Abstract:
A method and apparatus for implementing a training regimen which addresses motor control problems accompanied by sensory degradation. Accordingly, the training regimen is applicable to motor control disorders associated with a variety of different causes, including traumatic injury, disease, aging and gradual “occupational” type injury. For example, in an individual suffering from repetitive strain injury (RSI), the disabling motor control problems are often accompanied by sensory problems. These sensory problems appear to be caused over time by harmful attended rapid repetitive movements resulting in undesirable changes in the somatosensory, proprioceptive and/or kinesthetic ability of the affected regions of the individual. The present invention hypothesizes that repetitive delivery of simultaneous or nearly simultaneous afferent sensory inputs, under attended conditions of high cognitive drive, results in a learning-induced integration of the representation of the individuality of otherwise differentiable parts of the subjects thereby degrading the sensory feedback loop necessary for normal motor control. What started out as a degradation of the sensory feedback capability, essential for proper motor control, eventually manifests over time as a motor control problem. Thus, motor control problems which are accompanied by sensory degradation can be alleviated by a regimen of remedial re-differentiating sensory training of the affected regions of the individual. Accordingly, the training regimen differentially stimulates two locations within the afflicted portion of the individual. Feedback from the individual indicates the degree of difficulty the individual has in sensing differentially between the two locations. The stimulation is then adapted to the individual based on the feedback. Adaptation includes increasing the distance between the two locations and/or changing the spectral or temporal characteristics of the stimuli.

Description:
This is a Continuation application of application Ser. No. 08/970,339 filed on Nov. 14,1997 now abandoned. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to alleviation of motor control problems. More particularly, the present invention relates to a computerized method of improving motor control in an individual via somatosensory, proprioceptive and/or kinesthetic sensory training. 
     2. Description of the Related Art 
     Motor control problems in individuals are rooted in a variety of different causes, including traumatic injury, disease, aging and gradual “occupational” type injury. If the affected individual is motivated enough to participate in a rehabilitative training program, recovery is possible and is highly dependent on the quantity and quality of the training program. 
     In cases where motor control problems in individuals are caused by traumatic injury to or disease of the muscle(s) and/or related nerve(s), depending on the extent of injury to the nerve(s), such individuals may or may not experience a corresponding loss of sensory ability. Typical causes of injuries include trauma, stroke, aneurysm, and invasive surgery. Examples of diseases include meningitis and cancer. Historically, regardless of whether the motor control problem is accompanied by a loss of sensory ability, these individuals have been treated with strengthening, flexibility, conditioning and motor retraining techniques, with limited success. 
     Often, motor control problems are not caused by injury or disease, but are associated with a gradual degradation of motor control over time. Examples include work-induced focal dystonia, Alzheimer, torticollis, cerebral palsy, multiple sclerosis and movement disorders in Parkinson&#39;s Disease, Huntington&#39;s Chorea, and in other progressive neurological illnesses. 
     A common origin of focal dystonia is as a component of a repetitive strain injury (RSI) which appears to be the result of attended rapid movements repeated over a relatively long period of time. Generally, these potentially harmful rapid movements occur at a frequency at or below about 100 milliseconds. Typical symptoms of RSI include loss of motor control and involuntary movements of the affected hand, foot, limb or neck of the affected individual. 
     One example of rapid movements involves musicians and typists, or other skilled manual workers who are required to repeatedly execute rapid alternating movements, e.g., to produce trills and keyboard strokes, to perform a particular assembly line task, etc. When executed repeatedly over a period of time, these rapidly alternating movements put one at risk for RSI. 
     In a study involving musicians with focal hand dystonia, subjects shared common histories of increased practice and of extended, demanding performances under stressful conditions prior to the onset of the disabling symptoms. While most of their biomechanical tests were normal, there was a clear asymmetry in passive finger spread in the central digits, forearm and shoulder rotation. These motor control limitations forced some of the musicians to adopt compensatory awkward end range postures which in some cases caused inflammatory problems of the capsule, ligaments, tendons and fascia, i.e., typical RSI symptoms. 
     Potentially harmful rapid movements also include rapid simultaneous movement of adjacent portions of a limb which can otherwise be controlled independently, e.g., when multiple digits of one hand, are opened and closed rapidly. In one study involving primates, attended repetitive activities, under the conditions of high cognitive drive were conducted over a three month period. 
