First-principle data-driven models for assessment of motor disorders in Parkinson’s disease

Parkinson’s disease (PD) is an increasing neurological disorder in an aging society. The motor and non-motor symptoms of PD advance with the disease progression and occur in varying frequency and duration. In order to affirm the full extent of a patient’s condition, repeated assessments are necessary to adjust medical prescription. In clinical studies, symptoms are assessed using the unified Parkinson’s disease rating scale (UPDRS). On one hand, the subjective rating using UPDRS relies on clinical expertise. On the other hand, it requires the physical presence of patients in clinics which implies high logistical costs. Another limitation of clinical assessment is that the observation in hospital may not accurately represent a patient’s situation at home. For such reasons, the practical frequency of tracking PD symptoms may under-represent the true time scale of PD fluctuations and may result in an overall inaccurate assessment. Current technologies for at-home PD treatment are based on data-driven approaches for which the interpretation and reproduction of results are problematic.  The overall objective of this thesis is to develop and evaluate unobtrusive computer methods for enabling remote monitoring of patients with PD. It investigates first-principle data-driven model based novel signal and image processing techniques for extraction of clinically useful information from audio recordings of speech (in texts read aloud) and video recordings of gait and finger-tapping motor examinations. The aim is to map between PD symptoms severities estimated using novel computer methods and the clinical ratings based on UPDRS part-III (motor examination). A web-based test battery system consisting of self-assessment of symptoms and motor function tests was previously constructed for a touch screen mobile device. A comprehensive speech framework has been developed for this device to analyze text-dependent running speech by: (1) extracting novel signal features that are able to represent PD deficits in each individual component of the speech system, (2) mapping between clinical ratings and feature estimates of speech symptom severity, and (3) classifying between UPDRS part-III severity levels using speech features and statistical machine learning tools. A novel speech processing method called cepstral separation difference showed stronger ability to classify between speech symptom severities as compared to existing features of PD speech. In the case of finger tapping, the recorded videos of rapid finger tapping examination were processed using a novel computer-vision (CV) algorithm that extracts symptom information from video-based tapping signals using motion analysis of the index-finger which incorporates a face detection module for signal calibration. This algorithm was able to discriminate between UPDRS part III severity levels of finger tapping with high classification rates. Further analysis was performed on novel CV based gait features constructed using a standard human model to discriminate between a healthy gait and a Parkinsonian gait. The findings of this study suggest that the symptom severity levels in PD can be discriminated with high accuracies by involving a combination of first-principle (features) and data-driven (classification) approaches. The processing of audio and video recordings on one hand allows remote monitoring of speech, gait and finger-tapping examinations by the clinical staff. On the other hand, the first-principles approach eases the understanding of symptom estimates for clinicians. We have demonstrated that the selected features of speech, gait and finger tapping were able to discriminate between symptom severity levels, as well as, between healthy controls and PD patients with high classification rates. The findings support suitability of these methods to be used as decision support tools in the context of PD assessment.

Automatic spiral analysis for objective assessment of motor symptoms in Parkinson's disease

A challenge for the clinical management of advanced Parkinson’s disease (PD) patients is the emergence of fluctuations in motor performance, which represents a significant source of disability during activities of daily living of the patients. There is a lack of objective measurement of treatment effects for in-clinic and at-home use that can provide an overview of the treatment response. The objective of this paper was to develop a method for objective quantification of advanced PD motor symptoms related to off episodes and peak dose dyskinesia, using spiral data gathered by a touch screen telemetry device. More specifically, the aim was to objectively characterize motor symptoms (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Digitized upper limb movement data of 65 advanced PD patients and 10 healthy (HE) subjects were recorded as they performed spiral drawing tasks on a touch screen device in their home environment settings. Several spatiotemporal features were extracted from the time series and used as inputs to machine learning methods. The methods were validated against ratings on animated spirals scored by four movement disorder specialists who visually assessed a set of kinematic features and the motor symptom. The ability of the method to discriminate between PD patients and HE subjects and the test-retest reliability of the computed scores were also evaluated. Computed scores correlated well with mean visual ratings of individual kinematic features. The best performing classifier (Multilayer Perceptron) classified the motor symptom (bradykinesia or dyskinesia) with an accuracy of 84% and area under the receiver operating characteristics curve of 0.86 in relation to visual classifications of the raters. In addition, the method provided high discriminating power when distinguishing between PD patients and HE subjects as well as had good test-retest reliability. This study demonstrated the potential of using digital spiral analysis for objective quantification of PD-specific and/or treatment-induced motor symptoms.

