The biological and behavioral basis of upper limb asymmetries in sensorimotor performance

The role of cognitive load on interlimb differences in motor coordination in older adults

Although the dominant hand has been shown to have performance advantages over the nondominant hand, these interlimb differences have found to be dependent on task and biomechanical demands. The dynamic dominance hypothesis suggests that the left hemisphere is specialized for the control of intersegmental dynamics while the nondominant right hemisphere is specialized for postural control, in right-handers. In a real-world scenario, however, cognitive challenges might be expected to modulate these specialized behaviors. Therefore, we hypothesized that with increased cognitive load, lateralized motor control processes would become even more asymmetrical. We recruited 16 right-handed older adults (11 females, 5 males; 65.88 yr ± 1.99 SE) to perform 170 trials of a unilateral reaching task with each of their hands on the Kinereach system. In each trial, participants rapidly memorized pictorial instructions before identifying and reaching for the correct object on a screen. The complexity of the task increased over the course of the experiment. Our results demonstrated higher reaction times in the right than in the left hand (P = 0.0004). Movements became increasingly curved and erroneous with cognitive load, but interlimb differences in movement quality were absent. We found higher joint cocontraction in the right than in the left arm (P < 0.05), but these differences were unaffected by cognitive load. Hence, with the addition of a cognitive load, we observed asymmetries in reaction time but not in joint coordination or movement quality. This highlights the role of cognitive load in modulating limb/hemisphere specializations for control processes.NEW & NOTEWORTHY Although we know that motor control processes are lateralized to each hemisphere, the role of cognitive load on these specialized processes is undefined. We designed a unique task that incorporates a cognitive challenge to a typical reaching movement to examine how cognitive load affects limb asymmetries in motor control. In a group of typical older adults, we demonstrated interlimb asymmetries in reaction time but not in joint coordination or movement quality.

Cortical neural activity during responses to mechanical perturbation: Effects of hand preference and hand used

Handedness, as measured by self-reported hand preference, is an important feature of human behavioral lateralization that has often been associated with hemispheric specialization. We examined the extent to which hand preference and whether the dominant hand is used or not influence the motor and neural response during voluntary unimanual corrective actions. The experimental task involved controlling a robotic manipulandum to move a cursor from a center start point to a target presented above or below the start. In some trials, a mechanical perturbation of the hand was randomly applied by the robot either consistent or against the target direction, while electroencephalography (EEG) was recorded. Twelve left-handers and ten right-handers completed the experiment. Left-handed individuals had a greater negative peak in the frontal event-related potential (ERP) than right-handed participants during the initial response phase (N150) than right-handed individuals. Furthermore, left-handed individuals showed more symmetrical ERP distributions between two hemispheres than right-handed individuals in the frontal and parietal regions during the late voluntary response phase (P390). To the best of our knowledge, this is the first evidence that demonstrates the differences in the cortical control of voluntary corrective actions between left-handers and right-handers.

Effectiveness of a home training program on improving pinch force perception in older adults

BACKGROUND

Hand function is reduced with aging which can lead to impairments in the performance of daily activities and eventually loss of independence. The ability to perceive the forces being applied to an object is an important component of hand control that also declines with age. However, the extent to which force perception can be improved through training remains largely unknown.

PURPOSE

This study evaluated the effectiveness of a home-training program focused on improving force perception in older adults.

STUDY DESIGN

Quasi-experimental - Uncontrolled trial.

METHODS

Eleven independent, healthy adults (mean age: 77.2 ± 6.8 years) participated in a home-based sensorimotor hand training program 6 days/week for 6 weeks. Force perception, the primary outcome variable, was measured as the ability to reproduce a pinch force equal to 25% maximum voluntary contraction in the absence of visual feedback using either the ipsilateral remembered or contralateral concurrent (CC) hand. We also measured hand strength, dexterity, tactile acuity, and cognition before and after training.

RESULTS

After the program was completed, participants showed a 35% reduction in absolute (p < 0.01, confidence interval (CI): [7.3, 33.2], effect sizes (ES): 0.87) and constant (p = 0.05, CI: [0.0, 34.9], ES: 0.79) force matching errors in the CC condition. Improvements in dominant hand dexterity (Purdue pegboard test) (p < 0.05, CI: [0.2, 2.4], ES: 0.60) and tactile sensitivity (JVP thresholds) (p < 0.05, CI: [-1.7, -0.1], ES: 0.94), as well as cognition (Trail Making Test B) (p < 0.05, CI: [-24,1. -1.6], ES: 0.30) were also observed post-training.

CONCLUSIONS

The results suggest that home-hand training can be an effective way to improve force perception among older adults.

Moving from stable standing to single-limb stance or an up-on-the-toes position: The importance of vision to dynamic balance control

Understanding the contribution vision has to dynamic balance control may help in understanding where/why loss of balance occurs during everyday locomotion. The current study determined how body-centre-of-mass (BCoM) dynamics and postural stability when moving to and holding a single-limb-stance (SS) or an up-on-the-toes (UTT) position were affected by visual occlusion. From standing on a force platform, 18 adults (mean (SD) 26.7 (4.8) years; 1.73 (0.08) m; 84.0 (22.9) kg; 7 females) completed repeated trials (x3) with and without vision in which they moved to either a SS or an UTT position (order countered-balanced), and attempted to hold that position for 2 (SS) or 5 (UTT) seconds before returning to standing. UTT trials were also repeated at a fast speed, and SS trials were repeated using both the dominant and non-dominant limb. BCoM dynamics were assessed by analysing the displacement and peak velocity of the centre-of-pressure (CoP) when moving to and from the SS and UTT positions. Balance stability was the variability in the CoP displacement/velocity when holding these positions. Results indicate that under visual occlusion, the peak CoP velocity when moving to the SS or UTT position was reduced (ES, 0.67 and 0.68, respectively), suggesting greater caution. Both the variability in the CoP displacement/velocity when holding these positions and the peak CoP velocity when returning to flat-standing increased (SS: ES, 1.0 and 0.86, respectively; UTT: ES 1.26 and 0.66, respectively), suggesting, respectively, greater instability and poorer control. The poorer control in SS trials, occurred when returning to standing from the SS position held on the non-dominant limb, and correspondingly, the reduction in SS duration when vision was occluded was greater for the non-dominant limb trails (limb-vision interaction; p = 0.042). This suggests that movements initiated/controlled by the non-dominant limb are more reliant on visual feedback than those initiated/controlled by the dominant limb.

