Researchers have successfully reconstructed 3-D hand motions from brain signals recorded in a non-invasive way, according to a study in the March 3 issue of The Journal of Neuroscience. This finding uses a technique that may open new doors for portable brain-computer interface systems. Such a non-invasive system could potentially operate a robotic arm or motorized wheelchair – a huge advance for people with disabilities or paralysis.

Until now, to reconstruct hand motions, researchers have used non-portable and invasive methods that place sensors inside the brain. In this study, a team of neuroscientists led by José Contreras-Vidal, PhD, of the University of Maryland, College Park, placed an array of sensors on the scalps of five participants to record their brains’ electrical activity, using a process called electroencephalography, or EEG. Volunteers were asked to reach from a center button and touch eight other buttons in random order 10 times, while the authors recorded their brain signals and hand motions. Afterward, the researchers attempted to decode the signals and reconstruct the 3-D hand movements.

“Our results showed that electrical brain activity acquired from the scalp surface carries enough information to reconstruct continuous, unconstrained hand movements,” Contreras-Vidal said.

The researchers found that one sensor in particular (of the 34 used) provided the most accurate information. The sensor was located over a part of the brain called the primary sensorimotor cortex, a region associated with voluntary movement. Useful signals were also recorded from another region called the inferior parietal lobule, which is known to help guide limb movement. The authors used these findings to confirm the validity of their methods.

This study has implications for future brain-computer interface technologies and for those already in existence. “It may eventually be possible for people with severe neuromuscular disorders, such as amyotrophic lateral sclerosis (ALS), stroke, or spinal cord injury, to regain control of complex tasks without needing to have electrodes implanted in their brains,” said Jonathan Wolpaw, MD, of the New York State Department of Health’s Wadsworth Center in Albany, who was unaffiliated with the study. “The paper enhances the potential value of EEG for laboratory studies and clinical monitoring of brain function.”

The findings could also help improve existing EEG-based systems designed to allow movement-impaired people to control a computer cursor with just their thoughts. These systems now require that users undergo extensive training sessions. Contreras-Vidal said the length of this training could be reduced and more effortless control achieved using the methods in this study.

Treadmill training can be used to help people with Parkinson’s disease achieve better walking movements, say researchers. In a systematic review of the evidence, Cochrane Researchers concluded treadmill training could be used to improve specific gait parameters in Parkinson’s patients.

Gait hypokinesia, characterised by slowness of movement, is one of the main movement disorders that affects Parkinson’s patients and can have a major impact on quality of life. More recently, health professionals have started incorporating exercise into treatment regimes as a useful complement to traditional drug therapies. Training on treadmills is one option that may help to improve movement.

The researchers analysed data from eight trials including 203 patients for the review, published in The Cochrane Library. They compared treadmill training versus no treadmill training, using effects on walking speed, stride length, number of steps per minute (cadence) and walking distance to measure improvement in gait. Treadmill training had a positive impact on each of these measurements, apart from cadence.

“Treadmill training appears to be a safe and effective way of improving gait in patients with Parkinson’s disease,” said lead researcher Jan Mehrholz, of the Wissenschaftliches Institut in Kreischa, Germany. “Crucially, we saw very few adverse effects or drop outs in patients given this type of rehabilitation therapy.”

However, the researchers say the findings must be treated with care as they are based on a limited number of small trials. “There is still a need for larger trials to establish if treadmill training can be safely used as a routine therapy for Parkinson’s patients,” said Merhholz. “We also need to answer basic questions about how long the benefits last and what a good training programme should consist of. For instance, how often and how long should patients train for?”

Massage, manipulation and other hands-on approaches can safely and effectively help with pain management.

The January issue of Mayo Clinic Women’s HealthSource discusses the uses and benefits of massage, spinal manipulation, and Rolfing, as well as the Alexander technique and the Feldenkrais method.

Massage: Almost everyone feels better after the soothing strokes of a massage. This process involves applying pressure to the body’s soft tissues by rubbing, kneading or rolling. There are a variety of techniques and styles, such as deep tissue massage, where deeper layers of muscle and connective tissue are manipulated. Another approach focuses on trigger points — muscle “knots” that are painful when pressed.

Massage can help reduce pain, muscle soreness and swelling. It can improve circulation, joint flexibility and range of motion. Massage has been shown to help those with chronic back pain, migraines, knee osteoarthritis and cancer.

