Motor learning in children with hemiplegic cerebral palsy: feedback effects on skill acquisition

Burtner, Patricia A.; Leinwand, Robin; Sullivan, Katherine J.; Goh, Hui-Ting; Kantak, Shailesh

doi:10.1111/dmcn.12364

Cited by 35 publications

(24 citation statements)

References 28 publications

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“…This significant because it lends justification to the potential use of the normalization algorithms to conduct studies on patients with physical impairment. Physical impairment has often been cited as a confounding factor in motor learning studies, as researchers are unable to determine whether poor results are due to an inability to motor learn or because of physical barriers (Valvano and Rapport, 2006; Burtner et al, 2014; van Abswoude et al, 2015). Using normalization, therapists may be able to evaluate the cognitive ability of a patient independently of their physical impairment, alleviating the compounding factors surrounding motor learning.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors promote the well-developed “assist-as-needed” (AAN) paradigm (Jezernik et al, 2004) while others suggest that error-augmentation (EA) is more effective (Patton et al, 2006). The most recent evidence suggests that the answer depends on a range of factors, from frequency of feedback to initial skill level (Wulf et al, 2010; Burtner et al, 2014; Marchal-Crespo et al, 2015; Fujii et al, 2016). In other words, the potential for motor learning is largely subject-dependent.…”

Section: Introductionmentioning

confidence: 99%

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Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

Jarrett

McDaid

2017

Front. Neurosci.

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Motor learning is a critical component of the rehabilitation process; however, it can be difficult to separate the fundamental causes of a learning deficit when physical impairment is a confounding factor. In this paper, a new technique is proposed to augment the residual ability of physically impaired patients with a robotic rehabilitation exoskeleton, such that motor learning can be studied independently of physical impairment. The proposed technique augments the velocity of an on-screen cursor relative to the restricted physical motion. Radial Basis Functions (RBFs) are used to both model velocity and derive a function to scale velocity as a function of workspace position. Two variations of the algorithm are presented for comparison. In a cross-over pilot study, healthy participants were recruited and subjected to a simulated impairment to constrain their motion, imposed by the cable-driven wrist exoskeleton. Participants then completed a sinusoidal tracking task, in which the algorithms were statistically shown to augment the cursor velocity in the constrained state such that it matched position-dependent velocities recorded in the healthy state. A kinematic task was then designed as a motor-learning case study where the algorithms were statistically shown to allow participants to achieve the same performance when their motion was constrained as when unconstrained. The results of the pilot study provide motivation for further research into the use of this technique, thus providing a tool with which motor-learning can be studied in neurologically impaired populations. This could be used to give physiotherapists greater insight into underlying causes of motor learning deficits, consequently facilitating and enhancing subject-specific therapy regimes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

Jarrett

McDaid

2017

Front. Neurosci.

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“…Some of the computations needed for successful motor function are preserved in CP. For example, children with CP retain the ability to learn and show improvements in movement accuracy with practice, although less than in typically-developing (TD) children [ 36 ]. Children with CP have intact internal models of their own movement variability, being able to take into account their own motor variability when moving to reach a target [ 37 ].…”

Section: Introductionmentioning

confidence: 99%

The integration of probabilistic information during sensorimotor estimation is unimpaired in children with Cerebral Palsy

et al. 2017

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BackgroundIt is important to understand the motor deficits of children with Cerebral Palsy (CP). Our understanding of this motor disorder can be enriched by computational models of motor control. One crucial stage in generating movement involves combining uncertain information from different sources, and deficits in this process could contribute to reduced motor function in children with CP. Healthy adults can integrate previously-learned information (prior) with incoming sensory information (likelihood) in a close-to-optimal way when estimating object location, consistent with the use of Bayesian statistics. However, there are few studies investigating how children with CP perform sensorimotor integration. We compare sensorimotor estimation in children with CP and age-matched controls using a model-based analysis to understand the process.Methods and findingsWe examined Bayesian sensorimotor integration in children with CP, aged between 5 and 12 years old, with Gross Motor Function Classification System (GMFCS) levels 1–3 and compared their estimation behavior with age-matched typically-developing (TD) children. We used a simple sensorimotor estimation task which requires participants to combine probabilistic information from different sources: a likelihood distribution (current sensory information) with a prior distribution (learned target information). In order to examine sensorimotor integration, we quantified how participants weighed statistical information from the two sources (prior and likelihood) and compared this to the statistical optimal weighting. We found that the weighing of statistical information in children with CP was as statistically efficient as that of TD children.ConclusionsWe conclude that Bayesian sensorimotor integration is not impaired in children with CP and therefore, does not contribute to their motor deficits. Future research has the potential to enrich our understanding of motor disorders by investigating the stages of motor processing set out by computational models. Therapeutic interventions should exploit the ability of children with CP to use statistical information.

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“…In cases where a body part is not in use, the representation area of this part in the brain shrinks and vice versa (Burtner et al, 2014). When a specific part is continuously and widely used, the area representing that part in the brain is enlarged.…”

Section: Physiotherapy Managementmentioning

confidence: 99%

“…When a specific part is continuously and widely used, the area representing that part in the brain is enlarged. In the case of a brain injury that damages the representation of a part of the body in the primary motor cortex, plasticity will permit reorganisation to restore a representation (Burtner et al, 2014). While the primary motor cortex is the main and most powerful contributor to the corticospinal tract, the premotor cortex is also a secondary less powerful contributor.…”

Section: Physiotherapy Managementmentioning

confidence: 99%

The Home Treatment as a Supporting Method of Bobath for Treatment of Children with Cerebral Palsy in Kuwait

Al-Mater¹

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Motor learning in children with hemiplegic cerebral palsy: feedback effects on skill acquisition

Cited by 35 publications

References 28 publications

Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

The integration of probabilistic information during sensorimotor estimation is unimpaired in children with Cerebral Palsy

The Home Treatment as a Supporting Method of Bobath for Treatment of Children with Cerebral Palsy in Kuwait

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