Partnered dance evokes greater intrinsic motivation than home exercise as therapeutic activity for chemotherapy-induced deficits: secondary results of a randomized, controlled clinical trial.

Introduction: Dance has been proposed to support superior intrinsic motivation over non-dance forms of therapeutic physical activity. However, this hypothesis has yet to be evaluated empirically, particularly among populations living with neuropathology such as survivors of cancer with neurologic complications from chemotherapy treatment. Questions about motivation are relevant to clinical outcomes because motivation mediates neuroplasticity. We conducted this secondary analysis of a randomized-controlled study to begin to investigate the relationships between personal motivation and neurophysiologic effects of dance-based intervention for healthy aging among populations with neurologic complications of cancer. Methods: We measured motivation using the Intrinsic Motivation Inventory, a validated patient-reported outcome from the psychological approach of Self Determination Theory. We assessed intrinsic motivation, extrinsic motivation, and satisfaction with intervention within a randomized controlled trial of dance versus exercise designed to alleviate symptoms of chemotherapy-induced impairment. Fifty-two survivors of breast cancer with chemotherapy-induced neuropathy diagnosis and associated sensorimotor functional deficits were randomized (1:1) to 8 weeks of partnered dance or home exercise, performed biweekly (NCT05114005; R21-AG068831). Results: While satisfaction did not differ between interventions, intrinsic motivation was higher among participants randomized to dance than those randomized to exercise (p < 0.0001 at all timepoints: 2 weeks, 4 weeks, 6 weeks, and 8 weeks of intervention), as was extrinsic motivation at 2 weeks (p = 0.04) and 8 weeks (p = 0.01). Discussion: These data provide evidence that social dance is more motivating than the type of home exercise generally recommended as therapeutic physical activity. The results inform directions for future study of the effect of dance-based therapeutics on embodied agency, neuroplastic changes, and clinically-relevant neuropathic improvement.

Structured, Creative Dance Classes for Children with Developmental Disabilities: A Pilot Study of Feasibility and Preliminary Effect on Motor Function.

INTRODUCTION: Promoting physical wellness for preschool-aged children with developmental disorders (DD) is a known challenge. Interventions are more likely to succeed when physical activity opportunities are available to children within the context of their typical environments. We evaluated the feasibility and preliminary effect of 1 potential solution: structured creative dance classes delivered within a preschool environment. METHODS: Using a non-randomized feasibility study design, we offered physical activity in the form of creative dance classes for children with and without DD within an inclusive preschool. Classes lasted 30 minutes and were held once a week or 7 weeks. We measured attendance (primary), observed active participation (% of class duration), and balance (Pediatric Balance Scale). Non-parametric descriptive statistics are expressed as median (interquartile range). Balance was evaluated regarding (a) difference between groups at baseline (Mann-Whitney statistic) and (b) intervention effect for children with DD (1-tailed, paired t-test). RESULTS: Twelve preschoolers (age range = 3-5 years) participated: 4 with DD and 8 with neurotypical development. Attendance was 93% (79%-100%) for children with and 100% for children without DD. Per class, rate of active participation in dance activity was 33% (28%-45%) for children with and 80% (71%-82%) for children without DD. Starting balance scores were lower (P = .014) for children with DD (42 (39-45)) compared to those without (51 (50-52)). Post-intervention, balance scores improved for the children with DD to 50 (50-51) (df = 3, p = .014, t-statistic = 2.35); each child with DD surpassed minimal detectable change for balance. CONCLUSION: Creative dance classes, delivered within an inclusive preschool environment, are feasible for some preschool-aged children with DD to participate in and efficacious as a physical training challenge at low activity doses. More study is warranted of this potential solution to meet the need for physical wellness promotion among young children with DD.

Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trial and preliminary baseline data.

BACKGROUND: Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through neurologic dance training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. METHODS: In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1-month follow-up, and 6-month follow-up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. DISCUSSION: The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. TRIAL REGISTRATION: This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.

Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trail and preliminary baseline data.

Background Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through Neurologic Dance Training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. Methods In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1mo follow up, and 6mo follow up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. Discussion The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. Trial Registration This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.

Updates in the Treatment of Chemotherapy-Induced Peripheral Neuropathy.

