for each age decade. A linear model with a random intercept of "Condition" was used to assess the relationship between age and turning speed. The results indicated a significant negative relationship between age and turning speed (B = -0.66, p < 0.001). A spline-fit model determined a significant negative relationship between age and gait speed after the age of 65 (B = -0.0097, p = 0.002). The effect of age on gait speed before age 65 was not significant. INTERPRETATION: Turning speed significantly declines with age in a linear fashion while gait speed begins to decline after age 65. Turning speed may be more responsive to age than gait speed. More research is needed to determine if the decline in turning speed with age is associated with a decline in function.
Asunto(s)
Equilibrio Postural , Velocidad al Caminar , Adulto , Humanos , Adolescente , Adulto Joven , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Marcha , CaminataRESUMEN
Recent studies suggest that the EEG aperiodic exponent (often represented as a slope in log-log space) is sensitive to individual differences in momentary cognitive skills such as selective attention and information processing speed. However, findings are mixed, and most of the studies have focused on just a narrow range of cognitive domains. This study used an archival dataset to help clarify associations between resting aperiodic features and broad domains of cognitive ability, which vary in their demands on momentary processing. Undergraduates (N = 166) of age 18-52 years completed a resting EEG session as well as a standardized, individually administered assessment of cognitive ability that included measures of processing speed, working memory, and higher-order visuospatial and verbal skills. A subsample (n = 110) also completed a computerized reaction time task with three difficulty levels. Data reduction analyses revealed strong correlations between the aperiodic offset and slope across electrodes, and a single component accounted for ~60% of variance in slopes across the scalp, in both eyes-closed and eyes-open conditions. Structural equation models did not support relations between the slope and specific domains tapping momentary processes. However, secondary analyses indicated that the eyes-open slope was related to higher overall performance, as represented by a single general ability factor. A latent reaction time variable was significantly inversely related to both eyes-closed and eyes-open resting exponents, such that faster reaction times were associated with steeper slopes. These findings support and help clarify the relation of the resting EEG exponent to individual differences in cognitive skills.
Asunto(s)
Cognición , Electroencefalografía , Humanos , Adulto Joven , Masculino , Adulto , Adolescente , Femenino , Persona de Mediana Edad , Cognición/fisiología , Atención/fisiología , Tiempo de Reacción/fisiología , Individualidad , Memoria a Corto Plazo/fisiología , Aptitud/fisiología , Desempeño Psicomotor/fisiologíaRESUMEN
BACKGROUND: Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life. OBJECTIVE: To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes. METHODS: Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand. RESULTS: The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand. CONCLUSION: After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.
Asunto(s)
Traumatismos de los Nervios Periféricos , Humanos , Calidad de Vida , Mano , Extremidad Superior , Lateralidad Funcional/fisiologíaRESUMEN
Motor coordination is an important driver of development and improved coordination assessments could facilitate better screening, diagnosis, and intervention for children at risk of developmental disorders. Wearable sensors could provide data that enhance the characterization of coordination and the clinical utility of that data may vary depending on how sensor variables from different recording contexts relate to coordination. We used wearable sensors at the wrists to capture upper-limb movement in 85 children aged 6-12. Sensor variables were extracted from two recording contexts. Structured recordings occurred in the lab during a unilateral throwing task. Unstructured recordings occurred during free-living activity. The objective was to determine the influence of recording context (unstructured versus structured) and assessment type (direct vs. indirect) on the association between sensor variables and coordination. The greatest associations were between six sensor variables from the structured context and the direct measure of coordination. Worse coordination scores were associated with upper-limb movements that had higher peak magnitudes, greater variance, and less smoothness. The associations were consistent across both arms, even though the structured task was unilateral. This finding suggests that wearable sensors could be paired with a simple, structured task to yield clinically informative variables that relate to motor coordination.