     In one experiment, the monkeys placed a hand on two bars that passively spread apart within 20 milliseconds. The monkeys were required to squeeze the palm and the digits against a hand piece while maintaining close contact with the hand piece during the entire movement trial. The hand piece opened between one and seven times per trial for a total of 1300 repetitions in a training session. In a second experiment, the monkeys were required to repetitively squeeze the hand piece. A successful trial required full hand contact, 80 grams of force, squeezed for 500-1000 milliseconds. Each successful trial was rewarded, with approximately 400 trials completed per training session. 
     Following about eight weeks of training, despite continued rewards, these monkeys began to avoid training. For example, they began to decrease the time and repetitions of the sessions and would lick their thumbs or hand as if it was painful. They also developed some compensatory strategies such as reducing the intensity of the grasp on the hand piece and/or using an arm pulling instead of the required hand squeezing strategy. When training was continued, symptoms of an occupationally induced RSI emerged in all five subject monkeys after approximately five weeks. Four of the five monkeys showed signs of inefficient motor control of the required tasks as well as in other non-trial movements such as retrieving food. The fifth monkey developed the most serious dystonic movements in the fourth digit of the trained hand. 
     Hence, it appears that subjects who suffer from RSI can develop a form of focal dystonia, a disorder of motor control manifested in a specific context during rapid skilled, attended movements. Unlike traumatic injury patients, most RSI subjects experience a slow onset of symptoms, often beginning as a feeling of awkwardness, fatigue, or impaired timing or force. Eventually, if the potentially harmful repetitive movements are continued, the degradation of motor control is often preceded, paralleled or followed by painful inflammatory problems of the capsule, ligaments, tendons and fascia. 
     Conventional RSI treatment such as strengthening, flexibility, conditioning and motor retraining exercises appear to offer only temporary relief. This is because the conventional treatments are directed at the symptoms and but do not attempt to identify nor address the source of the problem. As a result, despite rest and conventional treatment, the motor control problems and any accompanying inflammation often return as soon as the subjects attempt to resume the repetitive movements. 
     In view of the foregoing, there are desired improved techniques for addressing motor control problems accompanied by sensory degradation using a training regimen that addresses the root of the motor control problem and not just the symptoms of motor control. Such a regimen should offer a comprehensive solution thereby enabling the affected individuals to substantially regain normal motor control over the longer term. 
     SUMMARY OF THE INVENTION 
     The present invention provides a method and apparatus for implementing a training regimen that addresses motor control problems accompanied by sensory degradation. Accordingly, the training regimen is applicable to motor control disorders associated with a variety of different causes, including traumatic injury, disease, aging and gradual “occupational” type injury. 
     For example, in an individual suffering from repetitive strain injury (RSI), the disabling motor control problems are often accompanied by sensory problems. These sensory problems do not appear to result from a peripheral nerve injury or disease. Instead, it appears that over time harmful attended rapid repetitive movements cause undesirable changes in the somatosensory, proprioceptive and/or kinesthetic ability of the affected regions of the individual. Briefly, somatosensory inputs include the light and deep tactile inputs, stretch, slow and rapidly adaptive tactile and vibratory tactile inputs. Proprioception and kinesthesia involve inputs from muscles, joints and skin contributing to movement control and locational sense control, respectively. 
     These sensory problems manifest themselves in a variety of symptoms. While some individuals with hand dystonias are able to differentiate light touch from deep touch, or sharp from dull pressure, they are unable to accurately interpret tactile cues through the skin, muscle afferents or tendons relative to location. In other words, these individuals appear to retain the ability to sense gross inputs but are unable to differentiate between the afflicted regions, i.e., there is a loss in sensory differentiation of the afflicted regions. For example, some individuals have difficulty determining which finger was stimulated, or whether one or more fingers were receiving the stimulus. 
     In some individuals, the motor control disorder includes involuntary motor control: co-contraction of flexors and extensors, inaccuracy, weakness, fatigue, loss of coordination and involuntary dystonic movements, e.g., when a hand touches a specific target interface. As a result, the individual can no longer perform tasks that require fine motor coordination of the affected portions. 
