Motor Control Assessment Research Articles

Kinematic synergies show good consistency when extracted with a low-cost markerless device and a marker-based motion tracking system

Recently, markerless tracking systems, such as RGB-Depth cameras, have spread to overcome some of the limitations of the gold standard marker-based tracking systems. Although these systems are valuable substitutes for human motion analysis, as they guarantee higher flexibility, faster setup time and lower costs, their tracking accuracy is lower with respect to marker-based systems. Many studies quantified the error made by markerless systems in terms of body segment length estimation, articular angles, and biomechanics, concluding that they are appropriate for many clinical applications related to motion analysis. We propose an innovative approach to compare a markerless tracking system (Kinect V2) with a gold standard marker-based system (Vicon), based on motor control assessment. We quantified kinematic synergies from the tracking data of fifteen participants performing multi-directional upper limb movements. Kinematic synergy analysis decomposes the kinematic data into a reduced set of motor primitives that describe how the central nervous system coordinates motion at spatial and temporal level. Synergies were extracted with the recently released mixed-matrix factorization algorithm. Four synergies were extracted from both marker-based and markerless datasets and synergies were grouped in 6 clusters for each dataset. Cosine similarity in each cluster was ⩾0.60 in both systems, showing good consistency of synergies. Good matching was found between synergies extracted from markerless and from marker-based data, with a cosine similarity between matched synergies ⩾0.60 in 5 out 6 synergies. These results showed that the markerless sensor can be feasible for kinematic synergy analysis for gross movements, as it correctly estimates the number of synergies and in most cases also their spatial and temporal organization.

Assessment of Motor Control in Chronic Mechanical Low Back Pain Patients with Flexible Flat Foot

Assessment of Motor Control in Chronic Mechanical Low Back Pain Patients with Flexible Flat Foot

The disposition of connections between the motor profile components in 4-year-old children

The aim of the study consists in following the connections between the components of the motor profile in children aged 4 years. It was implemented by compiling a list of indicators for determining the individual motor profile in children aged 4 and dividing them into blocks according to the level theory of the organization of motor activity according to M. Bernshtein [1], checking the presence and clarifying the nature of correlations between indicators from the compiled list, assessment on the basis of the obtained data on the fairness of the distribution of the selected indicators into blocks according to the levels of the organization of motor activity according to M. Bernstein. In the process of conducting the research, the analysis of literary sources, the correlation analysis of data according to the Karl Pearson method, the table of critical indicators of this coefficient were used. Scientific novelty. The article is devoted to the assessment of motor control in 4-year-old children. In particular, the study of connections between individual components of the motor profile of 4-year-old children, improvement of the test tool for determining such a profile. In the presented text, the correlations between individual indicators of the motor profile in 4-year-old children, determined using a test previously developed by us, are given. Also, an analysis of the given data based on the concept of "indirect" organization of motor control is presented here. In the article, we have formulated a number of recommendations on current areas of further research devoted to the assessment of motor control in humans. In the article, terms are proposed to indicate the current concepts of this direction of research, as well as the terminology used is consistent with the proposals of authoritative modern scientists dealing with motor control assessment and the use of its results in practice. We managed to include a list of individual motor profile indicators in a single comprehensive test. We could not confirm the presence of a particularly close connection between the success of 4-year-old children in performing tasks that belong to the same level of movement organization according to Bernstein.

Epidural stimulation restores muscle synergies by modulating neural drives in participants with sensorimotor complete spinal cord injuries