Handedness in Animals and Plants

Structural and functional asymmetries are traceable in every form of life, and some lateralities are homologous. Functionally speaking, the division of labour between the two halves of the brain is a basic characteristic of the nervous system that arose even before the appearance of vertebrates. The most well-known expression of this specialisation in humans is hand dominance, also known as handedness. Even if hand/limb/paw dominance is far more commonly associated with the presence of a nervous system, it is also observed in its own form in aneural organisms, such as plants. To date, little is known regarding the possible functional significance of this dominance in plants, and many questions remain open (among them, whether it reflects a generalised behavioural asymmetry). Here, we propose a comparative approach to the study of handedness, including plants, by taking advantage of the experimental models and paradigms already used to study laterality in humans and various animal species. By taking this approach, we aim to enrich our knowledge of the concept of handedness across natural kingdoms.

The associations of physical parameters with the Closed Kinetic Chain Upper Extremity Stability Test, the Upper Quarter Y Balance Test, and the Upper Limb Rotation Test in professional overhead athletes

OBJECTIVE

To investigate the associations of glenohumeral internal (IR) and external rotation (ER), horizontal adduction (HA), and thoracic spine rotation ranges of motion (ROM), isometric muscle strength of the shoulder rotators, and trunk muscle endurance with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Quarter Y Balance Test (YBT-UQ), and the Upper Limb Rotation Test (ULRT) in overhead athletes.

DESIGN

Cross-sectional study.

SETTINGS

Laboratory.

PARTICIPANTS

One hundred twenty-one athletes were enrolled.

MAIN OUTCOME MEASURES

Independent variables were: IR, ER, HA, and thoracic spine rotation ROMs, isometric muscle strength of glenohumeral IR and ER muscles, and trunk muscle endurance. Dependent variables were: CKCUEST, YBT-UQ, ULRT.

RESULTS

IR ROM of the nondominant side was associated with the CKCUEST, the YBT-UQ, and the ULRT. IR muscle strength of the dominant side was associated with the CKCUEST and the ULRT. Trunk flexor and lateral endurance of the dominant side were associated with the CKCUEST and the YBT-UQ, respectively.

CONCLUSIONS

Many of the physical parameters influencing scores on the CKCUEST and the YBT-UQ are different. Common parameters influence the CKCUEST and ULRT scores, yet more parameters influence the CKCUEST score. We suggest the combined use of the CKCUEST and the YBT-UQ in overhead athletes.

Handgrip strength asymmetry and cognitive impairment risk: Insights from a seven-year prospective cohort study

OBJECTIVES

This study aimed to explore the links of handgrip strength and asymmetry with cognitive impairment.

DESIGN

This was a seven-year prospective cohort study.

SETTING AND PARTICIPANTS

We used data from wave 3 (2015-2017) to wave 5 (2019-2022) from the ongoing Taiwan Initiative of Geriatric Epidemiological Research (TIGER), with wave 3 as the baseline (n = 446). The study included community-dwelling participants aged 65 years or older.

MEASUREMENTS

Handgrip strength was measured, and abnormalities were determined based on handgrip strength weakness and asymmetry. Handgrip strength asymmetry was categorized into three groups at baseline based on the handgrip strength ratio (left handgrip strength/right handgrip strength). Cognitive tests evaluating global and specific cognitive domains were conducted at baseline and two biennial follow-ups. Generalized linear mixed models were utilized to assess the associations of abnormal handgrip strength with global cognition and multiple cognitive domain progression over time.

RESULTS

This study included 392 dementia-free participants, with an average age of 75.8 years and 179 (45.7%) males. Mild handgrip strength asymmetry was present in 88 participants (22.4%), while 53 (13.5%) exhibited moderate asymmetry. In men, the coexistence of low handgrip strength and handgrip strength asymmetry was linked to cognitive impairment over time. These associations were observed in global cognition (β^ = -1.76, 95% CI: -2.79 to -0.74), memory (immediate free recall: β^ = -0.67, 95% CI: -1.17 to -0.17), executive function (Trail Making Test-A: β^ = -0.54, 95% CI: -0.94 to -0.13), and attention (Digit span-forward: β^ = -1.00, 95% CI: -1.46 to -0.54).

CONCLUSIONS

This study found that individuals with reduced handgrip strength and handgrip strength asymmetry had an increased risk of cognitive impairment across various domains. Moreover, this association appears to be more pronounced among men than women. Incorporating these simple assessments into regular clinical practice improves the allocation of limited screening resources and timely clinical interventions in older adults.

Elastic Resistance and Shoulder Movement Patterns: An Analysis of Reaching Tasks Based on Proprioception

This study departs from the conventional research on horizontal plane reach movements by examining human motor control strategies in vertical plane elastic load reach movements conducted without visual feedback. Here, participants performed shoulder presses with elastic resistances at low, moderate, and high intensities without access to visual information about their hand position, relying exclusively on proprioceptive feedback and synchronizing their movements with a metronome set at a 3 s interval. The results revealed consistent performance symmetry across different intensities in terms of the reach speed (p = 0.254-0.736), return speed (p = 0.205-0.882), and movement distance (p = 0.480-0.919). This discovery underscores the human capacity to uphold bilateral symmetry in movement execution when relying solely on proprioception. Furthermore, this study observed an asymmetric velocity profile where the reach duration remained consistent irrespective of the load (1.15 s), whereas the return duration increased with higher loads (1.39 s-1.45 s). These findings suggest that, in the absence of visual feedback, the asymmetric velocity profile does not result from the execution of the action but rather represents a deliberate deceleration post-reach aimed at achieving the target position as generated by the brain's internal model. These findings hold significant implications for interpreting rehabilitation approaches under settings devoid of visual feedback.