Asunto(s)
Dispositivos Electrónicos Vestibles , Niño , Humanos , Movimiento , Extremidad Superior , MuñecaRESUMEN
In adulthood, neurological structure and function are often affected by aging, with negative implications for daily life as well as laboratory-based tasks. Some of these changes include decreased efficiency modulating cortical activity and lower signal-to-noise ratios in neural processing (as inferred from surface electroencephalography). To better understand mechanisms influencing age-related changes in cortical activity, we explored the effects of aging on narrow-band alpha power (7.5-12.5 Hz) and broadband/aperiodic components that span a wider range (1.5-30.5 Hz) over the occipital region during eyes-open and eyes-closed wakeful rest in 19 healthy young adults (18-35 years) and 21 community-dwelling older adults (59+ years). Older adults exhibited a smaller change in alpha power across conditions compared to younger adults. Older adults also showed flatter aperiodic slopes in both conditions. These changes in narrow-band alpha are consistent with previous work and suggest that older adults may have a reduced ability to modulate state-specific activity. Differences in the aperiodic slope suggest age-related changes in the signal-noise-ratio in cortical oscillations. However, the relationship between narrow-band alpha modulation and the aperiodic slope was unclear, warranting further investigation into how these variables relate to each other in the aging process. In summary, aging is associated with a broadband flattening of the EEG power spectrum and reduced state-specific modulation of narrow-band alpha power, but these changes appear to be (at least partially) independent of each other. The present findings suggest that separate mechanisms may underlie age-related differences in aperiodic power and narrow-band oscillations.
Asunto(s)
Envejecimiento , Electroencefalografía , Adulto Joven , Humanos , Anciano , Lactante , Preescolar , Niño , Adolescente , Adulto , Estudios Transversales , Vigilia , Estudios de CohortesRESUMEN
BACKGROUND: Individuals with Parkinson disease and comorbid dementia (PDD) demonstrate gait impairments, but little is known about how these individuals respond to interventions for gait dysfunction. Rhythmic auditory stimulation (RAS), which utilizes music or other auditory cues to alter gait, has been shown to be effective for improving gait in individuals with PD without dementia, but has not been explored in individuals with PDD. RESEARCH QUESTION: Can individuals with PDD modulate their gait in response to music and mental singing cues? METHODS: This single center, cross-sectional, interventional study included 17 individuals with PDD. Participants received Music and Mental singing cues at tempos of 90 %, 100 %, 110 %, and 120 % of their uncued walking cadence. Participants were instructed to walk to the beat of the song. Gait variables were collected using APDM Opal sensors. Data were analyzed using mixed effect models to explore the impact of tempo and cue type (Music vs Mental) on selected gait parameters of velocity, cadence, and stride length. RESULTS: Mixed effects models showed a significant effect of tempo but not for cue type for velocity (F=11.51, p < .001), cadence (F=11.13, p < .001), and stride length (F=5.68, p = .002). When looking at the marginal means, velocity at a cue rate of 90 % was significantly different from 100 %, indicating participants walked slower with a cue rate of 90 %. Participants did not significantly increase their velocity, cadence, or stride length with faster cue rates of 110 % and 120 % SIGNIFICANCE: Individuals with PDD appear to be able to slow their velocity in response to slower cues, but do not appear to be able to increase their velocity, cadence, or stride length in response to faster cue tempos. This is different from what has been reported in individuals with PD without dementia. Further research is necessary to understand the underlying mechanism for these differences.