Multiple studies have corroborated the restoration of volitional motor control after motor-complete spinal cord injury (SCI) through the use of epidural spinal cord stimulation (eSCS), but rigorous quantitative descriptions of muscle coordination have been lacking. Six participants with chronic, motor and sensory complete SCI underwent a brain motor control assessment (BMCA) consisting of a set of structured motor tasks with and without eSCS. We investigated how muscle activity complexity and muscle synergies changed with and without stimulation. We performed this analysis to better characterize the impact of stimulation on neuromuscular control. We also recorded data from nine healthy participants as controls. Competition exists between the task origin and neural origin hypotheses underlying muscle synergies. The ability to restore motor control with eSCS in participants with motor and sensory complete SCI allows us to test whether changes in muscle synergies reflect a neural basis in the same task. Muscle activity complexity was computed with Higuchi Fractal Dimensional (HFD) analysis, and muscle synergies were estimated using non-negative matrix factorization (NNMF) in six participants with American Spinal Injury Association (ASIA) Impairment Score (AIS) A. We found that the complexity of muscle activity was immediately reduced by eSCS in the SCI participants. We also found that over the follow-up sessions, the muscle synergy structure of the SCI participants became more defined, and the number of synergies decreased over time, indicating improved coordination between muscle groups. Lastly, we found that the muscle synergies were restored with eSCS, supporting the neural hypothesis of muscle synergies. We conclude that eSCS restores muscle movements and muscle synergies that are distinct from those of healthy, able-bodied controls.

IMU-based assessment of motor control in a population of young subjects with idiopathic scoliosis: preliminary results from the motor-child study

Motor development is an adaptive process occurring within a self-organizing system and influenced by several factors. While evidence exists for motor control in severe pathologies (cerebral palsy), minor musculoskeletal conditions, such as scoliosis, have never been explored. Clinical-functional tests used for the analysis of motor control (Movement ABC-2 or TGMD-2) are time-consuming, hindering their applicability to large populations. In recent years wearable Inertial Measurement Units (IMUs) were introduced for low-cost ambulatory quantitative assessment allowing the estimation of temporal gait parameters [1] and of dynamics of motor control through nonlinear metrics [2–4]. The aim of this work was to assess motor control alterations in children affected by idiopathic scoliosis using clinical- functional tests and IMU-based metrics related to motor control. 34 children aged between 6 and 16 years with scoliosis (ATR ≥ 5 ° or Cobb ≥ 10°) were included. They underwent MovementABC-2 for clinical assessment of motor competence. Three tri-axial IMUs (MetamotionR, mbient-Lab, USA) were attached on the lower back and on the shanks [5] of each child. 3D acceleration and angular velocity data were recorded at 200 Hz while the participants walked at self- selected speed back and forth, two times in normal (NW) and once in tandem walking (TW) along a 15 m path. Stride (StrideT, seconds), stance (StanceT, % of StrideT), and double support time (DS, % of StrideT) were calculated from foot contact events. Temporal parameter variability was calculated as standard deviation. MSE (τ from 1 to 6), related to complexity and automaticity, and RQA, related to pattern regularity, were calculated on trunk acceleration data along the 3 directions. Data were compared to those of matched healthy peers. Movement ABC-2 test: 12 patients received scores above the 50th percentile (35.3%) and 22 below (64.7%). No significant correlation was observed with the degree of scoliosis (Cobb angle) or the degrees of torsion (ATR). Temporal parameters: subjects resulted slower during NW (longer StrideT), with larger dispersion of StanceT and DS than healthy peers. During TW, subjects above 12 years of age resulted slower, with longer StanceT and longer DS for increasing age as compared to their healthy peers. Non-linear metrics: subjects showed larger MSE during NW for lower values of τ (1 to 3) in the ML and V direction and reduced RQA in AP direction for increasing age as compared to healthy peers; during TW, reduced MSE for lower values of τ (1 to 3) in the V and AP direction and increased RQA in AP direction. Children affected by idiopathic scoliosis showed alterations of motor control. In particular, temporal parameters highlighted a slower and less stable gait, more evident for increasing age as related to TW. Lower stability is also related to a less mature motor control with a delay in the development of the automaticity characterizing healthy peers, and a reduced development of the motor complexity required for more demanding locomotor tasks. These preliminary data suggest that idiopathic scoliosis affects motor control in the developing population. IMU-derived metrics demonstrated their effectiveness in complementing clinical assessment.