Goal-directed modulation of stretch reflex gains is reduced in the non-dominant upper limb

Most individuals experience their dominant arm as being more dexterous than the non-dominant arm, but the neural mechanisms underlying this asymmetry in motor behaviour are unclear. Using a delayed-reach task, we have recently demonstrated strong goal-directed tuning of stretch reflex gains in the dominant upper limb of human participants. Here, we used an equivalent experimental paradigm to address the neural mechanisms that underlie the preparation for reaching movements with the non-dominant upper limb. There were consistent effects of load, preparatory delay duration and target direction on the long latency stretch reflex. However, by comparing stretch reflex responses in the non-dominant arm with those previously documented in the dominant arm, we demonstrate that goal-directed tuning of short and long latency stretch reflexes is markedly weaker in the non-dominant limb. The results indicate that the motor performance asymmetries across the two upper limbs are partly due to the more sophisticated control of reflexive stiffness in the dominant limb, likely facilitated by the superior goal-directed control of muscle spindle receptors. Our findings therefore suggest that fusimotor control may play a role in determining performance of complex motor behaviours and support existing proposals that the dominant arm is better supplied than the non-dominant arm for executing more complex tasks, such as trajectory control.

Does visual experience influence arm proprioception and its lateralization? Evidence from passive matching performance in congenitally-blind and sighted adults

In humans, body segments' position and movement can be estimated from multiple senses such as vision and proprioception. It has been suggested that vision and proprioception can influence each other and that upper-limb proprioception is asymmetrical, with proprioception of the non-dominant arm being more accurate and/or precise than proprioception of the dominant arm. However, the mechanisms underlying the lateralization of proprioceptive perception are not yet understood. Here we tested the hypothesis that early visual experience influences the lateralization of arm proprioceptive perception by comparing 8 congenitally-blind and 8 matched, sighted right-handed adults. Their proprioceptive perception was assessed at the elbow and wrist joints of both arms using an ipsilateral passive matching task. Results support and extend the view that proprioceptive precision is better at the non-dominant arm for blindfolded sighted individuals. While this finding was rather systematic across sighted individuals, proprioceptive precision of congenitally-blind individuals was not lateralized as systematically, suggesting that lack of visual experience during ontogenesis influences the lateralization of arm proprioception.

Force/moment tracking performance during constant-pose, force-varying, bilaterally symmetric, hand-wrist tasks

Bilateral movement is widely used for calibration of myoelectric prosthesis controllers, and is also relevant as rehabilitation therapy for patients with motor impairment and for athletic training. Target tracking and/or force matching tasks can be used to elicit such bilateral movement. Limited descriptive accuracy data exist in able-bodied subjects for bilateral target tracking or dominant vs non-dominant dynamic force matching tasks requiring more than one degree of freedom (DoF). We examined dynamic trajectory (0.75 Hz band-limited, white, uniform random) constant-posture, hand open-close, wrist pronation-supination target tracking and matching tasks. Tasks were normalized to maximum voluntary contraction (MVC), spanning a ± 30% MVC force range, in four 1-DoF and 2-DoF tasks: (1, 2) unilateral dominant limb tracking with/without visual feedback, and (3, 4) bilateral dominant/non-dominant limb tracking with mirror visual feedback. In 12 able-bodied subjects, unilateral tracking error with visual feedback averaged 10-15 %MVC, but up to 30 %MVC without visual feedback. Bilateral matching error averaged ∼10 %MVC and was affected little by visual feedback type, so long as feedback was provided. In 1-DoF bilateral tracking, the dominant side had statistically lower error than the non-dominant side. In 2-DoF bilateral tracking, the side providing mirror visual feedback exhibited lower error than the opposite side. In 2-DoF tasks (assumed to be more challenging than their constituent 1-DoF tracking tasks), hand grip force errors grew disproportionately larger than those of each wrist DoF. In unilateral 1-DoF tasks, both hand vs target and wrist vs target latency averaged 250-350 ms. In unilateral 2-DoF tasks, wrist vs target latency also averaged 250-350 ms, while hand vs target latency averaged > 500 ms. These results provide guidance on bilateral 2-DoF hand-wrist performance in target tracking, and dominant vs non-dominant force matching tasks.

Overt visual attention and between-limb asynchrony for bimanual reaching movements

Although synchrony between the limbs is an often-cited feature of bimanual coordination, recent studies have also highlighted the small asynchronies that can occur. The visuo-motor demands of any bimanual task are considered central to the emergence of asynchrony, but the relationship between the two remains largely unexplored. This study aimed to address this issue. Hand and eye movements were measured in 19 participants, while they made either unimanual or bimanual reach-to-point (aiming) movements to targets presented on a touchscreen. Bimanual movements were either congruent (same-sized targets) or incongruent (different-sized targets). Resulting hand data showed many of the typical patterns of movement previously reported. While temporal coupling between the limbs remained largely evident for bimanual movements, small between-limb asynchronies were apparent and demonstrated clear associations with the competing precision requirements of the targets and related visual attention. Participants mainly directed their gaze towards the more difficult target with corresponding reaching movements demonstrating greater precision than for the easier target. Additionally, there was a reliable tendency for the hand reaching towards the more difficult target to lead. Importantly, it was the competing visuo-motor demands of individual movements rather than overall difficulty that resulted in greater between-limb asynchrony; accordingly, where both targets were small (i.e., the most difficult condition), asynchrony was significantly less pronounced than for incongruent bimanual conditions. The results show how the visuo-motor system balances its apparent drive for synchrony in coordinating bimanual movements with the competing demands that characterise the constituent unimanual movements.

