Effects of Sensory Deficit on Phalanx Force Deviation During Power Grip Post Stroke

The effect of sensory deficits on power grip force from individual phalanges was examined. The authors found that stroke survivors with sensory deficits (determined by the Semmes-Weinstein monofilament test) gripped with phalanx force directed more tangential to the object surface, than those without, although both groups had similar motor deficits (Chedoke-McMaster and Fugl-Meyer), grip strength, and skin friction. Altered grip force direction elevates risk of finger slippage against the object thus grip loss/object dropping, hindering activities of daily living. Altered grip force direction was associated with altered muscle activation patterns. In summary, the motor impairment level alone may not describe hand motor control in detail. Information about sensory deficits helps elucidate patients' hand motor control with functional relevance.     

The representation of predictive force control and internal forward models: evidence from lesion studies and brain imaging

Force control on the basis of prediction avoids time delays from sensory feedback during motor performance. Thus, self-produced loads arising from gravitational and inertial forces during object manipulation can be compensated for by simultaneous anticipatory changes in grip force. It has been suggested that internal forward models predict the consequences of our movements, so that grip force can be programmed in anticipation of movement-induced loads. The cerebellum has been proposed as the anatomical correlate of such internal models. Here, we present behavioural data from patients with cerebellar damage and data from brain imaging in healthy subjects further elucidating the role of the cerebellum in predictive force control. Patients with cerebellar damage exhibited clear deficits in the coupling between grip force and load. A positron-emission-tomography (PET) paradigm that separated the process of the grip force/load coupling from the isolated production of similar grip forces and loads was developed. Interaction and conjunction analyses revealed a strong activation peak in the ipsilateral posterior cerebellum particularly devoted to the predictive coupling between grip force and load. Both approaches clearly demonstrate that the cerebellum plays a major role in force prediction that cannot be compensated for by other sensorimotor structures in case of cerebellar disease. However, evidence suggests that also extra-cerebellar structures may significantly contribute to predictive force control: (1) grip force/load coupling may also be impaired after cerebral and peripheral sensorimotor lesions, (2) a coupling-related activation outside the cerebellum was observed in our PET study, and (3) the scaling of the grip force level and the dynamic grip force coupling are dissociable aspects of grip force control.     

Motor prediction at the edge of instability: alteration of grip force control during changes in bimanual coordination

Predicting the consequences of actions is fundamental for skilled motor behavior. We investigated whether motor prediction is influenced by the fact that some movements are easier to perform and stabilize than others. Twelve subjects performed a bimanual rhythmical task either symmetrically or asymmetrically (the latter being more difficult and less stable) while oscillating in each hand an object attached to an elastic cord. Motor prediction was monitored through the adequacy of anticipatory grip force adjustments with respect to the elastic resisting force. Results showed less adequate predictive control during asymmetrical movements (compared with symmetrical ones). Furthermore, switching between modes of coordination induced even larger alterations. An interesting finding was that grip force control did not always stabilize around the expected value after voluntary transition. We conclude that motor prediction is affected by the degree of coordination between the upper limbs and by phase transitions and is prone to carryover effects.     

The man who executed "imagined" movements: evidence for dissociable components of the body schema

We examined the nature of representations underlying motor imagery and execution in a patient (CW) with bilateral parietal lesions. When imagining hand movements, CW executed the imagined motor act but was unaware of the movements. These movements were significantly more accurate than volitional movements for the left but not right hand. CW also exhibited preserved motor imagery for the left but not right hand. Consistent with previous accounts, these findings suggest that motor imagery may normally involve the inhibition of movements. CW's unawareness of movements during motor imagery may reflect inattention or misattribution of the unexpected sensory feedback. Furthermore, in line with current models of motor control, motor imagery may depend on the integrity of a "forward model" derived from motor outflow information to generate a prediction of the consequences of a motor command. Such predictions appear to be preserved for imagery of left but not right hand movements in CW. Action may additionally depend on precise updating of effector position derived from the comparison of predicted and actual sensory information. We propose that CW's impaired volitional movements may be attributable to the degradation of such an updating mechanism.     