OPINION STATEMENT: Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with treatment with platinum-based agents, taxanes, vinca alkaloids, and other specific agents. The long-term consequences of this condition can result in decreased patient quality of life and can lead to reduced dose intensity, which can negatively impact disease outcomes. There are currently no evidence-based preventative strategies for CIPN and only limited options for treatment. However, there are several strategies that can be utilized to improve patient experience and outcomes as more data are gathered in the prevention and treatment setting. Before treatment, patient education on the potential side effects of chemotherapy is key, and although trials have been limited, recommending exercise and a healthy lifestyle before and while undergoing chemotherapy may provide some overall benefit. In patients who develop painful CIPN, our approach is to offer duloxetine and titrate up to 60 mg daily. Chemotherapy doses may also need to be reduced if intolerable symptoms develop during treatment. Some patients may also try acupuncture and physical therapy to help address their symptoms, although this can be limited by cost, time commitment, and patient motivation. Additionally, data on these modalities are currently limited, as studies are ongoing. Overall, approaching each patient on an individual level and tailoring treatment options for them based on overall physical condition, their disease burden, goals of care and co-morbid health conditions, and willingness to trial different approaches is necessary when addressing CIPN.

A new perspective on transient characteristics of quiet stance postural control.

Postural control provides insight into health concerns such as fall risk but remains relatively untapped as a vital sign of health. One understudied aspect of postural control involves transient responses within center of pressure (CoP) data to events such as vision occlusion. Such responses are masked by common whole-trial analyses. We hypothesized that the transient behavior of postural control would yield unique and clinically-relevant information for quiet stance compared to traditionally calculated whole-trial CoP estimates. Three experiments were conducted to test different aspects of this central hypothesis. To test whether transient, epoch-based characteristics of CoP estimates provide different information than traditional whole-trial estimates, we investigated correlations between these estimates for a population of young adults performing three 60-second trials of quiet stance with eyes closed. Next, to test if transient behavior is a result of sensory reweighting after eye closure, we compared transient characteristics between eyes closed and eyes open conditions. Finally, to test if there was an effect of age on transient behavior, we compared transient characteristics during eyes closed stance between populations of young and older adults. Negligible correlations were found between transient characteristics and whole-trial estimates (p>0.08), demonstrating limited overlap in information between them. Additionally, transient behavior was exaggerated during eyes closed stance relative to eyes open (p<0.044). Lastly, we found that transient characteristics were able to distinguish between younger and older adults, supporting their clinical relevance (p<0.029). An epoch-based approach captured unique and potentially clinically-relevant postural control information compared to whole-trial estimates. While longer trials may improve the reliability of whole-trial estimates, including a complementary assessment of the initial transient characteristics may provide a more comprehensive characterization of postural control.

In-home neurogaming: Demonstrating the impact of valid gesture recognition method on high volume kinematic outcomes.

The process of cleaning motion capture data of aberrant points has been described as "the bane of motion capture operators". Yet, managing the high volume kinematic data generated through in-home neurogames requires data quality control that, executed insufficiently, jeopardizes accuracy of outcomes. To begin to address this issue at the intersection of biomechanics and "big data", we performed a secondary analysis of a neurogame, evaluating gesture count as well as shoulder and elbow joint angle outcomes calculated from kinematic data in which valid gestures were identified through 3 methods: visual review of regions of interest by an expert (BP); manufacturer-recommended data smoothing (MS); and automated methods (AI). We hypothesized that upper extremity kinematic outcomes from BP would be matched by AI but not MS methods. From one person with post-stroke hemiparesis, upper-extremity kinematic data were collected for 6 days over 2 weeks using a Microsoft Kinect™-based neurogame. We calculated gesture count, shoulder angle, and elbow angle outcomes from data managed using BP, MS, and AI methods. BP identified 1929 valid gestures total over 6 days which was different than the other two methods (p = 0.0015). In contrast, the AI algorithm with best precision identified 4372 and MS identified 4459 valid gestures. Furthermore, angle outcomes calculated from AI and MS methods resulted in different values than BP (p < 0.001 for 5 of 6 variables). More research is needed to automate treatment of high volume, low quality motion data to support investigation of motion associated with in-home rehabilitation neurogames.

Characterizing within-subject variability in quantified measures of balance control: A cohort study.

BACKGROUND: To longitudinally assess individuals using quantified measures, we must characterize within-subject variability (WSV) of the measures. RESEARCH QUESTION: What is the natural within-subject variability (WSV) that can be expected in postural control over 3+ days? METHODS: Thirteen individuals without orthopedic or neurologic impairment (mean(SD) = 55 (9) years; 76 (18) kg; 11 females/2 males) were recruited from a community workplace and consented to participate. Participants stood quietly with eyes closed (QEC) on a force platform (5 x 1 min x 6 days) in two stances: comfortable and narrow. We recorded center of pressure (COP) and calculated COP-based balance parameters. To analyze variance components, we applied a linear mixed model for repeated measures, calculating within-subject standard deviation (SDws) from the pooled variance not attributable to between-subject variability. To estimate WSV, we scaled SDws by a confidence interval (CI) factor (e.g. WSV at the 95%CI = WSV95 = SDws * 1.96) and report WSV95 for a range of conditions previously reported in the literature and the following measures previously found sensitive to or predictive of health: (primary) WSV95 of root-mean square amplitude of medial-lateral COP during QEC (RMSml); (secondary) WSV95 of COP ellipse area (COPa); (secondary) WSV95 of mean medial-lateral COP velocity (COPvml) during QEC. RESULTS: WSV95 was estimated at RMSml = 0.8 mm, COPa = 99mm2, and COPvml = 1.1 mm/s among healthy, middle-aged participants standing comfortably for one recommended data duration (4 × 30 s trials). A look up table provides values for alternate protocols that have been suggested in the literature and might prove relevant for clinical translation. SIGNIFICANCE: This work advances longitudinal assessment of individuals using quantified measures of postural control. Results enable practitioners/researchers to assess an individual's progress, maintenance, or decline relative to WSV at a defined CI level.