Lower Limb Asymmetry Evaluation Using the Balance Tracking System (BTrackS) Single Leg Stance Protocol

Single Leg Stance (SLS) balance testing is a common means of determining lower limb asymmetries in motor behavior. The Balance Tracking System (BTrackS) Balance Plate is a low-cost, portable force plate for objectively obtaining balance measurements. The present study provides the first known balance results for the BTrackS SLS protocol. BTrackS SLS testing was conducted on 161 young adults (90 women, 71 men) according to the test's standardized instructions. Specifically, participants performed one-legged (left or right) stance on the BTrackS Balance Plate for four, (2 practice, 2 actual) 20 s trials. SLS test outputs included total Center of Pressure path length and absolute symmetry index. Results showed that women had better SLS performance than men and that both sexes performed better on the actual compared to practice trial. Systematic one-sample t-tests of the Absolute Symmetry Index measures showed that a difference of 16% or greater between legs represented asymmetric performance. These results have clear value for individuals using BTrackS SLS testing to evaluate potential asymmetries. Additionally, these findings agree with previous reports showing sex differences favoring women on tests of static balance, and validate the use of a practice trial in the BTrackS SLS protocol.

Human Perception of Wrist Flexion and Extension Torque During Upper and Lower Extremity Movement

Real-world application of haptic feedback from kinesthetic devices is implemented while the user is in motion, but human wrist torque magnitude discrimination has previously only been characterized while users are stationary. In this study, we measured wrist torque discrimination in conditions relevant to activities of daily living, using a previously developed backdrivable wrist exoskeleton capable of applying wrist flexion and extension torque. We implemented a torque comparison test using a two-alternative forced-choice paradigm while participants were both seated and walking on a treadmill, with both a stationary and a moving wrist. Like most kinesthetic haptic devices, the wrist exoskeleton output torque is commanded in an open-loop manner. Thus, the study design was informed by Monte Carlo simulations to verify that the errors in the wrist exoskeleton output torque would not significantly affect the results. Results from ten participants show that although both walking and moving wrist conditions result in higher Weber Fractions (worse perception), participants were able to detect relatively small changes in torque of 12-19% on average in all grouped conditions. The results provide insight regarding the torque magnitudes necessary to make wrist-worn kinesthetic haptic devices noticeable and meaningful to the user in various conditions relevant to activities of daily living.

A comparison of different established and novel methods to determine horses' laterality and their relation to rein tension

The present study aimed to assess an agreement between established and novel methods to determine laterality and to identify the distribution of laterality in warmbloods and Thoroughbreds. Nine different methods to investigate a horses' laterality outside a riding context and during riding were compared across two groups of horses (sample A: 67 warmblood- type horses, sample B: 61 Thoroughbreds). Agreement between any two methods was assessed by calculating Cohen's kappa with McNemar's test or Bowker's Test of Symmetry, and the deviation from equal distributions was assessed with chi²-tests. Continuous variables such as rein tension parameters were analyzed using ANOVA or linear mixed models. Generally, laterality test results obtained outside a riding context did not agree with laterality during riding or among each other (Bonferroni corrected p > 0.0018). However, the rider's assessment of her/his horse's laterality allowed conclusions on rein tension symmetry (p = 0.003), and it also agreed substantially with the lateral displacement of the hindquarters (p = 0.0003), a method that was newly developed in the present study. The majority of warmbloods had their hindquarters displaced to the right (73.1%, X² = 14.3; p < 0.0001). The pattern of lateral displacement of the hindquarters was similar in the Thoroughbred sample (right: 60.7%, left: 39.3%), but did not deviate significantly from an equal distribution (X² = 2.8; p > 0.05). Laterality seems to be manifested in different ways, which generally are not related to each other. Attention should be paid to the desired information when selecting methods for the assessment of laterality. Horses' laterality has an impact on the magnitude and symmetry of rein tension. Matching horses and riders according to their laterality might be beneficial for the stability of rein tension and thus improve training.

Joint Specificity and Lateralization of Upper Limb Proprioceptive Perception

Proprioception is the sense of position and movement of body segments. The widespread distribution of proprioceptors in human anatomy raises questions about proprioceptive uniformity across different body parts. For the upper limbs, previous research, using mostly active and/or contralateral matching tasks, has suggested better proprioception of the non-preferred arm, and at the elbow rather than the wrist. Here we assessed proprioceptive perception through an ipsilateral passive matching task by comparing the elbow and wrist joints of the preferred and non-preferred arms. We hypothesized that upper limb proprioception would be better at the elbow of the non-preferred arm. We found signed errors to be less variable at the non-preferred elbow than at the preferred elbow and both wrists. Signed errors at the elbow were also more stable than at the wrist. Across individuals, signed errors at the preferred and non-preferred elbows were correlated. Also, variable signed errors at the preferred wrist, non-preferred wrist, and preferred elbow were correlated. These correlations suggest that an individual with relatively consistent matching errors at one joint may have relatively consistent matching errors at another joint. Our findings also support the view that proprioceptive perception varies across upper limb joints, meaning that a single joint assessment is insufficient to provide a general assessment of an individual's proprioception.

Delay of gaze fixation during reaching movement with the non-dominant hand to a distant target

The present study examined the effects of hand and task difficulty on eye-hand coordination related to gaze fixation behavior (i.e., fixating a gaze to the target until reach completion) in single reaching movements. Twenty right-handed young adults made reaches on a digitizer, while looking at a visual target and feedback of hand movements on a computer monitor. Task difficulty was altered by having three target distances. In a small portion of trials, visual feedback was randomly removed at the target presentation. The effect of a moderate amount of practice was also examined using a randomized trial schedule across target-distance and visual-feedback conditions in each hand. The results showed that the gaze distances covered during the early reaching phase were reduced, and the gaze fixation to the target was delayed when reaches were performed with the left hand and when the target distance increased. These results suggest that when the use of the non-dominant hand or an increased task difficulty reduces the predictability of hand movements and its sensory consequences, eye-hand coordination is modified to enhance visual monitoring of the reach progress prior to gaze fixation. The randomized practice facilitated this process. Nevertheless, variability of reach trajectory was more increased without visual feedback for right-hand reaches, indicating that control of the dominant arm integrates more visual feedback information during reaches. These results together suggest that the earlier gaze fixation and greater integration of visual feedback during right-hand reaches contribute to the faster and more accurate performance in the final reaching phase.

Measuring hand sensory function and force control in older adults: Are current hand assessment tools enough?

BACKGROUND

The ability to grasp and manipulate objects is essential for performing activities of daily living. However, there is limited information regarding age-related behavioral differences in hand sensorimotor function due, in part, to the lack of assessment tools capable of measuring subtle but important differences in hand function. The purpose of this study was to demonstrate performance differences in submaximal force control and tactile pattern recognition in healthy older adults using two custom-designed sensorimotor assessment tools.