Impairment of nonverbal oral movements in aphasia

Thirty-six patients with unilateral cerebral vascular damage were required to perform a number of oral motor tasks, both verbal and nonverbal. Nonfluent aphasics were impaired in the imitation of single oral movements, as previously reported. However, on the imitation of complex nonverbal oral movements fluent aphasics were impaired as well as nonfluents. This impairment was not explicable on the basis of visual memory or perceptual deficits, nor on the basis of sensory thresholds as measured on the tongue. The findings suggest that deficits in coordinating oral movements are fundamental to most aphasic impairments, the meaningfulness of the responses not being a critical factor in the appearance of the defect.     

Anticipatory modulation of precision grip force with variations in limb velocity of a curvilinear movement

The authors examined the relationship between peak velocity of a discrete horizontal elbow flexion movement in which the hand path was curvilinear and premovement modulation of precision grip force. The velocity of the movements of 7 participants was varied from maximal velocity to a velocity that required several seconds to reach a target. An object instrumented with force transducers for the forefinger and thumb measured precision grip force. There was a positively accelerating quadratic relationship between grip force change before movement and peak velocity of the ensuing limb movement. On some low-velocity trials, premovement grip force modulation reflected a net decrease. In contrast, high-velocity trials were preceded by net increases in grip force. Using cluster analysis, the authors classified grip forces in low-velocity movements as an empirically distinct set of entities from grip forces in high-velocity movements. The cluster of high-value grip forces suggested an anticipatory strategy that allowed participants a large safety margin in grip force to avoid object slip on movement initiation. The cluster of low-value grip forces at movement initiation suggested a second anticipatory strategy in which participants changed grip force very little, perhaps to increase the ability of proprioceptors in the hand to sense force changes. Those findings suggest that modulation of grip force before initiation of movements in which the hand path is curvilinear may be governed by two distinct velocity-dependent anticipatory strategies.     

Apraxia differs in corticobasal degeneration and left-parietal stroke: A case study.

Corticobasal degeneration (CBD) is a progressive disorder characterized by both cortical and basal ganglia dysfunction such as asymmetrical apraxia, and akinetic rigidity, involuntary movements, and cortical sensory loss. Although apraxia is a key finding for the differential diagnosis of CBD, it has not been determined whether the features of apraxia seen in subjects with CBD are similar to those features exhibited by subjects with left-hemisphere damage from stroke. Therefore, for both clinical purposes and in order to better understand the brain mechanisms that lead to apraxia in CBD, we studied praxis in a patient with CBD and compared him to patients who are apraxic from left-parietal strokes. We used three-dimensional movement analyses to compare the features of apraxic movement. This subject with CBD was a dentist whose initial complaint had been that he "forgot" how to use his tools in the mouths of his patients. Analyses were performed on the trajectories made when using a knife to actually slice bread, and when repetitively gesturing slicing made to verbal command. Movements of the left hand, wrist, elbow, and shoulder were digitized in 3-D space. Although the CBD subject was clearly apraxic, the features of his apraxia differed markedly from those of the subjects with lesions in the left parietal lobe. For movements to command, the CBD subject showed joint coordination deficits, but his wrist trajectories were produced in the appropriate spatial plane, were correctly restricted to a single plane, and, like control subjects, were linear in path shape. However, when he was actually manipulating the tool and object, all of these aspects of his trajectories became impaired. In contrast, the deficits of the apraxic subjects with left-parietal damage were most pronounced to verbal command with their movements improving slightly although remaining impaired during actual tool and object manipulation. Unlike patients with parietal strokes, patients with CBD have degeneration in several systems and perhaps deficits in these other areas may account for the differences in praxic behavior.     

Efficiency of grip force adjustments for impulsive loading during imposed and actively produced collisions

During object manipulation, both predictive feedforward and reactive feedback mechanisms are available to adjust grip force (GF) levels to compensate for the destabilizing effects of load force changes. During collisions, load force increases impulsively (     

Cerebellar ataxia: quantitative assessment and cybernetic interpretation

To assess neuromotor disorders clinicians often rely on rating scales. Unfortunately, these scales lack the sensitivity and accuracy needed to detect the small changes in motor coordination that reflect the clinical progression of the disease on the basis of which treatment programmes can be adjusted. As a contribution to this topic, the present paper proposes a straightforward kinematic and kinetic analysis of reaching movements of patients with cerebellar ataxia in conjunction with a cybernetic interpretation of the data. The aim of the approach is to capture key deficits in the underlying motor control processes. We suggest that cerebellar ataxia may be characterized by defective feedforward control.     

