scholarly journals Selective voluntary motor control measures of the lower extremity in children with upper motor neuron lesions: a systematic review

2017 ◽  
Vol 59 (7) ◽  
pp. 699-705 ◽  
Author(s):  
Julia Balzer ◽  
Marietta L van der Linden ◽  
Thomas H Mercer ◽  
Hubertus J A van Hedel
Keyword(s):  
Systematic Review ◽  
Motor Control ◽  
Lower Extremity ◽  
Motor Neuron ◽  
Control Measures ◽  
Voluntary Motor

scholarly journals First validation of a novel assessgame quantifying selective voluntary motor control in children with upper motor neuron lesions

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jeffrey W. Keller ◽  
Julia Balzer ◽  
Annina Fahr ◽  
Jan Lieber ◽  
Urs Keller ◽  
...  
Keyword(s):  
Motor Control ◽  
Motor Neuron ◽  
Low Cost ◽  
Compensatory Mechanisms ◽  
Involuntary Movements ◽  
Clinical Assessments ◽  
Voluntary Motor ◽  
Outcome Score ◽  
Computer Based ◽  
Neurologically Intact

AbstractThe question whether novel rehabilitation interventions can exploit restorative rather than compensatory mechanisms has gained momentum in recent years. Assessments measuring selective voluntary motor control could answer this question. However, while current clinical assessments are ordinal-scaled, which could affect their sensitivity, lab-based assessments are costly and time-consuming. We propose a novel, interval-scaled, computer-based assessment game using low-cost accelerometers to evaluate selective voluntary motor control. Participants steer an avatar owl on a star-studded path by moving the targeted joint of the upper or lower extremities. We calculate a target joint accuracy metric, and an outcome score for the frequency and amplitude of involuntary movements of adjacent and contralateral joints as well as the trunk. We detail the methods and, as a first proof of concept, relate the results of select children with upper motor neuron lesions (n = 48) to reference groups of neurologically intact children (n = 62) and adults (n = 64). Linear mixed models indicated that the cumulative therapist score, rating the degree of selectivity, was a good predictor of the involuntary movements outcome score. This highlights the validity of this assessgame approach to quantify selective voluntary motor control and warrants a more thorough exploration to quantify changes induced by restorative interventions.

scholarly journals An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study

10.2196/26028 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e26028
Author(s):  
Annina Fahr ◽  
Andrina Kläy ◽  
Jeffrey W Keller ◽  
Hubertus J A van Hedel
Keyword(s):  
Motor Control ◽  
Motor Neuron ◽  
Children And Adolescents ◽  
Response Times ◽  
Computer Game ◽  
Voluntary Motor ◽  
Game Features ◽  
Test Version ◽  
Feedback Modalities ◽  
Game Environment

Background Computer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance. Objective The overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility. Methods We identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions. Results The game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues. Conclusions The careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions.

scholarly journals Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Annina Fahr ◽  
Andrina Kläy ◽  
Larissa S. Coka ◽  
Hubertus J. A. van Hedel
Keyword(s):  
Motor Control ◽  
Motor Neuron ◽  
Primary Outcome ◽  
Children And Youth ◽  
Multiple Baseline ◽  
Multiple Baseline Design ◽  
Design Study ◽  
Baseline Design ◽  
Voluntary Motor ◽  
Secondary Outcomes

Abstract Background Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions. Methods We will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests. Discussion This study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting. Trial registration German Clinical Trials Register: DRKS00025184, registered on 28.04.2021.

scholarly journals An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Annina Fahr ◽  
Andrina Kläy ◽  
Jeffrey W Keller ◽  
Hubertus J A van Hedel
Keyword(s):  
Motor Control ◽  
Motor Neuron ◽  
Children And Adolescents ◽  
Response Times ◽  
Computer Game ◽  
Voluntary Motor ◽  
Game Features ◽  
Test Version ◽  
Feedback Modalities ◽  
Game Environment

BACKGROUND Computer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance. OBJECTIVE The overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility. METHODS We identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions. RESULTS The game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (<i>P</i>=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues. CONCLUSIONS The careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions. CLINICALTRIAL

scholarly journals Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110080
Author(s):  
Jeffrey W Keller ◽  
Annina Fahr ◽  
Julia Balzer ◽  
Jan Lieber ◽  
Hubertus JA van Hedel
Keyword(s):  
Motor Control ◽  
Motor Neuron ◽  
Concurrent Validity ◽  
Muscle Activation ◽  
Intraclass Correlation ◽  
Similarity Index ◽  
Validity And Reliability ◽  
Activation Patterns ◽  
Voluntary Motor ◽  
Muscle Activation Patterns

Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = −0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients’ median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.

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