In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming.

PURPOSE: People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game. METHODS: Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants' subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM). RESULTS: On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen's d) of 1.5 and 1.1, respectively. CONCLUSIONS: This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis.

Reducing concussion symptoms among teenage youth: Evaluation of a mobile health app.

OBJECTIVE: To evaluate whether a mobile health application that employs elements of social game design could compliment medical care for unresolved concussion symptoms. DESIGN: Phase I and Phase II (open-label, non-randomized, ecological momentary assessment methodology). SETTING: Outpatient concussion clinic. PARTICIPANTS: Youth, aged 13-18 years, with concussion symptoms 3+ weeks after injury; Phase I: n = 20; Phase II: n = 19. INTERVENTIONS: Participants received standard of care for concussion. The experimental group also used a mobile health application as a gamified symptoms journal. OUTCOME MEASURES: Phase I: feasibility and satisfaction with intervention (7-point Likert scale, 1 high). Phase II: change in SCAT-3 concussion symptoms (primary), depression and optimism. RESULTS: Phase 1: A plurality of participants completed the intervention (14 of 20) with high use (110 +/- 18% play) and satisfaction (median +/- interquartile range (IQR) = 2.0+/- 0.0). Phase II: Groups were equivalent on baseline symptoms, intervention duration, gender distribution, days since injury and medication prescription. Symptoms and optimism improved more for the experimental than for the active control cohort (U = 18.5, p = 0.028, effect size r = 0.50 and U = 18.5, p = 0.028, effect size r = 0.51, respectively). CONCLUSIONS: Mobile apps incorporating social game mechanics and a heroic narrative may promote health management among teenagers with unresolved concussion symptoms.

Training conditions that best reproduce the joint powers of unsupported walking.

OBJECTIVE: To identify the clinically relevant combinations of body weight support and speed that best reproduce the joint powers of unsupported walking. METHODS: Timing and magnitude of lower extremity joint powers were calculated for 8 neurologically intact volunteers (4M/4F) walking with 0%, 30% and 50% body weight support at three speeds (slow, comfortable, and fast). Lower extremity joint power absorption was analyzed during weight acceptance and forward propulsion. In addition, power generation was analyzed during forward propulsion. Timings and magnitudes of joint powers per condition were evaluated to identify the training combinations of body weight support and speed that best preserved the powers of unsupported walking at slow, comfortable and fast speeds. RESULTS: For all speeds examined, increasing body weight support to 30% without changing speed provided the best match. In general, changes in speed disrupted the joint power magnitudes and timings more than application of body weight support. Increasing body weight support when faster training speeds were used proved a viable method for reproducing the joint powers of slow, unsupported walking. CONCLUSIONS: These data provide a reference for understanding the effect of potential training conditions on power absorption and generation within the lower extremity joints during walking. It is possible to reproduce the joint powers of unsupported walking with certain combinations of body weight support and speed. We recommend applying adequate levels of BWS when training speeds are faster than the overground speed goal, as occurs during treadmill-based locomotor rehabilitation of individuals with incomplete spinal cord injury.

A new look at an old problem: defining weight acceptance in human walking.

BACKGROUND: Weight acceptance (WA) is an important phase of bipedal gait that has received relatively little study to date. This study tested the hypothesis that the first peak knee flexion would better demarcate the end of WA power absorption activity across varying gait speeds than would the more commonly used event of contralateral toe off (CTO) or the peak hip adduction angle. METHODS: Eight control subjects (4F/4M) walked on a treadmill at slow, self-selected, and fast speeds. Kinematic and kinetic data were recorded. Joint angles and power absorption were analyzed about the, lower extremity joints (sagittal ankle, knee, hip and frontal hip). Differences in event timings and, magnitudes of negative work were analyzed (ANOVA). RESULTS: Knee sagittal power absorption continued after the CTO event at self-selected (p=0.009) and fast speeds (p=0.001), while hip frontal power absorption continued after the CTO event at slow (p=0.019), self-selected (p=0.001), and fast speeds (p=0.001). The contribution of frontal hip to overall power absorption increased as speed decreased. DISCUSSION: Peak hip adduction angle is the best kinematic marker of the end of the WA phase, and peak knee flexion angle is the best alternative marker across speeds. CTO is only appropriate to use when gait speeds are slow. In addition, the relative contribution of power absorbed in the frontal hip during WA highlights the importance of frontal plane pelvic control in locomotion, especially when gait speed is slow.

