title: Motor-prediction improvements after virtual rehabilitation in geriatrics: frail patients reveal different learning curves for movement and postural control.
abstract: BACKGROUND
  Postural control associated with self-paced movement is critical for balance in frail older adults. The present work aimed to investigate the effects of a 2D virtual reality-based program on postural control associated with rapid arm movement in this population.
  
  
  METHODS
  Participants in an upright standing position performed rapid arm-raising movements towards a target. Practice-related changes were assessed by pre- and post-test comparisons of hand kinematics and centre-of-pressure (CoP) displacement parameters measured in a training group and a control group. During these pre- and post-test sessions, patients have to reach towards yellow balls appearing on the screen, form a standardized upright position (with 15cm between the two malleoli). Training group patients took part in six sessions of virtual game. In this, patients were asked to reach their arm towards yellow balls appearing on the screen, from an upright position.
  
  
  RESULTS
  After training, we observed improvements in arm movements and in the initial phase of CoP displacement, especially in the anticipatory postural adjustments. Learning curves for these two types of motor improvements showed different rates. These were continuous for the control of the arm movement, and discontinuous for the control of the CoP during the anticipatory postural adjustments.
  
  
  CONCLUSIONS
  These results suggest that some level of motor (re)-learning is maintained in frail patients with low functional reserves. They also suggest that re-learning of anticipatory postural control (i.e. motor prediction) is less robust than explicit motor learning involved for the arm reaching. This last point should encourage clinicians to extend the training course duration, even if reaching movement improvements seems acquired, in order to automate these anticipatory postural activities. However, other studies should be done to measure the retention of these two types of learning on a longer-term period.
authors: Institut national de la santé et de la recherche médicale (Inserm), unité 1093, cognition action et plasticité sensori-motrice, campus universitaire, université de Bourgogne, BP 27877, 21078 Dijon, France. Electronic address: Alexandre.Kubicki@u-bourgogne.fr.
authors: A
authors: A
authors: Kubicki
authors: Institut national de la santé et de la recherche médicale (Inserm), unité 1093, cognition action et plasticité sensori-motrice, campus universitaire, université de Bourgogne, BP 27877, 21078 Dijon, France; INRIA, Université de Montpellier 2, LIRMM, Demar Team, 161, rue Ada, 34095 Montpellier cedex 5, France; Institut Universitaire de France, 75005 Paris, France.
authors: F
authors: F
authors: Bonnetblanc
authors: SARL Fovea Interactive, Campus industriel - Espace Entreprises, route de Demigny, 71100 Chalon-sur-Saône, France.
authors: G
authors: G
authors: Petrement
authors: Institut national de la santé et de la recherche médicale (Inserm), unité 1093, cognition action et plasticité sensori-motrice, campus universitaire, université de Bourgogne, BP 27877, 21078 Dijon, France; Faculté de médecine, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
authors: F
authors: F
authors: Mourey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics; D006801:Humans; D007858:Learning; D008297:Male; D009043:Motor Activity; D009069:Movement Disorders / Q000534:rehabilitation*; D004856:Postural Balance; D063367:Virtual Reality Exposure Therapy
keywords: Ajustements posturaux anticipés; Anticipatory postural adjustments; Apprentissage; Contrôle moteur; Fragilité; Frailty; Learning; Motor control; Rééducation en réalité virtuelle; Virtual rehabilitation