METHODS

Sensorimotor function was assessed in 13 healthy older adults (mean age 72.2 ±5.5y, range: 65-84y) and 13 young adults (mean age 20 ±1.4y, range: 19-23y). Clinical assessments included the Montreal Cognitive Assessment (MoCA), monofilament testing, maximum voluntary contraction (MVC), and Grooved Pegboard Test. Sensorimotor assessments included submaximal (5, 20% MVC) grip force step-tracking and tactile pattern recognition tasks.

RESULTS

Clinical assessments revealed no or minimal group differences in MVC, monofilament thresholds, and MoCA. However, sensorimotor assessments showed that older adults took longer to discriminate tactile patterns and had poorer accuracy than young adults. Older adults also produced submaximal forces less smoothly than young adults at the 20% force level while greater variability in force maintenance was seen at 5% but not 20% MVC.

CONCLUSIONS

These results demonstrate the ability to integrate higher-order tactile information and control low grip forces is impaired in older adults despite no differences in grip strength or cognition. These findings underscore the need for more sensitive evaluation methods that focus on sensorimotor ability reflective of daily activities.

Bilateral Asymmetry of Hand Force Production in Dynamic Physically-Coupled Tasks

Physically-coupled bimanual tasks (activities where a force effect occurs between two human limbs) involve the coordination and cooperation of bilateral arms. Such uncertain contribution of two arms is often studied under static configuration, which is not sufficient to typify all activities of daily life (ADLs). This study aims to investigate peoples bilateral force production and control in dynamic tasks. Experiments were conducted with a customized robotic system that is characterized with two handles and programmable force fields between them. Fourteen healthy right-handed human volunteers were instructed to generate force with each hand when performing predefined trajectory tracking tasks, in which the sum of forces contributed by the left and the right hand is required to equal a target force. Significant asymmetry was found in the force output between bilateral hands. With the homologous muscles activated synchronously, the contribution of the left hand was larger, while when the non-homogenous muscles were activated synchronously, the laterality was subject to the moving direction. In addition, when considering the force difference between two hands in terms of direction and magnitude, the former decreased with the increase of the target force, but the latter was more sensitive to moving directions. The results reveal the unique characteristics of non-isometric force control tasks compared with isometric ones.

Handedness Development: A Model for Investigating the Development of Hemispheric Specialization and Interhemispheric Coordination

The author presents his perspective on the character of science, development, and handedness and relates these to his investigations of the early development of handedness. After presenting some ideas on what hemispheric specialization of function might mean for neural processing and how handedness should be assessed, the neuroscience of control of the arms/hands and interhemispheric communication and coordination are examined for how developmental processes can affect these mechanisms. The author’s work on the development of early handedness is reviewed and placed within a context of cascading events in which different forms of handedness emerge from earlier forms but not in a deterministic manner. This approach supports a continuous rather than categorical distribution of handedness and accounts for the predominance of right-handedness while maintaining a minority of left-handedness. Finally, the relation of the development of handedness to the development of several language and cognitive skills is examined.

Hand preference for the visual and auditory modalities in humans

The sensory dominance effect refers to the phenomenon that one sensory modality more frequently receives preferential processing (and eventually dominates consciousness and behavior) over and above other modalities. On the other hand, hand dominance is an innate aspect of the human motor system. To investigate how the sensory dominance effect interacts with hand dominance, we applied the adapted Colavita paradigm and recruited a large cohort of healthy right-handed participants (n = 119). While the visual dominance effect in bimodal trials was observed for the whole group (n = 119), about half of the right-handers (48%) showed a visual preference, i.e., their dominant hand effect manifested in responding to the visual stimuli. By contrast, 39% of the right-handers exhibited an auditory preference, i.e., the dominant hand effect occurred for the auditory responses. The remaining participants (13%) did not show any dominant hand preference for either visual or auditory responses. For the first time, the current behavioral data revealed that human beings possess a characteristic and persistent preferential link between different sensory modalities and the dominant vs. non-dominant hand. Whenever this preferential link between the sensory and the motor system was adopted, one dominance effect peaks upon the other dominance effect's best performance.

The challenge of being slow: Effects of tempo, laterality, and experience on dance movement consistency

In dance, music, or sports, reproducibility and consistency as well as bilateral dexterity/coordination of movement are crucial for motor control. Research into the biomechanics of movement consistency and variability is important for motor learning to achieve proficiency and maximize outcome reproduction and stability as well as to reduce the risk of injury. Thirty-six participants were instructed to perform a repetitive circular, ipsilateral motion of arms and legs at three different tempi, while being recorded with optical motion capture. Two velocity-based consistency measures were developed an overall measure of consistency and a laterality difference measure. Maintaining velocity consistency was more challenging at slower than at faster tempi, suggesting that slow movement could require more attentional focus and thus become more variable. Music experience resulted in higher consistency, especially on the subdominant body side, possibly due to extensive bilateral training. Outcomes could have potential implications for music instrument, dance, and sports practice and training.

Synergistic Activation Patterns of Hand Muscles in Left-and Right-Hand Dominant Individuals

Handedness has been associated with behavioral asymmetries between limbs that suggest specialized function of dominant and non-dominant hand. Whether patterns of muscle co-activation, representing muscle synergies, also differ between the limbs remains an open question. Previous investigations of proximal upper limb muscle synergies have reported little evidence of limb asymmetry; however, whether the same is true of the distal upper limb and hand remains unknown. This study compared forearm and hand muscle synergies between the dominant and non-dominant limb of left-handed and right-handed participants. Participants formed their hands into the postures of the American Sign Language (ASL) alphabet, while EMG was recorded from hand and forearm muscles. Muscle synergies were extracted for each limb individually by applying non-negative-matrix-factorization (NMF). Extracted synergies were compared between limbs for each individual, and between individuals to assess within and across participant differences. Results indicate no difference between the limbs for individuals, but differences in limb synergies at the population level. Left limb synergies were found to be more similar than right limb synergies across left- and right-handed individuals. Synergies of the left hand of left dominant individuals were found to have greater population level similarity than the other limbs tested. Results are interpreted with respect to known differences in the neuroanatomy and neurophysiology of proximal and distal upper limb motor control. Implications for skill training in sports requiring dexterous control of the hand are discussed.