Asunto(s)
Demencia , Música , Enfermedad de Parkinson , Humanos , Señales (Psicología) , Enfermedad de Parkinson/complicaciones , Estudios Transversales , Marcha/fisiología , Caminata/fisiología , Estimulación Acústica , Demencia/complicacionesRESUMEN
OPTIMAL theory predicts providing learners with a relatively easier criterion of success during practice enhances motor learning through increased self-efficacy, perceptions of competence, and intrinsic motivation. However, mixed results in the literature suggest this enhancement effect may be moderated by the number of successes achieved by learners practicing with the difficult criterion. To investigate this possibility, we manipulated quantity of practice to affect the absolute number of successes achieved by learners practicing with different success criteria. Eighty participants were divided into four groups and performed 50 or 100 trials of a mini-shuffleboard task. Groups practiced with either a large or a small zone of success surrounding the target. Learning was assessed 24 h after acquisition with retention and transfer tests. In terms of endpoint accuracy and precision, there were no learning or practice performance benefits of practicing with an easier criterion of success, regardless of the number of trials. This absence of a criterion of success effect was despite the efficacy of our manipulation in increasing the number of trials stopping within the zone of success, self-efficacy, perceptions of competence, and, for participants with 100 trials, intrinsic motivation. An equivalence test indicated that the effect of criterion of success was small, if existent. Moreover, at the individual level, intrinsic motivation did not predict posttest or acquisition performance. There were no benefits of easing the criterion of success on pressure, effort, accrual of explicit knowledge, or conscious processing. These data challenge key tenets of OPTIMAL theory and question the efficacy of easing criterion of success for motor learning.
Asunto(s)
Aprendizaje , Motivación , Humanos , Estado de Conciencia , Existencialismo , ConocimientoRESUMEN
Cognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more than double the steps and aerobic minutes can be achieved during inpatient rehabilitation versus usual care, and translates to improved long-term walking outcomes. Thus, the secondary analysis aim was to determine the effect of the DOSE protocol on cognitive outcomes over 1-year poststroke. The DOSE protocol progressively increased step number and aerobic minutes during inpatient stroke rehabilitation over 20 sessions. The Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), and Trail Making Test B were completed at baseline, post-intervention, and 6- and 12-months poststroke, administered using standardized guidelines. Using the DOSE data, we used mixed-effect spline regression to model participants' trajectories of cognitive recovery, controlling for relevant covariates. Participants (Usual Care n = 25, DOSE n = 50) were 56.7(11.7) years old, and 27(10) days post stroke. For the MoCA, there were statistically significant Group × Trajectory(p = 0.019), and Group × ΔTrajectory (p = 0.018) interactions with a substantial clinically meaningful difference, from +5.44 points/month improvement of the DOSE group compared to +1.59 points/month improvement with Usual Care during the 4-week intervention. The DSST and Trails B improved over time but were not different between groups. Taking advantage of this early difference may lend support to continued efforts to increase intensity, during and after discharge from inpatient rehabilitation, to improve cognition. Clinical trial registration: www.clinicaltrials.gov, NCT01915368.
RESUMEN
BACKGROUND: Developmental dysplasia of the hip (DDH) is a major risk factor for the early development of hip osteoarthritis. Recent studies have demonstrated how DDH alters hip muscle moment arms and elevates muscle-induced biomechanical variables such as joint reaction forces and acetabular edge loads. Understanding the link between abnormal biomechanics and patient-reported outcome measures (PROMs) is important for evidence-based clinical interventions that improve patient symptoms and functional outcomes. To our knowledge, there are no reports of the relationships between muscle-induced biomechanics and PROMs. QUESTIONS/PURPOSES: (1) Are there associations between PROMs and muscle-induced hip biomechanics during gait for patients with DDH and controls? (2) Are there associations among PROMs and separately among biomechanical variables? METHODS: Participants in this prospective cross-sectional comparative study included 20 female patients with DDH who had no prior surgery or osteoarthritis and 15 female individuals with no evidence of hip pathology (controls) (age: median 23 years [range 16 to 39 years]; BMI: median 22 kg/m 2 [range 17 to 27 kg/m 2 ]). Muscle-induced biomechanical variables for this cohort were reported and