Margaret A French's research while affiliated with University of Utah and other places

Publications (24)

Preprint
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As rehabilitation advances into the era of digital health, remote monitoring of physical activity via wearable devices has the potential to change how we provide care. However, uncertainties about patient adherence and the significant resource requirements needed create challenges to adoption of remote monitoring into clinical care. Here we aim to...
Article
Despite abundant evidence that pain alters movement performance, considerably less is known about the potential effects of pain on motor learning. Some of the brain regions involved in pain processing are also responsible for specific aspects of motor learning, indicating that the two functions have the potential to interact, yet it is unclear if t...
Preprint
Full-text available
Background After discharged from the hospital for acute stroke, individuals typically receive rehabilitation in one of three settings: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home with community services (i.e., home health or outpatient clinics). The initial setting of post-acute care (i.e., discharge locat...
Article
Full-text available
Background Low physical activity (PA) is associated with poor health outcomes after stroke. Step counts are a common metric of PA; however, other physiologic signals (eg, heart rate) may help to identify subgroups of individuals poststroke at varying levels of risk of poor health outcomes. Here, we aimed to identify clinically relevant subgroups of...
Article
Objective: Video-based pose estimation is an emerging technology that shows significant promise for improving clinical gait analysis by enabling quantitative movement analysis with little costs of money, time, or effort. The objective of this study is to determine the accuracy of pose estimation-based gait analysis when video recordings are constr...
Article
Background: Exercise priming, pairing high intensity exercise with a motor learning task, improves retention of upper extremity tasks in individuals after stroke, but has shown no benefit to locomotor learning. This difference may relate to the type of learning studied. Upper extremity studies used explicit, strategic tasks; locomotor studies used...
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Full-text available
Objective Clinical implementation of remote monitoring of human function requires an understanding of its feasibility. We evaluated adherence and the resources required to monitor physical, cognitive, and psychosocial function in individuals with either chronic obstructive pulmonary disease or stroke during a three-month period. Methods Seventy-th...
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Stroke rehabilitation occurs across the continuum of care starting in the acute hospital and through the inpatient and outpatient settings. Rehabilitation aims to minimize impairments and maximize function in individuals after stroke. Because patients often undergo rehabilitation for extended periods, longitudinal assessment of impairment, activity...
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Functional recovery and the response to rehabilitation interventions after stroke are highly variable. Understanding this variability will promote precision rehabilitation for stroke, allowing us to deliver targeted interventions to the right person at the right time. Capitalizing on large, heterogeneous data sets, such as those generated through c...
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Full-text available
Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation-an em...
Article
Precision medicine efforts are underway in many medical disciplines; however, the power of precision rehabilitation has not yet been explored. Precision medicine aims to deliver the right intervention, at the right time, in the right setting, for the right person, ultimately, bolstering the value of the care that we provide. To date precision medic...
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Objective: Previously it was found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. We therefore examined the effect of symptoms of depression on the mediated relati...
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Background and purpose: The ability to switch between walking patterns (ie, locomotor switching) is vital for successful community navigation and may be impacted by poststroke impairments. Thus, the purpose of this work was to examine locomotor switching and the relationship between locomotor switching and fluid cognition in individuals after stro...
Article
Background There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning. Objective To understand th...
Article
Implicit and explicit processes can occur within a single locomotor learning task. The combination of these learning processes may impact how individuals acquire/retain the task. Because these learning processes rely on distinct neural pathways, neurologic conditions may selectively impact the processes that occur, thus, impacting learning and rete...
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Full-text available
Studies of upper extremity reaching show that use-dependent plasticity, or learning from repetition, plays an important role in shaping motor behaviors. Yet, the impact of repetition on locomotor learning is unclear, despite the fact that gait is developed and practiced over millions of repetitions. To test if repetition alone can induce storage of...
Article
Full-text available
A single exercise bout has been found to improve the retention of a skill-based upper extremity motor task up to a week post-practice. This effect is the greatest when exercise intensity is high and exercise is administered immediately after motor practice (i.e., early in consolidation). Whether exercise can affect other motor learning types (e.g.,...
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Detecting gait events using ground reaction forces (i.e. kinetic detection) is the gold standard, but it is not always possible. Kinematic methods exist; however, accuracy of these methods in stroke survivors during treadmill and overground walking is unknown. Thus, this study compared the accuracy of three kinematic methods during overground and t...
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Distorted visual feedback (DVF) during locomotion has been suggested to result in the development of a new walking pattern in healthy individuals through implicit learning processes. Recent work in upper extremity visuomotor rotation paradigms suggest that these paradigms involve implicit and explicit learning. Additionally, in upper extremity visu...
Article
Key points: Previous work demonstrated an effect of a single high-intensity exercise bout coupled with motor practice on the retention of a newly acquired skilled arm movement, in both neurologically intact and impaired adults. In the present study, using behavioural and computational analyses we demonstrated that a single exercise bout, regardles...
Article
Background A single nucleotide polymorphism, Val66Met, in the Brain Derived Neurotrophic Factor (BDNF) gene has been studied for its role in recovery following stroke. Despite this work, the role of BDNF genotype on long-term recovery is unclear. Additionally, no study has examined its impact on functional mobility. As a result, the purpose of this...
Article
Background: Many outcome measures (OM) that assess individuals' ability or beliefs in their ability to perform tasks exist to evaluate activity and participation after stroke; however, the relationship between various OM and activity/participation is unclear. Objective: The purpose of this study was to explore the relationships between different...