     The present invention hypothesizes that repetitive delivery of simultaneous or nearly simultaneous afferent sensory inputs, under attended conditions of high cognitive drive, results in a learning-induced integration of the representation of the individuality of otherwise differentiable parts of the subjects thereby degrading the sensory feedback loop necessary for normal motor control. Hence, the learning-induced progressive destruction of the otherwise highly differentiable representations of digit skin and of muscle afferent inputs involved with the muscles controlling the fingers is the root cause of the degradation of hand movement control. In other words, what started out as a degradation of the sensory feedback capability, essential for proper motor control, eventually manifests over time as a motor control problem. 
     As discussed above, motor control problems can also be the result of nerve injury or disease. In such cases, where nervous regeneration is possible, recovery can be enhanced by addressing the sensory degradation problem. 
     Thus, motor control problems accompanied by sensory degradation due to input integration or nerve damage/disease, can be alleviated by a regimen of remedial re-differentiating sensory training of the affected regions of the individual. Accordingly, the training regimen of the present invention differentially stimulates two locations within the afflicted portion of the individual. Feedback from the individual indicates the degree of difficulty the individual has in sensing differentially between the two locations. The stimulation is then adapted to the individual based on the feedback. Adaptation includes increasing the distance between the two locations and /or changing the spectral or temporal characteristics of the stimulation. 
     The present invention is effective and long lasting because the training regimen addresses a root cause of the motor control problem and not just the symptoms. These and other advantages of the present invention will be apparent upon reading the following detailed descriptions and studying the various figures of the drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a block diagram of an exemplary computer system for practicing the invention. 
     FIG. 2 is a block diagram showing an exemplary hardware environment for implementing the various aspects of the present invention. 
     FIGS. 3A and 3B are flowcharts illustrating the remedial re-differential sensory training regimen of the present invention. 
     FIGS. 4-7B illustrate several embodiments of the stimulator useful for administering the training regimen of FIGS. 3A and 3B. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The present invention will now be described in detail with reference to a few preferred embodiments thereof as illustrated in the accompanying drawings. In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It will be apparent, however, to one skilled in the art, that the present invention may be practiced without some or all of these specific details. In other instances, well known process steps have not been described in detail in order to avoid unnecessarily obscuring the present invention. 
     FIG. 1 is a block diagram of an exemplary computer system  100  for practicing the various aspects of the present invention. Computer system  100  includes a display screen (or monitor)  104 , a printer  106 , a floppy disk drive  108 , a hard disk drive  110 , a network interface  112 , and a keyboard  114 . Computer system  100  includes a microprocessor  116 , a memory bus  118 , random access memory (RAM)  120 , read only memory (ROM)  122 , a peripheral bus  124 , and a keyboard controller  126 . Computer system  100  can be a personal computer (such as an Apple computer, e.g., an Apple Macintosh, an IBM personal computer, or one of the compatibles thereof), a workstation computer (such as a Sun Microsystems or Hewlett-Packard workstation), or some other type of computer. 
     Microprocessor  116  can be a general purpose digital processor which controls the operation of computer system  100 . Microprocessor  116  can be a single-chip processor or can be implemented with multiple components. Using instructions retrieved from memory, microprocessor  116  controls the reception and manipulation of input data and the output and display of data on output devices. 
     Memory bus  118  is used by microprocessor  116  to access RAM  120  and ROM  122 . RAM  120  is used by microprocessor  116  as a general storage area and as scratch-pad memory, and can also be used to store input data and processed data. ROM  122  can be used to store instructions or program code followed by microprocessor  116  as well as other data. 
     Peripheral bus  124  is used to access the input, output, and storage devices used by computer system  100 . In the described embodiment(s), these devices include display screen  104 , printer device  106 , floppy disk drive  108 , hard disk drive  110 , and network interface  112 . Keyboard controller  126  is used to receive input from keyboard  114  and send decoded symbols for each pressed key to microprocessor  116  over bus  128 . 
     Display screen  104  is an output device that displays images of data provided by microprocessor  116  via peripheral bus  124  or provided by other components in computer system  100 . Printer device  106  when operating as a printer provides an image on a sheet of paper or a similar surface. Other output devices such as a plotter, typesetter, etc. can be used in place of, or in addition to, printer device  106 . 
     Floppy disk drive  108  and hard disk drive  110  can be used to store various types of data. Floppy disk drive  108  facilitates transporting such data to other computer systems, and hard disk drive  110  permits fast access to large amounts of stored data. 