Does balance or motor impairment of limbs discriminate the ambulatory satus of stroke survivors?

Objective: This study was performed to determine if ambulatory function is governed by motor impairment of limbs or balance ability in subjects with hemiplegia caused by stroke.
Design: Seven patients who walked with physical assistance (FIM(TM) 4) after stroke and 13 who walked independently with assistive devices (FIM 6) were compared with 13 healthy subjects. Motor impairment of limbs was evaluated with the Fugl-Meyer Assessment. The Berg Balance Scale and limit of stability test of the Smart Balance Master were used to evaluate balance ability.
Results: The FIM 6 group and the controls were best differentiated by motor impairment of the paretic limbs and limit of stability in the backward direction. Motor impairment of the upper limb and limit of stability in direction toward the paretic side separated the FIM 4 from the FIM 6 group. Upper limb motor impairment and the Berg Balance Scale consistently separated the three subject groups.
Conclusions: Motor impairment in the paretic upper limb and balance dysfunction should be addressed in treatments working toward independent ambulation.

Does childhood motor skill proficiency predict adolescent fitness?

Purpose: To determine whether childhood fundamental motor skill proficiency predicts subsequent adolescent cardiorespiratory fitness.

Methods: In 2000, children's proficiency in a battery of skills was assessed as part of an elementary school-based intervention. Participants were followed up during 2006/2007 as part of the Physical Activity and Skills Study, and cardiorespiratory fitness was measured using the Multistage Fitness Test. Linear regression was used to examine the relationship between childhood fundamental motor skill proficiency and adolescent cardiorespiratory fitness controlling for gender. Composite object control (kick, catch, throw) and locomotor skill (hop, side gallop, vertical jump) were constructed for analysis. A separate linear regression examined the ability of the sprint run to predict cardiorespiratory fitness.

Results: Of the 928 original intervention participants, 481 were in 28 schools, 276 (57%) of whom were assessed. Two hundred and forty-four students (88.4%) completed the fitness test. One hundred and twenty-seven were females (52.1%), 60.1% of whom were in grade 10 and 39.0% were in grade 11. As children, almost all 244 completed each motor assessments, except for the sprint run (n = 154, 55.8%). The mean composite skill score in 2000 was 17.7 (SD 5.1). In 2006/2007, the mean number of laps on the Multistage Fitness Test was 50.5 (SD 24.4). Object control proficiency in childhood, adjusting for gender (P = 0.000), was associated with adolescent cardiorespiratory fitness (P = 0.012), accounting for 26% of fitness variation.

Conclusion: Children with good object control skills are more likely to become fit adolescents. Fundamental motor skill development in childhood may be an important component of interventions aiming to promote long-term fitness.

Corticomotor responses to attentionally demanding motor performance: a mini-review

Increased attentional demand has been shown to reduce motor performance, leading to increases in accidents, particularly in elderly populations. While these deficits have been well documented behaviorally, their cortical correlates are less well known. Increased attention has been shown to affect activity in prefrontal regions of the cortex. However there have been varying results within past research investigating corticomotor regions, mediating motor performance. This mini-review initially discusses past behavioral research, before moving to studies investigating corticomotor areas in response to changes in attention. Recent dual task studies have revealed a possible decline in the ability of older, but not younger, adults to activate inhibitory processes within the motor cortex, which may be correlated with poor motor performance, and thus accidents. A reduction in cortical inhibition may be caused by neurodegeneration within prefrontal regions of the cortex with age, rendering older adults less able to allocate attention to corticomotor regions.