Adaptive motor behavior of cerebellar patients during exposure to unfamiliar external forces

The authors investigated adaptation of goal-directed forearm movements to an unknown external viscous force assisting forearm flexion in 6 patients with cerebellar dysfunction and in 6 control participants. Motor performance was generally degraded in cerebellar patients and was markedly reduced under the force condition in both groups. However, patients and controls were able to adapt to the novel force within 8 trials. Only the healthy controls were able to improve motor performance when readapting to a null-force condition. The results indicate that cerebellar patients' motor control system has imprecise estimations of actual limb dynamics at its disposal. Force adaptation may have been preserved because single-joint movements were performed, whereas the negative viscous force alone and no interaction forces had to be compensated.     

Screening for apraxia: a short assessment for stroke patients

Apraxia is a disorder that involves impaired ability to execute previously learned movements that cannot be attributed to basic sensory or motor disturbances. A thorough assessment of apraxia typically entails both pantomiming and imitation of transitive (tool-related), intransitive (communication-related), and meaningless gestures, presented in an array of different, process-dependent sensory conditions. Precise and detailed assessment tools are often time-consuming and a shorter screening tool may be desirable for efficient surveillance of this disorder in stroke patients. In the present study, stroke patients (N = 37) were compared to healthy controls (N = 30) in their production of commonly used transitive and intransitive gestures. Five gestures (knife, flipper, tweezers, okay sign, cab hailing) were consistently performed with poorer accuracy in stroke patients when compared to healthy controls. The combination of gestures that best captured apraxic performance was statistically determined based on Z-score data. Results provide a shortened and sensitive method of detecting apraxia in stroke patients.     

Task requirements influence sensory integration during grasping in humans

The sensorimotor transformations necessary for generating appropriate motor commands depend on both current and previously acquired sensory information. To investigate the relative impact (or weighting) of visual and haptic information about object size during grasping movements, we let normal subjects perform a task in which, unbeknownst to the subjects, the object seen (visual object) and the object grasped (haptic object) were never the same physically. When the haptic object abruptly became larger or smaller than the visual object, subjects in the following trials automatically adapted their maximum grip aperture when reaching for the object. This adaptation was not dependent on conscious processes. We analyzed how visual and haptic information were weighted during the course of sensorimotor adaptation. The adaptation process was quicker and relied more on haptic information when the haptic objects increased in size than when they decreased in size. As such, sensory weighting seemed to be molded to avoid prehension error. We conclude from these results that the impact of a specific source of sensory information on the sensorimotor transformation is regulated to satisfy task requirements.     

Ideational action impairments in Alzheimer's disease

We report data from a group of patients with mild Alzheimer's disease on a range of tasks requiring either stored semantic knowledge about objects (e.g., naming object use) or the execution of action to objects (e.g., miming and using objects). We found that the patients were impaired at miming in response to objects, even when they could describe the object's function. On the other hand, copying gestures was not impaired relative to naming gestures, indicating that an ideomotor deficit in action execution, per se, was unlikely to explain the impairments in object use. We suggest instead that the patients had an impairment in stored motor programmes for action, over and above their deficits in semantic knowledge. Despite this, the patients were better at using than at miming to objects, consistent with the view that proprioceptive input (when using objects) can directly constrain selection of the appropriate motor programme for action.     

Evidence of Incomplete Motor Programming in Parkinson's Disease

One of the essential questions regarding movement deficits in Parkinson's disease (PD) is whether they stem from impaired selecting and switching among movements, impaired use of predictive information to prepare movement, or impaired execution of movement. PD subjects (n equals 9) and age-matched control subjects (n equals 8) performed a cued, sequential-response RT task. The cue provided either no information, accurate information, or inaccurate information about the upcoming response. PD subjects used predictive information to prepare and to switch among movement sequences normally, but second and third key press latencies were prolonged in comparison with the first key press latency. In Experiments 2 and 3, the effects of choice set and sequence length on key press latencies were examined. These results provide evidence that PD subjects initiate movement before the entire response sequence is prepared. PD does not impair motor programming or execution processes themselves but impairs the smooth coordination of those processes.     

