Coordination In Adults With Neurological Impairment – A Systematic Review Of Uncontrolled Manifold Studies

Publication date: Available online 2 January 2019

Source: Gait & Posture

Author(s): Daniela V Vaz, Valéria A Pinto, R S Ricardo, Daniela JS Mattos, Subhobrata Mitra

Abstract

Background

Analysis of sensorimotor synergies has been greatly advanced by the Uncontrolled Manifold (UCM) approach. The UCM method is based on partitioning inter-trial variance displayed by elemental variables into ‘good’ (V_UCM) and ‘bad’ (V_ORT) variability that, respectively, indicate maintenance or loss of task stability. In clinical populations, these indices can be used to investigate the strength, flexibility, stereotypy and agility of synergistic control.

Research question

How are synergies affected by neurological impairment in adults? Specifically, this study aimed to determine i) the impact of pathology on V_UCM, VORT, and their ratio (synergy index); ii) the relationship between synergy indices and functional performance; iii) changes in anticipatory synergy adjustments (ASAs); and iv) the effects of interventions on synergies.

Methods

Systematic review of UCM studies on adults with neurological impairment.

Results

Most of the 17 studies had moderate to high quality scores in the adapted Critical Review Form and the UCM reporting quality checklist developed for this review. i) Most of the studies found reduced synergy indices for patients with Parkinson's disease (PD), olivo-ponto-cerebellar atrophy, multiple sclerosis and spinocerebellar degeneration, with variable levels of change in V_UCM and V_ORT. Reduction in synergy indices was not as consistent for stroke, in three out of six studies it was unchanged. ii) Five of seven studies found no significant correlations between scores on motor function scales and UCM indices. iii) Seven studies consistently reported ASAs that are smaller in magnitude, delayed, or both, for patients compared to healthy controls. iv) Two studies reported increased synergy indices, either via increase in V_UCM or decrease in V_ORT, after dopaminergic drugs for patients with PD. There were similar synergy indices but improved ASAs after deep brain stimulation for patients with PD.

Significance

UCM can provide reliable and sensitive indicators of altered synergistic control in adults with neurological impairment.

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