Formation of cortical plasticity in older adults following tDCS and motor training

Neurodegeneration accompanies the process of natural aging, reducing the ability to perform functional daily activities. Transcranial direct current stimulation (tDCS) alters neuronal excitability and motor performance; however its beneficial effect on the induction of primary motor cortex (M1) plasticity in older adults is unclear. Moreover, little is known as to whether the tDCS electrode arrangement differentially affects M1 plasticity and motor performance in this population. In a double-blinded, cross-over trial, we compared unilateral, bilateral and sham tDCS combined with visuomotor tracking, on M1 plasticity and motor performance of the non-dominant upper limb, immediately post and 30 min following stimulation. We found (a) unilateral and bilateral tDCS decreased tracking error by 12–22% at both time points; with sham decreasing tracking error by 10% at 30 min only, (b) at both time points, motor evoked potentials (MEPs) were facilitated (38–54%) and short-interval intracortical inhibition was released (21–36%) for unilateral and bilateral conditions relative to sham, (c) there were no differences between unilateral and bilateral conditions for any measure. These findings suggest that tDCS modulated elements of M1 plasticity, which improved motor performance irrespective of the electrode arrangement. The results provide preliminary evidence indicating that tDCS is a safe non-invasive tool to preserve or improve neurological function and motor control in older adults.

Online motor control in children with developmental coordination disorder: chronometric analysis of double-step reaching performance

Background
Although there are a number of plausible accounts to explain movement clumsiness in children [or developmental coordination disorder (DCD)], the cause(s) of the disorder remain(s) an issue of debate. One aspect of motor control that is particularly important to the fluid expression of skill is rapid online control (ROC). Data on DCD have been conflicting. While some recent work using double-step reaching suggests no difficulty in online control, others suggest deficits (e.g. based on sequential pointing). To help resolve this debate, we suggest two things: use of recent neuro-computational models as a framework for investigating motor control in DCD, and more rigorous investigation of double-step reaching. Our working assumption here is that ROC is only viable through the seamless integration of predictive (or forward) models of movement and feedback-based mechanisms.

Aim
The aim of this chronometric study was to explore ROC in children with DCD using a double-step reaching paradigm. We predicted slower online adjustments in DCD based on the argument that these children manifest a core difficulty in predictive control.

Methods
Participants were a group of 17 children with DCD and 27 typically developing children aged between 7 and 12 years. Visual targets were presented on a 17-inch LCD touch screen, inclined to an angle of 15° from horizontal. The children were instructed to press each target as it appeared as quickly and accurately as possible. For 80% of the trials, the central target location remained unchanged for the duration of the movement (non-jump trials), while for the remaining 20% of trials, the target jumped at movement onset to one of the two peripheral locations (jump trials). Reaction time (RT), movement time (MT) and reaching errors were recorded.

Results
For both groups, RT did not vary according to trial condition, while children with DCD were slower to initiate movement. Further, the MT of children with DCD was prolonged to a far greater extent on jump trials relative to controls, with a large effect size. As well, children with DCD committed significantly more errors, notably a reduced ability to inhibit central responses on jump trials.

Conclusion
Our findings help reconcile some disparate findings in the literature using similar tasks. The pattern of performance in children with DCD suggests impairment in the ability to make rapid online adjustments that are based on a predictive (or internal) model of the action. These results pave the way for future kinematic investigation.