Feasibility of recurrence quantification analysis (RQA) in quantifying dynamical coordination among muscles

Surface electromyography (EMG) signal is a powerful tool to investigate motor control. However, due to the non-linearity and non-stationarity of EMG signals, linear methods hardly quantify the dynamical coordination among muscles. To quantify the dynamical characteristics and promote the applications of nonlinear methods in motor neuroscience and neurorehabilitation, this study assessed the feasibility of a nonlinear approach, recurrence quantification analysis (RQA), in quantifying the dynamical muscle coordination by calculating four RQA measurements, recurrence rate (RR), determinism (DET), entropy (ENT), and laminarity (LAM) of each trial, movement, and subject. By analyzing the variability of four RQA measurements, the results showed the feasibility of using RQA to quantify dynamic characteristics among muscles during reaching movements. Especially, DET and LAM had less variation among trials, indicating they were more appropriate for dynamical analysis. The results also reported significant differences of each measurement among subjects and among movements, and inter-subject variability was larger than inter-movement. It suggests that future studies should focus more on dynamical variations of one person rather than comparisons between subjects and/or movements. This study provides a dynamic perspective to research motor control and clinical diagnoses and assessment in future work.

Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial

IntroductionSpinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies...

179 Clinical Outcomes From a Single-Site Phase I Study of Neural Stem Cell Transplantation for Chronic Spinal Cord Injury

INTRODUCTION: We previously reported safe implantation and improvement in motor and sensory scores using neural stem cell line (NSC) NSI-566 in chronic thoracic complete spinal cord injury (SCI) patients. METHODS: A total of four subjects received NSI-566 spinal cord implantation. All subjects tolerated the procedure well with no serious adverse events in the immediate post-procedure period. Prospective data have been collected including ISNCSCI scores, functional and pain surveys, SCIM scores, electromyography (EMG), Brain Motor Control Assessment (BMCA), and serial MRI. RESULTS: Two patients experienced improvements in neurological level of injury (NLI), motor score, and sensory score. BMCA showed newly developed muscle responsiveness in lower limbs to reinforcement maneuvers in one patient. Three subjects experienced new EMG activity in lower muscle groups. Two patients had overall decreased pain scores post-operatively, which included both discomfort and allodynia in the transition zone, surgical site pain, and neuropathic and nociceptive pain elsewhere. MR imaging showed no radiographical evidence of immediate or delayed complications after the stem cell injections. CONCLUSION: Our current clinical data demonstrate that spinal grafting of the human NSI-566 cell line in chronic spinal trauma patients is safe with no detectable side effects identified at 60 months after cell delivery. Despite the small sample size, the key strengths of the study are the extensive follow-up period and the timeline of treatment. Like other Phase I studies, this study was intended to provide proof of safety and tolerability and proof of concept data that will justify the next cohort.

Predictors of gross motor function and activities of daily living in children with cerebral palsy

To determine the influence of selected impairment variables, spasticity, trunk control, upper limb function and selective motor control of the lower limb on gross motor function and activities of daily living in children with cerebral palsy (CP). Seventy children with CP, 40 boys and 30 girls, with age range between 11 and 156 months were recruited in this cross-sectional study. Data on spasticity, selective motor control of the lower limb, upper limb function and trunk control were assessed using modified Ashworth scale (MAS), selective motor control of the lower limb (SCALE), paediatric arm function test, trunk motor control assessment and GMFM88, respectively. Among all the variables assessed, only trunk control significantly predicted gross motor function (beta = 0.880; P < 0.001) and activities of daily living (beta = 0.550; P < 0.05). However, gross motor function and activities of daily living have significant (P < 0.05) negative correlations with spasticity, and positive correlations with selective motor control of the lower limb and trunk control. Trunk control is the most influencing factor on gross motor function and activities of daily living in children with CP. Therefore, achieving trunk control especially in those at GMFCS levels V and VI should be a priority during the rehabilitation of children with CP.

Internal Consistency of Sway Measures via Embedded Head-Mounted Accelerometers: Implications for Neuromotor Investigations.