     Microprocessor  116  together with an operating system operates to execute computer code and produce and use data. The computer code and data may reside on RAM  120 , ROM  122 , or hard disk drive  120 . The computer code and data could also reside on a removable program medium and loaded or installed onto computer system  100  when needed. Removable program mediums include, for example, CD-ROM, PC-CARD, floppy disk and magnetic tape. 
     Network interface circuit  112  is used to send and receive data over a network connected to other computer systems. An interface card or similar device and appropriate software implemented by microprocessor  116  can be used to connect computer system  100  to an existing network and transfer data according to standard protocols. 
     Keyboard  114  is used by a user to input commands and other instructions to computer system  100 . Other types of user input devices can also be used in conjunction with the present invention. For example, pointing devices such as a computer mouse, a track ball, a stylus, or a tablet can be used to manipulate a pointer on a screen of a general-purpose computer. 
     The present invention can also be embodied as computer readable code on a computer readable medium. The computer readable medium is any data storage device that can store data which can be thereafter be read by a computer system. Examples of the computer readable medium include read-only memory, random-access memory, magnetic data storage devices such as diskettes, and optical data storage devices such as CD-ROMs. The computer readable medium can also be distributed over a network coupled computer systems so that the computer readable code is stored and executed in a distributed fashion. 
     The training regimen of the present invention is applicable to individuals whose motor control problems are accompanied by a degradation of differential sensory inputs in the somatosensory, proprioceptive and/or kinesthetic sensory domains. As discussed above, the causes of the motor control problems in such individuals are varied and include traumatic injury, disease, aging, and motor control disorders which appear to be induced by gradual destructive “learning” over time such as repetitive strain injury (RSI). However, although the training regimen is applicable to a wide range of motor control problems, the regimen is described below using an exemplary motor control impaired individual who is afflicted with RSI, hereinafter referred to as the RSI individual. 
     The present invention hypothesizes that motor control problems in the RSI individual start out as a progressive destructive integration of sensory representations of the afflicted portions of the RSI individual, resulting in the gradual loss of differential motor control. In turn the loss of motor control leads to awkward end range postures which increases the risk for painful inflammatory problems of the capsule, ligaments, tendons and fascia. 
     One explanation for the origin of the underlying integration problem is that the brain of most primates is unable to separately process and hence differentiate sensory input information that is not separated by more than about forty to about two hundred milliseconds in time. In time, the continued bombardment of stereotyped inputs in this time domain begins to destructively retrain the brain. Unable to distinguish these rapid and nearly simultaneous inputs as distinct inputs, in accordance with brain plasticity hypotheses of the present invention, the brain begins to integrate these inputs representationally, over time. Eventually, the RSI individual retrains his/her brain into integrating these inputs. Fine details of sensory inputs that were formerly represented separately are now represented only in a degraded, integrated form. As a result, what started out as a degradation of the sensory feedback capability, essential for proper motor control, eventually manifests over time as a motor control problem. 
     In view of the above hypothesis, the sensory retraining regimen of the present invention is effective because voluntary primate motor control is basically a closed loop control system with a sensory feedback loop. Accordingly, when the sensory feedback loop is degraded, a corresponding degradation of the motor control function is expected. Conversely, conventional treatment regimens that do not address the feedback loop and only attempt to correct the motor control function are inefficient because they do not directly address the degradation of the sensory loop, and are unlikely to result in a lasting satisfactory resumption of normal motor control. 
     As shown in FIG. 2, an exemplary sensory trainer  200  provides a platform for administering a training regimen for an RSI individual  290  afflicted with motor control problem accompanied by sensory degradation (MCSD). Trainer  200 , also referred to herein as stimulation system  200 , includes processor  116 , peripheral bus  124 , a stimulator  250  and an input device  260 . 
     Sensory inputs useful for the training regimen include somatosensory, proprioceptive and/or kinesthetic sensory inputs. Somatosensory inputs include the light and deep tactile inputs, stretch, slow and rapidly adaptive tactile, and vibratory tactile inputs. Proprioception and kinesthesia involve inputs from muscles, joints and skin contributing to movement control and locational sense control, respectively. Accordingly, sensory stimulus provided by stimulator  250  shall include one or more of the following: 
     Light touch (e.g., meaningful/meaningless form and textual detection) 
     Deep touch (slowly adapting and rapidly adapting fibers) 
     Vibration (different frequencies and intensities) 
     Proprioception of position (e.g. mid range and extremes of motion) 
     Temperature (cold to hot) 
     Stretch (golgi tendon organs, muscle spindles) 
     FIGS. 3A and 3B are flowcharts illustrating the training regimen of the present invention. Referring also to FIG. 2, since the extent of the motor control problem will vary from one individual to another, the first step of the regimen is a diagnostic of an individual, e.g., individual  290 , to select a suitable pair of locations for starting the sensory training. Accordingly, in step  310 , an initial first and second location is selected for which individual  290  may have difficulty sensing differentially. Stimulator  250  begins to provide stimuli differentially between the first and second location (step  320 ). 