Interrater reliability assessment using the Test of Gross Motor Development-2

Objectives: The aim was to examine interrater reliability of the object control subtest from the Test of Gross Motor Development-2 by live observation in a school field setting. Design:: Reliability Study - cross sectional. Methods: Raters were rated on their ability to agree on (1) the raw total for the six object control skills; (2) each skill performance and (3) the skill components. Agreement for the object control subtest and the individual skills was assessed by an intraclass correlation (ICC) and a kappa statistic assessed for skill component agreement. Results: A total of 37 children (65% girls) aged 4-8 years (M= 6.2, SD=0.8) were assessed in six skills by two raters; equating to 222 skill tests. Interrater reliability was excellent for the object control subset (ICC= 0.93), and for individual skills, highest for the dribble (ICC= 0.94) followed by strike (ICC= 0.85), overhand throw (ICC= 0.84), underhand roll (ICC= 0.82), kick (ICC= 0.80) and the catch (ICC= 0.71). The strike and the throw had more components with less agreement. Conclusions: Even though the overall subtest score and individual skill agreement was good, some skill components had lower agreement, suggesting these may be more problematic to assess. This may mean some skill components need to be specified differently in order to improve component reliability.

Responsible management of motor vehicle drivers with dementia

When Bridget Driscoll, a 44-year-old mother of two died after being struck by a motor vehicle, considered to be the first motor vehicle fatality in UK and possibly the world, the coroner stated 'I trust this sort of nonsense will never happen again'.1 Sadly, the coroner, medical practitioners and general public would be deeply and repeatedly disappointed. It was 1896. Motor vehicles were a curiosity. Drivers did not undergo any form of testing, be it medical fitness, driving ability or otherwise, and there were no licensing regulatory agencies. By 2010, road injury was the ninth most common cause of death globally (1.3 million deaths per annum) and dementia the fourth most common in high income countries.2 By 2030 the number of all licensed UK drivers who are 65 years or older will increase by almost 50% to almost one in every four drivers.3 If the juxtaposition of driving with dementia in an ageing population is not already a contentious social, political and medical issue, it certainly will become so.

Oral treatment with Cu(II)(atsm) increases mutant SOD1 in vivo but protects motor neurons and improves the phenotype of a transgenic mouse model of amyotrophic lateral sclerosis

Mutations in the metallo-protein Cu/Zn-superoxide dismutase (SOD1) cause amyotrophic lateral sclerosis (ALS) in humans and an expression level-dependent phenotype in transgenic rodents. We show that oral treatment with the therapeutic agent diacetyl-bis(4-methylthiosemicarbazonato)copper(II) [Cu(II)(atsm)] increased the concentration of mutant SOD1 (SOD1G37R) in ALS model mice, but paradoxically improved locomotor function and survival of the mice. To determine why the mice with increased levels of mutant SOD1 had an improved phenotype, we analyzed tissues by mass spectrometry. These analyses revealed most SOD1 in the spinal cord tissue of the SOD1G37R mice was Cu deficient. Treating with Cu(II)(atsm) decreased the pool of Cu-deficient SOD1 and increased the pool of fully metallated (holo) SOD1. Tracking isotopically enriched (65)Cu(II)(atsm) confirmed the increase in holo-SOD1 involved transfer of Cu from Cu(II)(atsm) to SOD1, suggesting the improved locomotor function and survival of the Cu(II)(atsm)-treated SOD1G37R mice involved, at least in part, the ability of the compound to improve the Cu content of the mutant SOD1. This was supported by improved survival of SOD1G37R mice that expressed the human gene for the Cu uptake protein CTR1. Improving the metal content of mutant SOD1 in vivo with Cu(II)(atsm) did not decrease levels of misfolded SOD1. These outcomes indicate the metal content of SOD1 may be a greater determinant of the toxicity of the protein in mutant SOD1-associated forms of ALS than the mutations themselves. Improving the metal content of SOD1 therefore represents a valid therapeutic strategy for treating ALS caused by SOD1.

Developmental improvements in reaching correction efficiency are associated with an increased ability to represent action mentally

We investigated the purported association between developmental changes in the efficiency of online reaching corrections and improved action representation. Younger children (6-7years), older children (8-12years), adolescents (13-17years), and young adults (18-24years) completed a double-step reaching paradigm and a motor imagery task. Results showed similar nonlinear performance improvements across both tasks, typified by substantial changes in efficiency after 6 or 7years followed by incremental improvements. Regression showed that imagery ability significantly predicted reaching efficiency and that this association stayed constant across age. Findings provide the first empirical evidence that more efficient online control through development is predicted, partly, by improved action representation.