Grasp force control in older adults

Diminished tactile sensibility and impaired hand dexterity have been reported for elderly individuals. Reports that younger adults with severely impaired tactile sensibility use excessive grasp force during routine grasp and manipulation tasks raise the possibility that elderly persons likewise produce large grasp forces that may contribute to impaired dexterity. Impaired pseudomotor functioning also occurs in elderly subjects and may yield a slipperier skin surface that enhances the possibility for excessive grasp force. The present study measured grasp force in 10 elderly and 9 young adult individuals, during grasp and vertical lift of a small object, using a precision (pinch) grip of the thumb and index finger. The slipperiness of the object's gripped surfaces was unexpectedly varied. Skin slipperiness was estimated by also measuring the grasp force at which the object slipped from grasp. The older subjects employed grasp forces that were, on average, twice as large as those of the young subjects, with some producing forces many times greater than the young subjects' average grip force. Grip forces also were significantly more variable across trials in older subjects. This increased variability was not caused simply by the elderly subjects' increased grip force. A portion of the increased force was due to increased skin slipperiness. The grip force that the elderly subjects produced in excess of the slip force (the "margin of safety" against object slippage) was larger than would have been predicted from their skin slipperiness, however. It is suggested that, in part, the excessive grasp forces represent a strategic response to tactile sensibility impairment. Twopoint discrimination limina in the older subjects averaged about four times greater than in the younger subjects. Increased grasp forces in elderly persons may result from other factors, such as increased variability in grip force production. The contributions of excessive grasp forces to impaired dexterity in older persons still need to be addressed experimentally.     

Impairment of nonlinguistic hand movements in a deaf aphasic

A deaf man who became aphasic for sign language was seen 4 years after a left-hemisphere stroke. While not impaired on traditional apraxia tests, he was impaired, relative to nonaphasic deaf controls, in the imitation of complex nonlinguistic hand movements. He was not impaired on single isolated movements. These findings are interpreted as supporting a concept of left-hemisphere function which emphasizes complex motor control.     

Neuropsychological functioning in hemiparkinsonism

A standardized neuropsychological battery including measures of intellectual cognitive, memory, attention-concentration, language, abstraction and mental flexibility, and sensory and motor functions was administered to 21 hemiparkinsonian patients (14 with right side and 7 with left side symptoms) and 17 controls matched for age and education. Patients were impaired in all functions except sensory. For motor functions, impairment was ipsilateral to the side of symptoms. For cognitive functions, right side symptoms were associated with verbal deficits whereas left side symptoms were associated with spatial deficits. Thus, a pattern of neuropsychological deficits consistent with the lateralization of motor symptoms may appear in the early stages of the disease.     

Impaired processing of rapid stimulus sequences in dyslexia

Apart from their reading difficulties, dyslexic subjects often suffer from a variety of subtle sensory and motor deficits. Whether these deficits have a causal relationship to the reading disorder, form additional risk factors, or are totally independent of the reading problem, is under vivid debate. In this article, we review the evidence and suggest that ‘sluggish attentional shifting’ (SAS) can account for the impaired processing of rapid stimulus sequences in dyslexia. Within this novel framework attention-related prolongation of input chunks is decisive for many small deficits found in dyslexic subjects.     

Hand Grip and Load Force Coordination of the Ipsilesional Hand of Chronic Stroke Individuals

Object manipulation depends on a refined control of grip force (GF) and load force (LF). After a brain injury, the GF control is altered in the paretic hand but what happens with the non-paretic hand is still unclear. In this study, we compared the GF control and GF–LF coordination of the non-paretic hand of 10 stroke individuals who suffered right brain damage (RBD) and 10 who suffered left brain damage (LBD), with 20 healthy individuals during lifting and oscillation task, using an instrumented object. GF was recorded with a force transducer, and LF was estimated from the object weight and acceleration. Overall, the ipsilesional hand of stroke individuals, independent of the lesion side, presented similar GF control and GF–LF coordination. However, LBD individuals took longer to start lifting the object, which may be due to the need of more time to obtain somatosensory information from the contact with the object. The findings indicate that stroke individuals preserve their ability to control and coordinate GF and LF when using their ipsilesional hand for object manipulation and the left hemisphere may play an essential role in the processing of somatosensory information needed for the GF control.