Training-based interventions in motor rehabilitation after stroke: theoretical and clinical considerations

Basic neuroscience research on brain plasticity, motor learning and recovery has stimulated new concepts in neurological rehabilitation. Combined with the development of set methodological standards in clinical outcome research, these findings have led to a double-paradigm shift in motor rehabilitation: (a) the move towards evidence-based procedures for the assessment of clinical outcome & the employment of disablement models to anchor outcome parameters, and (b) the introduction of practice-based concepts that are derived from testable models that specify treatment mechanisms. In this context, constraint-induced movement therapy (CIT) has played a catalytic role in taking motor rehabilitation forward into the scientific arena. As a theoretically founded and hypothesis-driven intervention, CIT research focuses on two main issues. The first issue is the assessment of long-term clinical benefits in an increasing range of patient groups, and the second issue is the investigation of neuronal and behavioural treatment mechanisms and their interactive contribution to treatment success. These studies are mainly conducted in the research environment and will eventually lead to increased treatment benefits for patients in standard health care. However, gradual but presumably more immediate benefits for patients may be achieved by introducing and testing derivates of the CIT concept that are more compatible with current clinical practice. Here, we summarize the theoretical and empirical issues related to the translation of research-based CIT work into the clinical context of standard health care.     

Coping through emotional approach: a new look at emotion, coping, and health-related outcomes

Researchers studying stress and coping processes have attempted to identify which coping strategies are most adaptive in stressful encounters. A generally accepted conclusion has been that emotion-focused coping processes are associated with dysfunctional outcomes. Studies from our and other research teams challenge the "bad reputation" of emotion-focused coping by demonstrating that items measuring emotion-focused strategies in published coping questionnaires are confounded with distress and self-deprecation. We have developed and validated new instruments to assess coping though acknowledging, understanding, and expressing emotion, that is, coping through emotional approach. Longitudinal and experimental studies using these new scales have documented the adaptive potential of emotional-approach coping in the context of several types of stressors, including infertility, breast cancer, and chronic pain. However, characteristics of the environmental context, stressful experience, and individual are important moderators of the relations of emotional-approach coping and health-related outcomes. Potential mediators and moderators of coping through emotional approach, clinical relevance of the construct, and directions for research are discussed.     

Prehension in young children with Down syndrome

Prehension was examined in 3-year old children with Down syndrome (DS, n = 3) and in typically-developing children matched in chronological age (3-year olds; n = 3) or mental age and motor experience (2-year olds; n = 3). The task required reaching to grasp dowels. Video-based movement analysis yielded temporal and kinematic measures. Children with DS were hypothesized to have deficits in feedback-dependent components of prehension (anticipatory grip-closure and deceleration of reach), whereas feedforward components (reach's acceleration phase; grasp's preshaping) were assumed to be unimpaired [Latash, 1993, Control of human movement, pp. 283-292; Latash, 1994, What is clumsiness? In: Motor Control and Down Syndrome II Proceedings of the second international conference, pp. 68-71]. The findings supported these hypotheses. In comparison to control groups, children with DS had significantly: (a) less time in deceleration of reaching, (b) fewer anticipatory grip-closures, and (c) longer movement times for dowel-lift. Young children with DS appeared to use dowel-contact to decelerate the limb and initiate grip-closure. In contrast, reach-acceleration time and grasp-preshaping did not differ across groups. These findings suggest that children with DS display qualitative differences in motor capabilities rather than simply a delayed rate of typical developmental progression.     

Modeling language acquisition in atypical phenotypes

An increasing number of connectionist models have been proposed to explain behavioral deficits in developmental disorders. These simulations motivate serious consideration of the theoretical implications of the claim that a developmental disorder fits within the parameter space of a particular computational model of normal development. The authors examine these issues in depth with respect to a series of new simulations investigating past-tense formation in Williams syndrome. This syndrome and the past-tense domain are highly relevant because both have been used to make strong theoretical claims about the processes underlying normal language acquisition. The authors conclude that computational models have great potential to advance psychologists' understanding of developmental deficits because they focus on the developmental process itself as a pivotal causal factor in producing atypical phenotypic outcomes.     