Accelerometers are being increasingly incorporated into neuroimaging devices to enable real-time filtering of movement artifacts. In this study, we evaluate the reliability of sway metrics derived from these accelerometers in a standard eyes-open balance assessment to determine their utility in multimodal study designs. Ten participants equipped with a head-mounted accelerometer performed an eyes-open standing condition on 7 consecutive days. Sway performance was quantified with 4 standard metrics: root-mean-square (RMS) acceleration, peak-to-peak (P2P) acceleration, jerk, and ellipse area. Intraclass correlation coefficients (ICC) quantified reliability. P2P in both the mediolateral (ICC = 0.65) and anteroposterior (ICC = 0.67) planes yielded the poorest reliability. Both ellipse area and RMS exhibited good reliability, ranging from 0.76 to 0.84 depending on the plane. Finally, jerk displayed the highest reliability with an ICC value of 0.95. Moderate to excellent reliability was observed in all sway metrics. These findings demonstrate that head-mounted accelerometers, commonly found in neuroimaging devices, can be used to reliably assess sway. These data validate the use of head-mounted accelerometers in the assessment of motor control alongside other measures of brain activity such as electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS).

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

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.

Development and Validation of a Probe Word List to Assess Speech Motor Skills in Children.

Purpose The aim of the study was to develop and validate a probe word list and scoring system to assess speech motor skills in preschool and school-age children with motor speech disorders. Method This article describes the development of a probe word list and scoring system using a modified word complexity measure and principles based on the hierarchical development of speech motor control known as the Motor Speech Hierarchy (MSH). The probe word list development accounted for factors related to word (i.e., motoric) complexity, linguistic variables, and content familiarity. The probe word list and scoring system was administered to 48 preschool and school-age children with moderate-to-severe speech motor delay at clinical centers in Ontario, Canada, and then evaluated for reliability and validity. Results One-way analyses of variance revealed that the motor complexity of the probe words increased significantly for each MSH stage, while no significant differences in the linguistic complexity were found for neighborhood density, mean biphone frequency, or log word frequency. The probe word list and scoring system yielded high reliability on measures of internal consistency and intrarater reliability. Interrater reliability indicated moderate agreement across the MSH stages, with the exception of MSH Stage V, which yielded substantial agreement. The probe word list and scoring system demonstrated high content, construct (unidimensionality, convergent validity, and discriminant validity), and criterion-related (concurrent and predictive) validity. Conclusions The probe word list and scoring system described in the current study provide a standardized method that speech-language pathologists can use in the assessment of speech motor control. It can support clinicians in identifying speech motor difficulties in preschool and school-age children, set appropriate goals, and potentially measure changes in these goals across time and/or after intervention.

A multimodal approach to capture post-stroke temporal dynamics of recovery

Objective. Several training programs have been developed in the past to restore motor functions after stroke. Their efficacy strongly relies on the possibility to assess individual levels of impairment and recovery rate. However, commonly used clinical scales rely mainly on subjective functional assessments and are not able to provide a complete description of patients’ neuro-biomechanical status. Therefore, current clinical tests should be integrated with specific physiological measurements, i.e. kinematic, muscular, and brain activities, to obtain a deep understanding of patients’ condition and of its evolution through time and rehabilitative intervention. Approach. We proposed a multivariate approach for motor control assessment that simultaneously measures kinematic, muscle and brain activity and combines the main physiological variables extracted from these signals using principal component analysis (PCA). We tested it in a group of six sub-acute stroke subjects evaluated extensively before and after a four-week training, using an upper-limb exoskeleton while performing a reaching task, along with brain and muscle measurements. Main results. After training, all subjects exhibited clinical improvements correlating with changes in kinematics, muscle synergies, and spinal maps. Movements were smoother and faster, while muscle synergies increased in numbers and became more similar to those of the healthy controls. These findings were coupled with changes in cortical oscillations depicted by EEG-topographies. When combining these physiological variables using PCA, we found that (i) patients’ kinematic and spinal maps parameters improved continuously during the four assessments; (ii) muscle coordination augmented mainly during treatment, and (iii) brain oscillations recovered mostly pre-treatment as a consequence of short-term subacute changes. Significance. Although these are preliminary results, the proposed approach has the potential of identifying significant biomarkers for patient stratification as well as for the design of more effective rehabilitation protocols.

Long-Term Spinal Cord Stimulation After Chronic Complete Spinal Cord Injury Enables Volitional Movement in the Absence of Stimulation.