Motor Deficits in the Ipsilesional Arm of Severely Paretic Stroke Survivors Correlate With Functional Independence in Left, but Not Right Hemisphere Damage

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage (10 left-, 10 right-hemisphere damaged individuals) to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment (UEFM). Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test (JTHFT), grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r ₍₁₀₎ = -0.73, p = 0.017]; grip strength: [r ₍₁₀₎ = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r ₍₁₀₎ = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors.

Vibration of calf muscles has reverse effects on right and left ankle proprioception in high and low proprioceptive performer groups

PURPOSE

Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception.

MATERIALS AND METHODS

Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles.

RESULTS

When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011).

CONCLUSIONS

The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future.

Are the Predictions of the Dynamic Dominance Model of Laterality Applicable to Children?

According to the dynamic dominance model, the left cerebral hemisphere is specialized for the control of intersegmental dynamics and the right hemisphere for impedance control. Our aim was to test predictions from the dynamic dominance model in children by comparing performance between the right (preferred) and left hands in aiming. Three groups were compared: 4-7, 8-11, and 18-38 years old. Results showed higher movement linearity in the performance with the right hand in all age groups (P < .01), while initial directional error and endpoint accuracy were equivalent between hands. These results provided partial support for the dynamic dominance model.

Improvement of the Upper Extremity at the Subacute Stage Poststroke: Does Hand Dominance Play a Role?

BACKGROUND

The impact of hand dominance on the expected (motor and functional ability and daily use) improvement of the affected upper extremity (UE) in subacute stroke has not yet been investigated.

OBJECTIVES

To compare between the affected dominant and affected nondominant UE (1) on rehabilitation admission (T1) for motor and sensory abilities, functional ability, and daily use and (2) 6 weeks poststroke onset (T2) and the UE recovery between T1 and T2 regarding percent change, improvement effect size, and percent of participants achieving minimal clinical important difference (MCID).

METHODS

Multicenter longitudinal study.

RESULTS

Thirty-eight participants with affected dominant and 51 participants with affected nondominant UE were recruited. On T1 and T2, between-group differences were not seen for all UE variables. Significant improvement in the motor and functional ability, daily use, and perceived recovery between T1 and T2 were seen for the affected dominant (z = -3.01 to -4.13, P < .01) and nondominant UEs (z = -4.59 to -5.32, P < .01). Effect size improvement values were moderate and large in the affected dominant and nondominant UE (respectively). In addition, 14% to 40% of the participants in both UEs achieved MCID.

CONCLUSIONS

Significant and similar clinical meaningfulness in UE improvement can be expected during subacute rehabilitation; however, improvement magnitude and percent improvement is different for the UE domains of the affected dominant and the affected nondominant UEs. These findings highlight the distinct roles of the dominant and nondominant hands during bimanual daily activities, which can guide clinicians during stroke rehabilitation.

Fast responses to stepping-target displacements when walking

Key points

Goal‐directed arm movements can be adjusted at short latency to target shifts.

We tested whether similar adjustments are present during walking on a treadmill with shifting stepping targets.

Participants responded at short latency with an adequate gain to small shifts of the stepping targets.

Movements of the feet during walking are controlled in a similar way to goal‐directed arm movements if balance is not violated.

Abstract

It is well‐known that goal‐directed hand movements can be adjusted to small changes in target location with a latency of about 100 ms. We tested whether people make similar fast adjustments when a target location for foot placement changes slightly as they walk over a flat surface. Participants walked at 3 km/h on a treadmill on which stepping stones were projected. The stones were 50 cm apart in the walking direction. Every 5–8 steps, a stepping stone was unexpectedly displaced by 2.5 cm in the medio‐lateral direction. The displacement took place during the first half of the swing phase. We found fast adjustments of the foot trajectory, with a latency of about 155 ms, initiated by changes in muscle activation 123 ms after the perturbation. The responses corrected for about 80% of the perturbation. We conclude that goal‐directed movements of the foot are controlled in a similar way to those of the hand, thus also giving very fast adjustments.

Goal‐directed arm movements can be adjusted at short latency to target shifts.

We tested whether similar adjustments are present during walking on a treadmill with shifting stepping targets.

Participants responded at short latency with an adequate gain to small shifts of the stepping targets.

Movements of the feet during walking are controlled in a similar way to goal‐directed arm movements if balance is not violated.

Motor-Equivalent Intersegmental Coordination Is Impaired in Chronic Stroke

Background. Kinematic abundance permits using different movement patterns for task completion. Individuals poststroke may take advantage of abundance by using compensatory trunk displacement to overcome upper limb (UL) movement deficits. However, movement adaptation in tasks requiring specific intersegment coordination may remain limited. Objective. We tested movement adaptation in both arms of individuals with chronic stroke (n = 16) and nondominant arms of controls (n = 12) using 2 no-vision reaching tasks involving trunk movement (40 trials/arm). Methods. In the "stationary hand task" (SHT), subjects maintained the hand motionless over a target while leaning the trunk forward. In the "reaching hand task" (RHT), subjects reached to the target while leaning forward. For both tasks, trunk movement was unexpectedly blocked in 40% of trials to assess the influence of trunk movement on adaptive arm positioning or reaching. UL sensorimotor impairment, activity, and sitting balance were assessed in the stroke group. The primary outcome measure for SHT was gain (g), defined as the extent to which trunk displacement contributing to hand motion was offset by appropriate changes in UL movements (g = 1: complete compensation) and endpoint deviation for RHT. Results. Individuals poststroke had lower gains and greater endpoint deviation using the more-affected compared with less-affected UL and controls. Those with less sensorimotor impairment, greater activity levels, and better sitting balance had higher gains and smaller endpoint deviations. Lower gains were associated with diminished UL adaptability. Conclusions. Tests of condition-specific adaptability of interjoint coordination may be used to measure UL adaptability and changes in adaptability with treatment.

