Use of audio motor learning for the rehabilitation of

upper limb reaching in hemiparetic subjects.

Robertson, J. 1, 2, Hoellinger,
Hoellinger, T. 1, Hanneton,
Hanneton, S. 1 and Roby- Brami, A. 1, 2
Roby-Brami,

1 Laboratoire de Neurophysique et Physiologie, Université Paris Descartes, CNRS UMR 8119, 45 Rue des St Pères, Paris 75006.
2 Service MPR, Laboratoire d’Analyse du Mouvement, Hôpital Raymond Poincaré, Garches, 92380.
johanna.robertson@univ-paris5.fr
INTRODUCTION
< 50% of stroke patients recover functional ability in the Typical kinematic deficits in hemiparetic pointing movements

Angular Velocity (deg/sec)

upper limb. Recovery of reaching movements in the hemiparetic

Trunk Flexion Angle (deg)

Shoulder Ang Vel (deg/sec)

Elbow
seg
upper limb is a rehabilitation problem. 12 ° forward lean me Shoulder

Hand Velocity (m/s)

0,6 80
98 20
96 0,5
nta
Temperospatial parameters are frequently altered during tio 60
94 0,4 n
92 10 40
reaching movements (Roby-Brami, 2003, Cirstea 2003). 90
0,3
88 0,2 20
0
Studies show that feedback is an essential component of 86 0,1
0
84 0,0
motor learning. (Schmidt, 2004). 0,0 0,5 1,0 1,5 0,0 0,4 0,8 1,2 0 10 20 30 40 50 60 70 0,0 0,2 0,4 0,6 0,8 1,0 1,2
Time (sec) Elbow Ang Vel (deg/sec) Time (sec)
Time (sec)
Auditory feedback on kinematic parameters of movement
could enhance performance in the hemiparetic upper limb Excessive Segmented Non-linear relationship Non-synchronous
(Maulucci, 2001). trunk tangential velocity between elbow and timing of elbow and
motion curves of hand shoulder velocity shoulder angular
trajectory velocity peaks

OBJECTIVES OF PRELIMINARY STUDY RESULTS

¾ To assess the effect of auditory feedback on kinematic movement Significant improvements in spatial characteristics of hand trajectory
parameters during reaching movements of the hemiparetic upper limb. (length and curvature).
* *
¾ To compare the effect of simple feedback with spatialised feedback. * *
Length of hand path (cm)
*
37
1,15

Curve Ratio
MATERIALS 36
1,14
3D ‘on line’ recording of movement with electromagnetic motion tracking 35
system: POLHEMUS 1,13
34
Sensors positioned on trunk, acromion, arm and hand record translation
1,12
and orientation (Euler’s angles) at 30 Hz. None Simple Spatialised None Simple Spatialised
Feedback Feedback
Increased smoothness with feedback (decreased number of velocity peaks
FEEDBACK and decreased jerk metric).
* *
3D spatialised sound produced using Open Al. * *
Number of Vel Peaks

4,0 * *
‘Listener’ corresponds to the hand sensor allowing hand motion to influence 5
perceived sound (see Hoellinger et al. poster).
Jerk Metric

4
3,5
‘Buzzing’ sound accompanies movements volume increases towards 3
target.
2
Simple feedback varies according to hand distance from target. 3,0
1

Spatialised feedback also varies according to hand orientation None Simple Spatialised None Simple Spatialised
relative to target. Feedback Feedback
Effects significantly greater with spatialised feedback than simple feedback.
* Statistically significant difference (p<0.05).
METHODS
Subjects 6 hemiparetic patients (1 left, 5 right)
DISCUSSION / CONCLUSION / PERSPECTIVES
1 female, 5 males
Mean age = 46 years Auditory feedback appears to improve spatial parameters of movement.
Dominant hand affected = 3 Spatialised feedback appears to have a particular effect on parameters
Barthel = 70 –100 / 100 relating to smoothness.
ARAT = 28-57 / 57 More subjects are required, however, in order to confirm these preliminary
90% arm
findings.
30°
length 20 cm We wish to explore the effects simple and spatialised auditory feedback on
Design 2 sessions (randomised) Subject inter-joint coordination and trunk motion.
¾ No feedback simple feedback Following this, we aim to develop different types of auditory feedback,
¾ No feedback spatialised feedback using positive and negative reinforcement in order to improve inter-joint
coordination and decrease use of trunk motion.
Our long-term aim is to develop a ‘tool-box’ of sensory motor activities for
Task 3 consecutive reaching movements to 9 targets (random): reaching and grasping using auditory feedback.
¾ 3 close (60% arm length) Each activity will be specific to a particular temperospatial deficit and will
be adaptable for each patient.
¾ 3 far (90% arm length)
Our hypothesis is that improvements at the impairment level will positively
¾ 3 far + high (17cm) affect function.

REFERENCES Roby-Brami, A., Feydy, A. et al. (2003). "Motor compensation and recovery for reaching in stroke patients." Acta Neurol Scand 107(5): 369-81.
Cirstea, M. C., Mitnitski, A.B. et al. (2003). "Interjoint coordination dynamics during reaching in stroke." Exp Brain Res 151(3): 289-300.
Schmidt, R., and Wrisberg, C. (2004) Motor learning and performance.Human Kinetics, Leeds, UK.
Maulucci, R. A. and R. H. Eckhouse (2001). "Retraining reaching in chronic stroke with real-time auditory feedback." NeuroRehabilitation 16(3): 171-82.