     In the preferred embodiment, individual  290  provides feedback indicating the degree of difficulty that he/she is experiencing in differentiating the stimuli between the first and the second location (step  330 ). Feedback from individual  290  can be in the form of tactile responses, e.g., depressing a pressure sensitive switch under a finger, and/or via verbal responses, e.g., speaking into a microphone. In some embodiments, visual cues for guiding individual  290  during the sensory training regimen can be provided by monitor  104 . In other embodiments of stimulation system  200 , visual cues for individual  290  may not be necessary, thereby eliminating the need for monitor  104 . 
     Depending on the feedback from step  330 , stimulator  250  adaptively varies the stimuli at the first and second location (step  340 ). The stimuli can be modified or varied temporally and/or spectrally. Modifiable parameters include intensity, spectral frequency, duration, temporality and spatial orientation. 
     Referring to FIG. 3B, if individual  290  is unable to differentiate or has great difficulty differentiating stimuli between the first and second location, a third location is selected, wherein the distance between the first and third location is greater than the distance between the first and the second location. Conversely, if individual  290  can easily differentiate stimuli between the first and second location, a third location is selected, wherein the distance between the first and third location is smaller than the distance between the first and second location. (Step  350 ). 
     In step  360 , differential stimuli resumes with the first and third location. Again, depending on the feedback from individual  290  indicating his/her degree of difficulty in differentiating between the first and third location, stimulator  250  adaptively varies the stimuli on the first and third location (steps  370 ,  380 ). 
     In accordance with the brain plasticity principles, substantial improvement in the motor control ability of individual  290 , attributable to the training regimen of the present invention, should be observable after about 10 to 30 days of consistent re-differential sensory training. The training regimen should include about 1000 to 3000 stimuli exercises distributed into daily sessions, each session approximately one to two hours in duration, with rest breaks. Ideally, the training monitored by a physical therapist for compliance and safety reasons. Further, since the brain of individual  290  is plastic and is continually learning, continuing the training regimen beyond the initial training period should result in further improvement in motor control. 
     If individual  290  has an accompanying peripheral nerve injury, the sensory discrimination training is modulated according to the return of sensation along with positioning and maintenance of normal postures and normal movement despite any isolated paralysis. Accordingly, the present training regimen should positively influence the rate of recovery of sensation. 
     In accordance with another aspect of the invention, the training regimen provides motivation to encourage compliance. For example, the training regimen may be disguised as a treasure hunt implemented as a multimedia game. The clues for the treasures may be textural. Correct identification of the texture advances individual  290  to the next sequence of the treasure hunt. 
     As discussed above, there are numerous ways of providing stimuli to individual  290 , including somatosensory, proprioceptive and/or kinesthetic stimuli. In the following detailed description of exemplary implementations of stimulator  250 , the primary stimuli to be provided by stimulator  250  is textural/tactile stimuli and to a lesser extent pressure and/or positional stimuli. 
     Referring now to FIG. 4, stimulation system  200  includes a pair of spools  420 ,  430  which accommodate a tape  410 . Tape  410  has embossed patterns  410   a ,  410   b ,  420   c ,  410   d ,  410   e ,  410   f , and  410   g  distributed on one surface. Examples of suitable embossed patterns include Braille characters, alpha numeric characters and textural patterns. 
     Tape  410  is presented to individual  290  over a roller  440 . In addition to supporting tape  410 , roller  440  may also provide pressure, e.g., forced feedback to individual  290 . Patterns  410   a ,  410   b ,  420   c ,  410   d ,  410   e ,  410   f , and  410   g  may be presented at various speeds. The presentation. can either be a smooth continuous flow or one stop frame (pattern) at a time as in a movie projector. Individual  290  places a finger on top of the exposed portion  410   d  of tape  410  and is required to differentiate patterns  410   a ,  410   b ,  420   c ,  410   d ,  410   e ,  410   f , and  410   g.    