had been calculated from patient-specific musculoskeletal models, motion data, and MRI. Biomechanical variables included joint reaction forces, acetabular edge loads, hip center lateralization, and gluteus medius muscle moment arm lengths. PROMs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the WOMAC, International Hip Outcome Tool-12, National Institutes of Health Patient-Reported Outcome Measure Information System (PROMIS) Pain Interference and Physical Function subscales, and University of California Los Angeles activity scale. Associations between PROMs and biomechanical variables were tested using Spearman rank-order correlations and corrected for multiple comparisons using the Benjamini-Yekutieli method. For this study, associations between variables were considered to exist when correlations were statistically significant (p < 0.05) and were either strong (ρ ≥ 0.60) or moderate (ρ = 0.40 to 0.59). RESULTS: Acetabular edge load impulses (the cumulative acetabular edge load across the gait cycle), medially directed joint reaction forces, and hip center lateralization most commonly demonstrated moderate or strong associations with PROMs. The strongest associations were a negative correlation between acetabular edge load impulse on the superior acetabulum and the HOOS function in daily living subscale (ρ = -0.63; p = 0.001), followed by a negative correlation between hip center lateralization and the HOOS pain subscale (ρ = -0.6; p = 0.003), and a positive correlation between hip center lateralization and the PROMIS pain subscale (ρ = 0.62; p = 0.002). The University of California Los Angeles activity scale was the only PROM that did not demonstrate associations with any biomechanical variable. All PROMs, aside from the University of California Los Angeles activity scale, were associated with one another. Although most of the biomechanical variables were associated with one another, these relationships were not as consistent as those among PROMs. CONCLUSION: The associations with PROMs detected in the current study suggest that muscle-induced biomechanics may have wide-reaching effects not only on loads within the hip, but also on patients' perceptions of their health and function. As the treatment of DDH evolves, patient-specific joint preservation strategies may benefit from targeting the underlying causes of biomechanical outcomes associated with PROMs. LEVEL OF EVIDENCE: Level III, prognostic study.
Asunto(s)
Luxación de la Cadera , Osteoartritis de la Cadera , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Luxación de la Cadera/cirugía , Estudios Prospectivos , Fenómenos Biomecánicos , Estudios Transversales , Resultado del Tratamiento , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/etiología , Medición de Resultados Informados por el Paciente , Músculo Esquelético , Dolor , Articulación de la Cadera/cirugíaRESUMEN
Older adults who report a fear of falling are more likely to subsequently fall, yet, some gait anxiety-related alterations may protect balance. We examined the effect of age on walking in anxiety-inducing virtual reality (VR) settings. We predicted a high elevation-related postural threat would impair gait in older age, and differences in cognitive and physical function would relate to the observed effects. Altogether, 24 adults (age (y) = 49.2 (18.7), 13 women) walked on a 2.2-m walkway at self-selected and fast speeds at low (ground) and high (15 m) VR elevation. Self-reported cognitive and somatic anxiety and mental effort were greater at high elevations (all p < 0.001), but age- and speed-related effects were not observed. At high VR elevations, participants walked slower, took shorter steps, and reduced turning speed (all p < 0.001). Significant interactions with age in gait speed and step length showed that relatively older adults walked slower (ß = - 0.05, p = 0.024) and took shorter steps (ß = - 0.05, p = 0.001) at self-selected speeds at high compared to low elevation settings. The effect of Age on gait speed and step length disappeared between self-selected and fast speeds and at high elevation. At self-selected speeds, older adults took shorter and slower steps at high elevation without changing step width, suggesting that in threatening settings relatively older people change gait parameters to promote stability. At fast speeds, older adults walked like relatively younger adults (or young adults walked like older adults) supporting the notion that people opt to walk faster in a way that still protects balance and stability in threatening settings.
Asunto(s)
Longevidad , Realidad Virtual , Adulto Joven , Humanos , Femenino , Anciano , Miedo , Caminata , Marcha , Velocidad al Caminar , AnsiedadRESUMEN
INTRODUCTION: Physical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. METHODS AND ANALYSIS: A parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. ETHICS AND DISSEMINATION: The Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications.