Spinal manipulation: Also called spinal adjustment, this therapy is used to treat restricted spinal mobility. The goal is to restore spinal movement, improving function and relieving pain. The practitioner uses his or her hands to apply a controlled force or thrust to a joint of the spine. Some techniques are more rhythmic and less abrupt than others.

Spinal manipulation can provide short- and long-term relief for pain, especially if the pain hasn’t improved with self-care. Manipulation may also boost psychological well-being and everyday functioning. Some evidence shows that the therapy may improve headache symptoms and neck pain.

Rolfing: Rolfing manipulates the fascia — the protective tissue that surrounds the muscles. It aims to improve posture and realign the body.

Patients lie on a massage table while the practitioner uses hands, knuckles, thumbs, elbows and knees to manipulate the patient’s tissues. It can be painful.

There’s little research on the effectiveness of Rolfing in relieving pain. Some patients report that Rolfing helps with flexibility and improves their posture. It may relieve stress and anxiety.

Alexander technique and Feldenkrais method: These therapies use different approaches, but both aim to help patients become more aware of their habitual or everyday movements. The theory is that changing movement can help with pain and other health problems.

Both therapies use touch and direction to help the patient become more aware of movement. An Alexander session might begin with the patient seated in a chair. The practitioner helps the patient adjust head, neck and spine positions.

With Feldenkrais, the patient may be lying down, sitting on a chair or standing. The practitioner guides the participant through a series of movements designed to improve flexibility and coordination. Research suggests that the Alexander technique can provide long-term relief for back pain.

These hands-on therapies probably won’t replace pain relief medications but they could help manage chronic pain. A combination of approaches often works best in achieving long-term pain control.

Remotely monitored in-home virtual reality videogames improved hand function and forearm bone health in teens with hemiplegic cerebral palsy, helping them perform activities of daily living such as eating, dressing, cooking, and other tasks for which two hands are needed.

“While these initial encouraging results were in teens with limited hand and arm function due to perinatal brain injury, we suspect using these games could similarly benefit individuals with other illness that affect movement, such as multiple sclerosis, stroke, arthritis and even those with orthopedic injuries affecting the arm or hand,” said Meredith R. Golomb, M.D, M.Sc., Indiana University School of Medicine associate professor of neurology. A pediatric neurologist at Riley Hospital for Children, she is the first author of a pilot study which reported on the rehabilitative benefits of these custom videogames.

This project was done in collaboration with the Rutgers University Tele-Rehabilitation Institute, headed by Grigore Burdea, Ph.D., professor of electrical and computer engineering. The study appears in the January 2010 issue of Archives of Physical Medicine and Rehabilitation.

The researchers also reported that improved hand function appears to be reflected in brain activity changes as seen on functional magnetic resonance imaging (fMRI) scans.

The three study participants were asked to exercise the affected hand about 30 minutes a day, five days a week using a specially fitted sensor glove linked to a remotely monitored videogame console installed in their home. Games, such as one making images appear (“sliders”) were custom developed at Rutgers, calibrated to the individual teen’s hand functionality, included a screen avatar of the hand, and focused on improvement of whole hand function.

“Popular off-the-shelf games are targeted to people with normal hand and arm function and coordination. These games don’t work for or benefit those with moderate-severe hemiplegic cerebral palsy and many other disorders that affect movement. They just aren’t made to be used by or improve hands that can’t pinch or grasp” said Dr. Golomb.

In the future, physical therapists could remotely monitor patients’ progress and make adjustments to the intensity of game play to allow progressive work on affected muscles. In addition to meeting an unfulfilled need, this could potentially also save healthcare dollars and time.

Typically, insurance or government program coverage for rehabilitation therapy for cerebral palsy does not cover teens. Long term physical rehabilitation is costly. And even if cost is not an issue, taking an adolescent out of school and transporting him or her to the hospital or rehab center puts stress on both the patient and their parents. These specially developed games motivated rehabilitation exercises in the home at a time convenient for the teens, broadening access to rehabilitation

Researchers in the US who compared the effects on hip, knee and ankle joints of running barefoot versus running in modern running shoes, concluded that running in shoes exerted more stress on these joints compared to running barefoot or even walking in high-heeled shoes.

The study was the work of lead author Dr D Casey Kerrigan, of JKM Technologies LLC, in Charlottesville, Virginia and colleagues from the University of Colorado and the University of Virginia, and was published in the December 2009 issue of PM&R: The journal of injury, function and rehabilitation.

Knee osteoarthritis (OA) accounts for more disability in the elderly than any other disease, and although running has been shown to benefit health in many ways, including cardiovascular health, it can stress the joints in the leg, such as the hip, knee, and ankle.