Vigor of reaching, walking, and gazing movements: on the consistency of interindividual differences

Movement vigor is an important feature of motor control that is thought to originate from cortico-basal ganglia circuits and processes shared with decision-making, such as temporal reward discounting. Accordingly, vigor may be related to one's relationship with time, which may, in turn, reflect a general trait-like feature of individuality. While significant interindividual differences of vigor have been typically reported for isolated motor tasks, little is known about the consistency of such differences across tasks and movement effectors. Here, we assessed interindividual consistency of vigor across reaching (both dominant and nondominant arm), walking, and gazing movements of various distances within the same group of 20 participants. Given distinct neural pathways and biomechanical specificities of each movement modality, a significant consistency would corroborate the trait-like aspect of vigor. Vigor scores for dominant and nondominant arm movements were found to be highly correlated across individuals. Vigor scores of reaching and walking were also significantly correlated across individuals, indicating that people who reach faster than others also tend to walk faster. At last, vigor scores of saccades were uncorrelated with those of reaching and walking, reaffirming that the vigor of stimulus-elicited eye saccades is distinct. These findings highlight the trait-like aspect of vigor for reaching movements with either arms and, to a lesser extent, walking.NEW & NOTEWORTHY Robust interindividual differences of movement vigor have been reported for arm reaching and saccades. Beyond biomechanics, personality trait-like characteristics have been proposed to account for those differences. Here, we examined for the first time the consistency of interindividual differences of vigor during dominant/nondominant arm reaching, walking, and gazing to assess the trait-like aspect of vigor. We found a significant consistency of vigor within our group of individuals for all tested tasks/effectors except saccades.

Associations between Turning Characteristics and Corticospinal Inhibition in Young and Older Adults

The effects of aging are multifaceted including deleterious changes to the structure and function of the nervous system which often results in reduced mobility and quality of life. Turning while walking (dynamic) and in-place (stable) are ubiquitous aspects of mobility and have substantial consequences if performed poorly. Further, turning is thought to require higher cortical control compared to bouts of straight-ahead walking. This study sought to understand how relative amounts of corticospinal inhibition as measured by transcranial magnetic stimulation and the cortical silent period within the primary motor cortices are associated with various turning characteristics in neurotypical young (YA) and older adults (OA). In the current study, OA had reduced peak turn velocity and increased turn duration for both dynamic and stable turns. Further, OA demonstrated significantly reduced corticospinal inhibition within the right motor cortex. Finally, all associations between corticospinal inhibition and turning performance were specific to the right hemisphere, reflecting that those OA who maintained high levels of inhibition performed turning similar to their younger counterparts. These results compliment the right hemisphere model of aging and lateralization specification of cortically regulated temporal measures of dynamic movement. While additional investigations are required, these pilot findings provide an additional understanding as to the neural control of dynamic movements.

Interaction between position sense and force control in bimanual tasks

Background

Several daily living activities require people to coordinate the motion and the force produced by both arms, using their position sense and sense of effort. However, to date, the interaction in bimanual tasks has not been extensively investigated.

Methods

We focused on bimanual tasks where subjects were required:

(Experiment 1) to move their hands until reaching the same position – equal hand position implied identical arm configurations in joint space - under different loading conditions;

(Experiment 2) to produce the same amount of isometric force by pushing upward, with their hands placed in symmetric or asymmetric positions.

The arm motions and forces required for accomplishing these tasks were in the vertical direction. We enrolled a healthy population of 20 subjects for Experiment 1 and 25 for Experiment 2. Our primary outcome was the systematic difference between the two hands at the end of each trial in terms of position for Experiment 1 and force for Experiment 2. In both experiments using repeated measure ANOVA we evaluated the effect of each specific condition, namely loading in the former case and hand configuration in the latter.

Results

In the first experiment, the difference between the hands’ positions was greater when they were concurrently loaded with different weights. Conversely, in the second experiment, when subjects were asked to exert equal forces with both arms, the systematic difference between left and right force was not influenced by symmetric or asymmetric arm configurations, but by the position of the left hand, regardless of the right hand position. The performance was better when the left hand was in the higher position.

Conclusions

The experiments report the reciprocal interaction between position sense and sense of effort inbimanual tasks performed by healthy subjects. Apart for the intrinsic interest for a better understanding of basic sensorimotor processes, the results are also relevant to clinical applications, for defining functional evaluation and rehabilitative protocols for people with neurological diseases or conditions that impair the ability to sense and control concurrently position and force.

Changing handedness: What can we learn from preference shift studies?

Handedness is a dynamic and complex aspect of human behavior. Changing it through practice, either willingly or obliged by some reason, requires a considerable amount of effort. Analyzing studies that presented handedness shifts may expand our comprehension of this phenomenon, since knowing how to change it might provide insights into how it develops. Therefore, we reviewed the outcomes of handedness shifts. The results suggest that neural asymmetries related to handedness are likely a consequence of lateralized practice since they correlate with modifications in the behavioral patterns. Clearly, practice is not the only factor influencing handedness development, but it seems to play a significant role in the formation and consolidation of neural and behavioral asymmetries. Another key finding of our review is the suggestion of a ceiling effect for the capacity to change handedness direction and degree, considering none of the reviewed studies reported complete shifts in behavioral measures and brain activation patterns.

Effect of 8-week Nordic walking training on nondominant hand grip and shoulder strength in middle-aged women

Nordic walking (NW) is a full body training that can be performed with special pole, and has been recognized as an effective out-door activity which can improve the strength of upper extremity. Most previous studies mainly analyzed the effect of NW on the strength of dominant (DN) hand-grip strength, however, a clear scientific examination is needed whether nondominant (NDN) extremity can also be ameliorated by the NW. Therefore, the aim of our study is to investigate the effectiveness of 8 weeks NW training on the NDN handgrip and shoulder strength in healthy middle-aged women. 29 subjects were randomly divided into three groups: Nordic walking group (NWG, n=10), brisk walking group (BWG, n=11), and control group (CG, n=8). Handgrip and shoulder strength were measured by the hand dynamometer and isokinetic machine. NW training was performed 3 times a week, and had 10-min warm-up, 40-min main program consisted of ALFA (Attention, Long arms, Flat poles, Adaptes) technique and Turbo walking, and 10-min cool-down. In handgrip strength of DN hand and the shoulder flexor strength in the both sides, NWG and BWG showed significantly higher value compared to CG. In the NDN hand, NWG also showed significantly higher strength compared to CG, however, there was no significant difference in the handgrip strength/weight among groups. In NDN shoulder extension, significantly higher improvement was found in NWG and BWG compared to that of CG. In conclusion, our study showed that NW can improve the strength of upper extremity in subjects, and can be better approach to improve the NDN handgrip strength than brisk walking method could.