Background: Chronic spinal cord injury (SCI) portends a low probability of recovery, especially in the most severe subset of motor-complete injuries. Active spinal cord stimulation with or without intensive locomotor training has been reported to restore movement after traumatic SCI. Only three cases have been reported where participants developed restored volitional movement with active stimulation turned off after a period of chronic stimulation and only after intensive rehabilitation with locomotor training. It is unknown whether restoration of movement without stimulation is possible after stimulation alone.Objective: We describe the development of spontaneous volitional movement (SVM) without active stimulation in a subset of participants in the Epidural Stimulation After Neurologic Damage (ESTAND) trial, in which locomotor training is not prescribed as part of the study protocol, and subject’s rehabilitation therapies are not modified.Methods: Volitional movement was evaluated with the Brain Motor Control Assessment using sEMG recordings and visual examination at baseline and at follow-up visits with and without stimulation. Additional functional assessment with a motor-assisted bicycle exercise at follow-up with and without stimulation identified generated work with and without effort.Results: The first seven participants had ASIA Impairment Scale (AIS) A or B thoracic SCI, a mean age of 42 years, and 7.7 years post-injury on average. Four patients developed evidence of sustained volitional movement, even in the absence of active stimulation after undergoing chronic epidural spinal cord stimulation (eSCS). Significant increases in volitional power were found between those observed to spontaneously move without stimulation and those unable (p < 0.0005). The likelihood of recovery of spontaneous volitional control was correlated with spasticity scores prior to the start of eSCS therapy (p = 0.048). Volitional power progressively improved over time (p = 0.016). Additionally, cycling was possible without stimulation (p < 0.005).Conclusion: While some SVM after eSCS has been reported in the literature, this study demonstrates sustained restoration without active stimulation after long-term eSCS stimulation in chronic and complete SCI in a subset of participants. This finding supports previous studies suggesting that “complete” SCI is likely not as common as previously believed, if it exists at all in the absence of transection and that preserved pathways are substrates for eSCS-mediated recovery in clinically motor-complete SCI.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03026816.

Regarding the Necessity of Functional Assessment Including Motor Control Assessment of Post-Mastectomy Patients Qualified for Latissimus Dorsi Breast Reconstruction Procedure-Pilot Study.

The purpose of the paper is a functional assessment of post-mastectomy patients who underwent latissimus dorsi breast reconstruction (LDBR), and of healthy women, through an analysis of selected muscle function parameters, including motor control assessment. Twenty participants were included in the study (ten LDBR-procedure individuals and ten healthy controls). The research consisted of a DASH (The Disabilities of the Arm, Shoulder and Hand) questionnaire assessment, shoulder area static assessment, shoulder mobility assessment, latissimus dorsi flexibility assessment and shoulder motor control assessment. LDBR-procedure individuals—when compared to healthy controls—exhibited a decrease in physical aspects of quality of life, shoulder area postural alterations, limitations in shoulder mobility and decrease in shoulder motor control. LDBR procedure may have an influence on limiting shoulder active mobility, as well as on decrease of shoulder motor and postural control. Standard functional assessment diversified on motor control assessment of post-mastectomy patients qualified for the LDBR procedure seems to be necessary.

Brain motor control assessment post intensive whole-body exercise &lt;i&gt;vs.&lt;/i&gt; upper body exercise after spinal cord injury

Neuroimmunology and Neuroinflammation is an open access journal, with focuses on neuroimmunology and neuroinflammation research, and coverage extending to other basic and clinical studies related to neuroscience.

Respiratory muscle activity in voluntary breathing tracking tasks: Implications for the assessment of respiratory motor control