For the study, Kerrigan and colleagues recruited from the general population, 68 healthy young adults (37 women, 31 men) with no history of musculoskeletal injury and who regularly ran at least 15 miles a week in running shoes that are typically available in the shops.

They gave each of the participants a pair of running shoes that was typical of most running footwear, but bore no particular design characteristics and appeared neutral. They then observed the participants running with these shoes on, and also barefoot, on a treadmill, with a motion analysis system. The data was collected after a warm up period and while the runners were running at a pace that was comfortable to them individually.

They observed that, compared with barefoot running, running with running shoes resulted in:

* Increased joint torques at the hip, knee and ankle.

* Disproportionately large increases in the hip internal rotation torque and in the knee flexion and knee varus torques.

* On average these torque increases were: 54 per cent in hip internal rotational, 36 per cent in knee flexion, and 38 per cent in knee varus.

(Joint torque is a measure of the amount of twisting about an axis that goes on at that joint. There are several kinds of torque measure, depending on the joint, which axis is the centre of rotation, and the types of movement through which the attached limbs travel.)

The researchers concluded that while typical running shoes support and protect feet quite well, they increase stress on the hips, knees and ankles, and this is likely to be caused by an elevated heel and extra material under the medial arch.

They also remarked that the 36 to 38 per cent ncreased torque on knee joints observed in the running shoes is even greater than that observed in earlier research on walking in high heeled shoes, which showed a 20 to 26 per increased torque on knee joints.

“Considering that lower extremity joint loading is of a significantly greater magnitude during running than is experienced during walking, the current findings indeed represent substantial biomechanical changes,” said Kerrigan in a press statement, adding that the goal of new footwear design should be to reduce joint torque so it is on a par with barefoot running, while not compromising other functions.

To most of us the holiday season is all about tradition, fun, and family, but if we’re not careful, the holidays can also be a pain in the neck-literally-says the American Physical Therapy Association (APTA). Typical holiday activities, such as shopping “till you drop,” lifting heavy boxes and presents, and countless hours of cooking and baking, can cause muscles to work harder than usual, many times resulting in neck, shoulder, and back pain.

This holiday season APTA recommends taking precautions-from distributing the weight of shopping bags equally on both sides of your body to lifting boxes carefully-in order to keeps aches and injuries at bay.

“The added demands of the holidays stresses the body, which may increase the risk of injuries related to the extra activities,” says APTA spokesperson and physical therapist E. Anne Reicherter, PT, DPT, PhD. “Using proper body mechanics can help prevent muscle and joint discomfort this holiday season.”

Lifting

- Test an object’s weight before attempting to lift heavy packages or luggage. Try pushing it with your foot. If it seems too heavy then take smaller loads, which are less likely to strain your back and are easier on arm and shoulder muscles.
- Keep the load close to your body when lifting.
- Ask for help or use an assistive device to lift heavy objects.
- Seek help from a physical therapist if your back pain lasts more than a few days or gets worse.

Shopping Without Dropping

- Distribute the weight of shopping bags equally on both sides of your body.
- Consider carrying a small backpack rather than a heavy purse.
- Wear comfortable shoes; carrying packages while wearing high heels on hard surfaces can contribute to foot and ankle injuries.
- Don’t carry overstuffed shopping bags for extended periods.
- Consider using a shopping cart or getting help to carry packages to your car.
- Make frequent trips to the car to drop off purchases.
- Avoid prime shopping times to decrease wait times that can increase or exceed standing/walking time tolerances.
- Plan your shopping trip ahead of time. Having a set list of gifts you intend to buy will help you plan for extra help, if needed, to carry purchases.

Baking

- Choose a work surface that is approximately at the level of your forearms when your elbows are bent at a right angle (90 degrees) or at elbow height. Shoulders and upper back will be in better position and this will decrease the risk of upper back, neck, and shoulder strain.

- Work on a padded surface. If you have tile, vinyl, or wood flooring, for cushioning consider purchasing an inexpensive area rug that has grippers on the back to keep the rug from moving and you from slipping or tripping. Standing long periods on a hard surface can lead to muscle fatigue and back ache.

- Use good lifting mechanics when retrieving small kitchen appliances from lower shelves or drawers. Kneel down if necessary and keep the object close to your body.

- Be careful when bending to take items in and out of a conventional floor-model stove.

- Frequently perform gentle movement exercises to keep the muscles in your neck and shoulders loose.