     Alternatively, as shown in stimulation system  200  of FIG. 5, patterns  510   a ,  510   b ,  520   c ,  510   d ,  510   e  and  510   f  are embossed on a drum  510 . With this setup, a relatively large embossed pattern, e.g., pattern  510   d , can be presented to individual  290 . As such, it is possible to provide stimuli to several locations simultaneously. 
     FIG. 6 illustrates yet another embodiment of stimulation system  200  which includes a ball  630 , i.e., stimulator  250 , operatively coupled to a base  620 , i.e., input device  260 . In this example, individual  290  places a hand over ball  630 , with finger pads over stimuli pads  610   a ,  610   b ,  610   c ,  610   d  and  610   e  located on ball  630 . Stimuli pads  610   a ,  610   b ,  610   c ,  610   d  and  610   e  may be electromechanical or piezoelectric driven pads with pins protruding from the pads when actuated. Suitable Braille pads include the Cell  16  pads of the PowerBraille Product Family and are available from Telesensory Corp. of Sunnyvale, Calif. (see website “www.telesensory.com”). 
     Individual  290  provides positional feedback to stimulation system  200  by manipulating ball  630  relative to base  620 , in a manner not unlike that of manipulating a joystick of a multimedia game. Several degrees of movement and rotation can be provided by system  200 . Optional feedback can be provided by individual via pressure sensitive switches located below the respective stimuli pads  610   a ,  610   b ,  610   c ,  610   d  and  610   e.    
     FIGS. 7A and 7B are cross-sectional diagrams of yet another embodiment of stimulation system  200 . Stimulation system  200  includes a glove-like stimuli device  700  with a plurality of finger stimuli rings  710 ,  720 ,  730 ,  740  and  750 . Individual  290  inserts the fingers of a hand into the respective holes  715 ,  725 ,  735 ,  745  and  755  of stimuli rings  710 ,  720 ,  730 ,  740  and  750 . 
     FIG. 7B is a detailed cross sectional diagram of one of the stimuli rings, e.g., stimuli ring  710 . Note that a finger tip pad  795   b  of a finger tip segment  795  of a finger of individual  290  is resting on probes  770 . Actuators  780  are operatively coupled to probes  770  and are guided by channels  760 . Blunt probe tips of probes  770  are in contact with finger tip pad  795   b . Stimuli is selectively provided to individual  290  by controlling actuators  780  which moves one or more of the blunt tips of probes  770  towards and away from pad  795   b.    
     Note that actuators  780  are located on the back of the hand, i.e., on the nail  795   a  side of finger tip segment  795 , in order to minimize the profile of the portion of stimuli ring  710  under finger pad  795   b . Such an arrangement maximizes the freedom of movement that can be provided by glove-like stimuli device  700  to the fingers. 
     Feedback from individual  290  can be verbal, i.e., via a microphone, or via a motion of the finger(s). Accordingly, three-dimensional position sensing capability can be incorporated into glove-like stimuli device  700 . An optional corresponding model of the hand can be displayed on monitor  104  of stimulation system  200 , thereby providing visual cues to individual  290  during the training session. In addition, force feedback capability can also be incorporated into device  700 . The position sensing, display and feedback capabilities are available from Virtual Technologies Inc. of Palo Alto, Calif. (see website www.virtex.com). 
     Many modifications are possible. For example, in a simplified embodiment of stimulation system  200 , feedback is not required of individual  290 , i.e., efficiency and the ability to monitor compliance can be traded off for simplicity of design and low cost. In addition, the training regimen described above is also applicable for remedial training, i.e., to avoid developing the motor control problem, e.g., focal dystonia. By starting treatment early, preventative use of the training regimen can prevent the destructive process of sensory integration before an observable motor control problem develops. The present invention is advantageous because the training regimen of the present invention addresses the root cause of the motor control problem. As such, motor control improvements resulting from the re-establishment of differential sensory ability should be substantial and long lasting. 
     While this invention has been described in terms of several preferred embodiments, there are alterations, permutations, and equivalents which fall within the scope of this invention. For example, while the above described RSI injuries involve the hand, such injuries can occur with another portion of the body, e.g., the feet. It is therefore intended that the following appended claims be interpreted as including all such alterations, permutations, and equivalents as fall within the true spirit and scope of the present invention.