Citations

... In clinical populations such as stroke or osteoarthritis, where differences between the left and right are more apparent, these asymmetry measures may be more valid. This has been the case for 2D video pose estimation systems which demonstrated moderate-to-excellent agreement with gold-standard 3D motion capture for step length asymmetry and step time asymmetry measures in people with stroke (John et al., 2023). Further research should evaluate the validity of these variability and asymmetry parameters with smartphone accelerometry in clinical populations. ...
... From the 26 cross-sectional studies, 14 studies (54%) were considered to be of high quality 67,68,70,76,80,[84][85][86]91,93,94,97,102,103 and 12 studies (46%) of fair quality. 34,71,74,75,82,83,87,89,90,95,98,104 From the 19 cohort studies, nine studies (47%) were considered to be of high quality 13,62-66,79,81,99 and 10 studies (53%) of fair quality. ...
... Reminders were sent to participants to synchronise their devices and complete online assessments, with 65% of participants requiring at least one reminder to achieve a wear time of 77%. 59 This small study included a selective and relatively young population, questioning the feasibility of remote monitoring in older or less healthy individuals. A recent study of 82 people (mean age 80 years) with dementia, including vascular dementia, demonstrated that remote monitoring of physiological parameters was feasible with carer support but needs confirmation. ...
... There is a large current emphasis in neurorehabilitation on outcomes data collection; big data frameworks will undoubtedly lead to very valuable insights for neurorehabilitation [27,28]. When modeling data, key attention to specific outcomes and their context is extraordinarily important. ...
... We think this may have been a result of the HPE algorithm selected. Currently, full-body HPE techniques are typically better at tracking gross body movements, like those in the FTN, compared to smaller motions at extremities like the hand [42]. Our results support this statement as tracking a participant's digits during an HPS task was a challenge for our algorithms. ...
... Furthermore, people with more severe impairment in the acute phase show wider outcome variation in the chronic phase (Prabhakaran et al., 2008). Variation in treatment response even among subpopulations of stroke survivors, as seen in our data, has led to a shift in the field toward precision rehabilitation, which aims to "deliver the right intervention at the right time, to the right individual" (French et al., 2022). However, there are few known 'right interventions' for stroke survivors with chronic, severe sensorimotor impairment. ...
... For example, we did not examine impact of myoelectric control strategies, such as pattern recognition, or surgical interventions, such as targeted muscle innervation, that may improve myoelectric controls and thus impact prosthesis usability experience or prosthesis adoption. Nor did we include factors such as access to prosthetic care, amount and type of prosthetic training, socio-economic status, or psychosocial factors such as presence of depressive symptomology, cognitive abilities, and aspects of the social environment (e.g., marital and employment status), which may impact upper limb use in daily life in prior studies of upper limb impairment [68][69][70]. It is possible these factors and other factors such as prosthesis embodiment may influence Prosthesis Usability and Extent of Prosthesis Adoption as well. ...
... 6,12,13 Explicit learning can be used during gait in both neurologically intact individuals and those post-stroke by providing visual feedback and specific task instructions. [14][15][16] A key feature of this process is that it can be volitionally "switched" on or off in response to context or instructions. 3,13,17,18 Sensorimotor adaptation is an implicit motor learning process that is essential for maintaining well-calibrated movements in response to ever-changing environments and body states. ...
... A computer monitor placed in front of the treadmill provided real-time feedback of participants' left step lengths (The MotionMonitor Toolbox, Innovative Sports Training). We chose to focus on step length because it is a robustly modifiable gait parameter that has frequently been the focus of locomotor learning paradigms (Reisman et al., 2005;Roemmich et al., 2016;French et al., 2018French et al., , 2021Wood et al., 2020Wood et al., , 2021 and because both implicit and explicit forms of motor memory have been observed after learning an altered step length pattern (French et al., 2018(French et al., , 2021Wood et al., 2020Wood et al., , 2021. ...
... For comparison, we recruited a group that performed the same walking pattern using explicit, target error feedback, which does not induce significant exploration. Prior work has demonstrated that use-dependent learning is the predominant source of implicit aftereffects in this target error paradigm (Wood et al., 2020(Wood et al., , 2021, and neither implicit aftereffects nor explicit retention is contaminated by sensory prediction errors. We hypothesized that the reward prediction error group would learn the new walking pattern using greater exploration (a greater increase in motor variability above baseline) and that they would have larger implicit aftereffects and more accurate explicit retention compared with the target error group. ...