Asunto(s)
Esclerosis Múltiple , Humanos , Esclerosis Múltiple/rehabilitación , Calidad de Vida , Recurrencia Local de Neoplasia , Caminata , Modalidades de Fisioterapia , Terapia por Ejercicio/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Accelerometers allow for direct measurement of upper limb (UL) activity. Recently, multi-dimensional categories of UL performance have been formed to provide a more complete measure of UL use in daily life. Prediction of motor outcomes after stroke have tremendous clinical utility and a next step is to explore what factors might predict someone's subsequent UL performance category. PURPOSE: To explore how different machine learning techniques can be used to understand how clinical measures and participant demographics captured early after stroke are associated with the subsequent UL performance categories. METHODS: This study analyzed data from two time points from a previous cohort (n = 54). Data used was participant characteristics and clinical measures from early after stroke and a previously established category of UL performance at a later post stroke time point. Different machine learning techniques (a single decision tree, bagged trees, and random forests) were used to build predictive models with different input variables. Model performance was quantified with the explanatory power (in-sample accuracy), predictive power (out-of-bag estimate of error), and variable importance. RESULTS: A total of seven models were built, including one single decision tree, three bagged trees, and three random forests. Measures of UL impairment and capacity were the most important predictors of the subsequent UL performance category, regardless of the machine learning algorithm used. Other non-motor clinical measures emerged as key predictors, while participant demographics predictors (with the exception of age) were generally less important across the models. Models built with the bagging algorithms outperformed the single decision tree for in-sample accuracy (26-30% better classification) but had only modest cross-validation accuracy (48-55% out of bag classification). CONCLUSIONS: UL clinical measures were the most important predictors of the subsequent UL performance category in this exploratory analysis regardless of the machine learning algorithm used. Interestingly, cognitive and affective measures emerged as important predictors when the number of input variables was expanded. These results reinforce that UL performance, in vivo, is not a simple product of body functions nor the capacity for movement, instead being a complex phenomenon dependent on many physiological and psychological factors. Utilizing machine learning, this exploratory analysis is a productive step toward the prediction of UL performance. Trial registration NA.
Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/complicaciones , Extremidad Superior , Actividad Motora/fisiología , MovimientoRESUMEN
BACKGROUND: Patients' pretreatment preferences can influence outcomes of nonpharmacologic treatments for musculoskeletal pain. Less is known about how patients' treatment preferences change following exposure to treatment. OBJECTIVE: To examine the effect of exposure to treatment and change in disability and pain on treatment preference ratings of two exercise-based treatments for people with chronic low back pain (LBP). DESIGN: Secondary analysis of a subsample of participants from a randomized clinical trial. SETTING: Academic research setting. PARTICIPANTS: Individuals with chronic LBP (n = 83). INTERVENTIONS: 6 weekly sessions of motor skill training (MST) or strength and flexibility exercise (SFE). MAIN OUTCOME MEASURES: Prior to treatment, participants completed a treatment preference assessment measure (TPA) describing MST and SFE. Participants rated four attributes (effectiveness, acceptability/logicality, suitability/appropriateness, convenience) of each treatment on a 5-point Likert scale (0-4) with higher scores indicating higher ratings. An overall preference rating was calculated as the mean of the attribute ratings. The TPA was administered 12 months post treatment to reassess participants' ratings of the treatment they received. RESULTS: Participants who received MST rated their preference for MST higher 12 months post treatment and participants who received SFE rated their preference for SFE lower. Smaller improvements (to worsening) in pain were associated with a reduction in preference ratings in the SFE group, whereas the MST group generally increased their ratings regardless of pain. Changes in disability were not related to changes in preference ratings. CONCLUSIONS: Participants changed their preference ratings of two exercise-based treatments for LBP after exposure to the treatment. Participants who received the less familiar MST viewed this treatment more favorably 12 months post treatment, and this change was less contingent on changes in disability/pain than for participants in the SFE group. Assessing preference ratings at various times during treatment is crucial to understand a person's preference for and perceptions of a treatment.