A feasibility study using interactive graphic art feedback to augment acute neurorehabilitation therapy.

BACKGROUND: Interactive arts technologies, designed to augment the acute neurorehabilitation provided by expert therapists, may overcome existing barriers of access for patients with low motor and cognitive function. OBJECTIVES: Develop an application prototype to present movement feedback interactively and creatively. Evaluate feasibility of use within acute neurorehabilitation. METHODS: Record demographics and Functional Independent Measure™ scores among inpatients who used the technology during physical, occupational or recreational therapy. Record exercises performed with the technology, longest exercise duration performed (calculated from sensor data), user feedback, and therapist responses to a validated technology assessment questionnaire. RESULTS: Inpatients (n = 21) between the ages of 19 and 86 (mean 57 ± 18; 12 male/9 female) receiving treatment for motor deficits associated with neuropathology used the application in conjunction with occupational, recreational, or physical therapy during 1 to 7 sessions. Patients classified on the Functional Independence Measure™ as requiring 75%+ assistance for cognitive and motor function were able to use the interactive application. CONCLUSIONS: Customized interactive arts applications are appropriate for further study as a therapeutic modality. In addition to providing interactivity to individuals with low motor function, interactive arts applications might serve to augment activity-based medicine among inpatients with low problem-solving and memory function.

Proof of concept of the ability of the kinect to quantify upper extremity function in dystrophinopathy.

INTRODUCTION: Individuals with dystrophinopathy lose upper extremity strength in proximal muscles followed by those more distal. Current upper extremity evaluation tools fail to fully capture changes in upper extremity strength and function across the disease spectrum as they tend to focus solely on distal ability. The Kinect by Microsoft is a gaming interface that can gather positional information about an individual's upper extremity movement which can be used to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. The purpose of this study was to determine the feasibility of using the Kinect platform to assess upper extremity function in individuals with dystrophinopathy across the spectrum of abilities. METHODS: Investigators developed a proof-of-concept device, ACTIVE (Abilities Captured Through Interactive Video Evaluation), to measure functional reaching volume, movement velocity, and rate of fatigue. Five subjects with dystrophinopathy and 5 normal controls were tested using ACTIVE during one testing session. A single subject with dystrophinopathy was simultaneously tested with ACTIVE and a marker-based motion analysis system to establish preliminary validity of measurements. RESULTS: ACTIVE proof-of-concept ranked the upper extremity abilities of subjects with dystrophinopathy by Brooke score, and also differentiated them from performance of normal controls for the functional reaching volume and velocity tests. Preliminary test-retest reliability of the ACTIVE for 2 sequential trials was excellent for functional reaching volume (ICC=0.986, p<0.001) and velocity trials (ICC=0.963, p<0.001). DISCUSSION: The data from our pilot study with ACTIVE proof-of-concept demonstrates that newly available gaming technology has potential to be used to create a low-cost, widely-accessible and functional upper extremity outcome measure for use with children and adults with dystrophinopathy.

A split-crank bicycle ergometer uses servomotors to provide programmable pedal forces for studies in human biomechanics.

This paper presents a novel computer-controlled bicycle ergometer, the TiltCycle, for use in human biomechanics studies of locomotion. The TiltCycle has a tilting (reclining) seat and backboard, a split pedal crankshaft to isolate the left and right loads to the feet of the pedaler, and two belt-driven, computer-controlled motors to provide assistance or resistance loads independently to each crank. Sensors measure the kinematics and force production of the legs to calculate work performed, and the system allows for goniometric and electromyography signals to be recorded. The technical description presented includes the mechanical design, low-level software and control algorithms, system identification and validation test results.

Poststroke upper extremity rehabilitation: a review of robotic systems and clinical results.

Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of clinical study of the devices make it difficult to follow and interpret the results in this new field. This article is a review of the current state-of-the-art in robotic applications in poststroke therapy for the upper extremity, written specifically to help clinicians determine the differences between various systems. We concentrate primarily on systems that have been tested clinically. Robotic systems are grouped by rehabilitation application (e.g., gross motor movement, bilateral training, etc.), and, where possible, the neurorehabilitation strategies employed by each system are described. We close with a discussion of the benefits and concerns of using robotics in rehabilitation and an indication of challenges that must be addressed for therapeutic robots to be applied practically in the clinic.