How the involuntary (bulbospinal) and voluntary (corticospinal) pathways interact in respiratory muscle control is not established. To determine the role of excitatory corticobulbar pathways in humans, studies typically compare electromyographic activity (EMG) or evoked responses in respiratory muscles during hypercapnic and voluntary tasks. Although ventilation is matched between tasks by having participants track signals of ventilation, these tasks may not result in matched respiratory muscle activity. The aim of this study was to describe respiratory muscle activity and ribcage and abdominal excursions during two different voluntary conditions, compared to hypercapnic hyperventilation. Ventilation was matched in the voluntary conditions via (i) a simple target of lung volume (‘volume tracking’) or (ii) targets of both ribcage and abdominal excursions, adjusted to end-expiratory lung volume in hypercapnic hyperventilation (‘bands tracking’). Compared to hypercapnic hyperventilation, respiratory parameters such as tidal volume were similar, but the ratio of ribcage to abdominal excursion was higher for both voluntary tasks. Inspiratory scalene and parasternal intercostal muscle activity was higher in volume tracking, but diaphragm and abdominal muscle activity showed little to no change. There were no differences in muscle activity in bands tracking for any muscle, compared to hypercapnic hyperventilation. An elevated ratio of ribcage to abdominal excursion in the bands tracking task indicates that participants could not accurately match the targets in this condition. Inspiratory muscle activity is altered in some muscles in some voluntary tasks, compared to hypercapnia. Therefore, differences in muscle activity should be considered in interpretation of studies that use these protocols to investigate respiratory muscle control.

Quantitative Evaluation of Post-stroke Spasticity Using Neurophysiological and Radiological Tools: A Pilot Study.

ObjectiveTo determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients.MethodsEight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. ResultsMAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2–R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis.ConclusionThe BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.

Oral and Laryngeal Diadochokinetic Rate in Multiple Sclerosis: Relationship to Disease Progression

Background: The first purpose of this study was to investigate the rate of oral and laryngeal Diadochokinesis (DDK) in Multiple Sclerosis (MS) patients in comparison with healthy people. The second goal was to determine if DDK rate has any relationship with the disease progression. Methods: In this cross-sectional study, two groups were enrolled: MS patients (n=31) and healthy subjects (n=14) . The samples of DDK tasks were collected. The scores of Expanded Disability Status Scale (EDSS) and duration of disease were considered as the indices of disease progression. Results: There were significant differences between the two groups in the rates of all DDK tasks (P≤0.001). Significant correlations were found between laryngeal DDK tasks and disease progression (r = - 0.488, r = -0.396, r = -0.444, r = - 0.667, P ≤ 0.027). Two oral DDK tasks were in correlation with EDSS and the disease duration (r = -0.403, r = -0.446, r =-0.521, r = -0.465, p≤0.025). There were high correlations between functional systems of EDSS (pyramidal, cerebellar and brainstem) and DDK tasks (r = - 0.448, r = -452, r = -0.458, r =-0.379, P ≤ 0.036). Conclusions: In the present study, poor performance in DDK tasks provided evidence for insufficient motor control over related speech subsystems in MS. These findings suggest that DDK rate is a sensitive beneficial speech motor control assessment in MS. Moreover, DDK tasks might be introduced as additional prognostic parameters for detecting disease progression and evaluating treatment achievements.

The validity and reliability of the Test of Arm Selective Control for children with cerebral palsy: a prospective cross-sectional study.

This study examined the reliability and validity of the Test of Arm Selective Control (TASC) to examine upper extremity selective voluntary motor control in children and adolescents with all types of spastic cerebral palsy (CP). Fifty-six participants with CP, ranging in age from 5years 9months to 18years 11months (average 11y 7mo, SD 3y 9mo; 25 males, 31 females), participated in this prospective cross-sectional study. They were evaluated using the TASC and several clinical measures. TASC and Manual Ability Classification System (r=-0.529, p<0.001), TASC and ABILHAND-Kids (r=0.596, p<0.001), and TASC and affected extremities (r=-0.486, p=0.001) were moderately correlated. There was a weak correlation between the TASC and Gross Motor Function Classification System (r=-0.363, p=0.006) and no correlation between the TASC and age (p=0.366) or rater (p=0.713). Interrater reliability for upper extremity total score (intraclass correlation coefficient [ICC]=0.92-0.94) and upper extremity limb scores (ICC=0.92-0.96) was high for two independent rater groups (p≤0.001). Average time to administer was 16minutes, 18seconds. The TASC is a reliable and valid tool for objective assessment of selective voluntary motor control. Clinically this measure may guide the selection of medical, surgical, or therapy interventions and may improve outcome prognosis. The Test of Arm Selective Control (TASC) demonstrates a high degree of reliability and multiple aspects of validity when assessing upper extremity selective control in those with cerebral palsy. The TASC is an upper limb companion to the Selective Control Assessment of the Lower Extremity.