Word associations in deep dyslexia

Deep dyslexia is an acquired reading disorder resulting in the production of semantic errors during oral reading and an inability to read aloud nonwords. Several researchers have postulated that patients with deep dyslexia have both phonological and semantic access impairments but the data supporting these claims are not convincing. In fact, the hallmark feature of deep dyslexia--the semantic errors--strongly implies that these patients can access semantic information from printed words. We test the integrity of the semantic system in two such patients through auditory and visual word association tasks. The data support the notion that semantics remains intact and that the disorder and associated errors arise through a selection impairment related to failure of inhibitory connections in the phonological lexicon.     

Unique transitions between stimuli and responses in SRT tasks: Evidence for the primacy of response predictions

The present experiments aimed at separating the impact stimulus and response predictions have on serial learning and performance in SRT tasks. In Experiment 1, a unique transition between two of four responses in an otherwise random response sequence was triggered by ambiguous stimulus transitions, allowing local response predictions but no stimulus predictions. The data indicated explicit transition knowledge and strong performance benefits. In Experiments 2 and 3, unique transitions between two of four stimuli in otherwise random stimulus sequences allowed local stimulus predictions under conditions of ambiguous response transitions. The data indicated fragmentary explicit transition knowledge but no performance effects. Experiments 4a and 4b reveal that the inefficacy of the unique stimulus transitions in Experiments 2 and 3 was presumably due to the fact that the stimuli differed with respect to conjunctions of response relevant and response irrelevant features which participants did not have to attend. However, although in Experiments 4a and 4b unique transitions between response relevant stimuli were applied, substantial explicit transition knowledge but only marginal performance effects resulted. It is argued i) that in SRT tasks learning mechanisms are addressed that primarily strive for reliable predictions of forthcoming responses and ii) that for these mechanisms to work the predictors have to be attended. Response transitions are easily learned and used because both criteria are fulfilled. In contrast, pure stimulus transitions are learned only if the predictive stimuli are attended, and learned stimulus transitions become effective only to the extent that the predicted stimuli specify the required responses.     

Semantic categorization in the human brain: spatiotemporal dynamics revealed by magnetoencephalography

We examined the cortical representation of semantic categorization using magnetic source imaging in a task that revealed both dissociations among superordinate categories and associations among different base-level concepts within these categories. Around 200 ms after stimulus onset, the spatiotemporal correlation of brain activity elicited by base-level concepts was greater within than across superordinate categories in the right temporal lobe. Unsupervised clustering of data showed similar categorization between 210 and 450 ms mainly in the left hemisphere. This pattern suggests that well-defined semantic categories are represented in spatially distinct, macroscopically separable neural networks, independent of physical stimulus properties. In contrast, a broader, task-required categorization (natural/man-made) was not evident in our data. The perceptual dynamics of the categorization process is initially evident in the extrastriate areas of the right hemisphere; this activation is followed by higher-level activity along the ventral processing stream, implicating primarily the left temporal lobe.     

But I can’t pass that far! The influence of motor skill on decision making

Objectives

The influence of motor skill on perceptual-cognitive and perceptual-motor decision making has been theorised but not verified empirically.

Method

Expert (n = 19), developmental (n = 20), and lesser-skilled netballers (n = 19) completed tests designed to evaluate three different components of domain-specific expertise: (i) motor skill-execution; (ii) perceptual-cognitive decision making; and (iii) perceptual-motor decision making.

Results

Each of the three measures was found to improve commensurate with domain-specific skill. Decisions requiring movements (perceptual-motor) elicited more accurate decision making than simple verbal responses (perceptual-cognitive), irrespective of participant skill. Although motor skill was found to be related to the successful execution of a most appropriate movement in a game situation, it was not found to limit the nature of the decision made by participants. No evidence was found to support the supposition that lesser-skilled participants bias their perceptual-cognitive decisions towards ones supported by their motor ability.

Conclusions

Results fail to comprehensively support the contemporary models for the development of perceptual-cognitive and perceptual-motor skill in sport.