Reduced motor imagery efficiency is associated with online control difficulties in children with probable developmental coordination disorder

Recent evidence indicates that the ability to correct reaching movements in response to unexpected target changes (i.e., online control) is reduced in children with developmental coordination disorder (DCD). Recent computational modeling of human reaching suggests that these inefficiencies may result from difficulties generating and/or monitoring internal representations of movement. This study was the first to test this putative relationship empirically. We did so by investigating the degree to which the capacity to correct reaching mid-flight could be predicted by motor imagery (MI) proficiency in a sample of children with probable DCD (pDCD). Thirty-four children aged 8 to 12 years (17 children with pDCD and 17 age-matched controls) completed the hand rotation task, a well-validated measure of MI, and a double-step reaching task (DSRT), a protocol commonly adopted to infer one's capacity for correcting reaching online. As per previous research, children with pDCD demonstrated inefficiencies in their ability to generate internal action representations and correct their reaching online, demonstrated by inefficient hand rotation performance and slower correction to the reach trajectory following unexpected target perturbation during the DSRT compared to age-matched controls. Critically, hierarchical moderating regression demonstrated that even after general reaching ability was controlled for, MI efficiency was a significant predictor of reaching correction efficiency, a relationship that was constant across groups. Ours is the first study to provide direct pilot evidence in support of the view that a decreased capacity for online control of reaching typical of DCD may be associated with inefficiencies generating and/or using internal representations of action.

Fuzzy logic controller optimized by particle swarm optimization for DC motor speed control

In this paper, we presented an optimized fuzzy logic controller using particle swarm optimization for DC motor speed control. The controller model is simulated using MATLAB software and also experimentally tested on a laboratory DC motor. A comparison of the performance of different controllers such as PID controller, fuzzy logic controller and optimized fuzzy logic controller is presented as well. With reference to the results of digital simulations and experiment, the designed FLC-PSO speed controller obtains much better dynamic behavior compared to PID and the normal FLC designed. Moreover, it can acquire superior performance of the DC motor, and also perfect speed tracking with no overshoot. The optimized membership functions (MFs) are obviously proved to be able to provide a better performance and higher robustness in comparison with a regular fuzzy model, when the MFs were heuristically defined. Besides, experimental results verify the ability of proposed FLC under sudden change of the load torque which leads to speed variances.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

Comparação entre o desempenho motor de hommes e mulheres em séries múltiplas de exercícios com pesos

The magnitude of men and women's neuromuscular, metabolic, and morphologic responses seems to be quite different even when both are submitted to exercise protocols using similar weight exercises protocols. However, differences in the motor performance between men and women have been predominantly reported in protocols based on isometric and isokinetic contractions. Thus, this study aimed to analyze men and women's behavior during multiple sets of weight exercises achieving the exhaustion, and later verifying possible differences as to the physical performance between genders using weights with similar intensity. For this, 83 subjects (50 men, and 33 women), 48 hours after being submitted to 1-RM tests in bench press, squat and arm curl performed a protocol composed by four sets at 1-RM 80% up to achieving the exhaustion in each of three exercises to evaluate the endurance ability to the fatigue in different muscular groups. It was used the ANOVA and ANCOVA for repeated measurements, followed by the Tukey's post hoc test, where P < 0.05 to the data treatment. It was verified a significant fall in the performance both in men and in women since the first up to the fourth sets of every exercise investigated (P < 0.01). Although the fatigue magnitude was higher in men in all the three exercises, the effect on the gender was only identified in the arm curl exercise (P < 0.01). The results of this study indicated that men and women presented quite different behavior in multiple sets of weight exercises, and women presented a more stable performance and a higher endurance ability to the fatigue in the arm curl as well.