A historical, systematic review of handedness origins

Handedness ontogenesis is still under debate in science. This systematic review analyzed articles regarding the theories and basis of handedness formation, highlighting the historical knowledge path that this literature underwent. Cochrane Library, LILACS, Web of Sciences, Science Direct and PubMed databases were searched. This review included review studies with handedness as the main topic. Only papers written in English with analyses exclusively in neurotypical humans (any age range) were included. Different approaches (genetic, neural, social, and behavioural) were reviewed in light of growing evidence, summarizing the current state of the art. Genetic and environmental/social impacts are common points in most of the reviews, each given more or less importance, depending on the author and theory proposed. Multifactorial, developmental approaches to handedness formation seem to be the most up to date view of the phenomenon. Different control mechanisms between hemisphere and neural asymmetries are also contributing factors to handedness formation.

Effects of Hand and Hemispace on Multisensory Integration of Hand Position and Visual Feedback

The brain generally integrates a multitude of sensory signals to form a unified percept. Even in cursor control tasks, such as reaching while looking at rotated visual feedback on a monitor, visual information on cursor position and proprioceptive information on hand position are partially integrated (sensory coupling), resulting in mutual biases of the perceived positions of cursor and hand. Previous studies showed that the strength of sensory coupling (sum of the mutual biases) depends on the experience of kinematic correlations between hand movements and cursor motions, whereas the asymmetry of sensory coupling (difference between the biases) depends on the relative reliabilities (inverse of variability) of hand-position and cursor-position estimates (reliability rule). Furthermore, the precision of movement control and perception of hand position are known to differ between hands (left, right) and workspaces (ipsilateral, contralateral), and so does the experience of kinematic correlations from daily life activities. Thus, in the present study, we tested whether strength and asymmetry of sensory coupling for the endpoints of reaches in a cursor control task differ between the right and left hand and between ipsilateral and contralateral hemispace. No differences were found in the strength of sensory coupling between hands or between hemispaces. However, asymmetry of sensory coupling was less in ipsilateral than in contralateral hemispace: in ipsilateral hemispace, the bias of the perceived hand position was reduced, which was accompanied by a smaller variability of the estimates. The variability of position estimates of the dominant right hand was also less than for the non-dominant left hand, but this difference was not accompanied by a difference in the asymmetry of sensory coupling – a violation of the reliability rule, probably due a stronger influence of visual information on right-hand movements. According to these results, the long-term effects of the experienced kinematic correlation between hand movements and cursor motions on the strength of sensory coupling are generic and not specific for hemispaces or hands, whereas the effects of relative reliabilities on the asymmetry of sensory coupling are specific for hemispaces but not for hands.

Compatibility between object size and response side in grasping: the left hand prefers smaller objects, the right hand prefers larger objects

It has been proposed that the brain processes quantities such as space, size, number, and other magnitudes using a common neural metric, and that this common representation system reflects a direct link to motor control, because the integration of spatial, temporal, and other quantity-related information is fundamental for sensorimotor transformation processes. In the present study, we examined compatibility effects between physical stimulus size and spatial (response) location during a sensorimotor task. Participants reached and grasped for a small or large object with either their non-dominant left or their dominant right hand. Our results revealed that participants initiated left hand movements faster when grasping the small cube compared to the large cube, whereas they initiated right hand movements faster when grasping the large cube compared to the small cube. Moreover, the compatibility effect influenced the timing of grip aperture kinematics. These findings indicate that the interaction between object size and response hand affects the planning of grasping movements and supports the notion of a strong link between the cognitive representation of (object) size, spatial (response) parameters, and sensorimotor control.

Beyond handedness: assessing younger adults and older people lateral preference in six laterality dimensions

Lateral preference is influenced by many different factors. Although studies that assessed handedness contributed greatly to our understanding of the phenomenon, looking to other dimensions of motor laterality, such as lower limbs, trunk, visual and hearing preference, may be an interesting strategy to further advance in the field. Comparing different age groups with a complete inventory also contributes to understanding the ageing impact on these variables. Our aim, therefore, was to assess six motor laterality dimensions in younger adults and older people. Two hundred subjects participated in this study (102 adults, 30.6 ± 11.2 years old, and 98 elders, 70.4 ± 7.22 years old) and lateral preference was assessed by the Global Lateral Preference Inventory. We verified significant differences between groups in all dimensions, except the visual one, with proportionally stronger right preference in the older group. Compared to other dimensions, higher frequency of ambidexterity was observed in trunk, hearing and visual preference for both groups. These results might indicate that lateral preference is, indeed, multifactorial, being affected by ageing, task complexity and other possible related aspects.

Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception

BACKGROUND

Proprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic interventions, it is essential to quantify proprioceptive deficits accurately and sensitively. However, current clinical assessments lack sensitivity due to ordinal scales and suffer from poor reliability and ceiling effects. Robotic technology offers new possibilities to address some of these limitations. Nevertheless, it is important to investigate the psychometric and clinimetric properties of technology-assisted assessments.

METHODS

We present an automated robot-assisted assessment of proprioception at the level of the metacarpophalangeal joint, and evaluate its reliability, validity, and clinical feasibility in a study with 23 participants with stroke and an age-matched group of 29 neurologically intact controls. The assessment uses a two-alternative forced choice paradigm and an adaptive sampling procedure to identify objectively the difference threshold of angular joint position.

RESULTS

Results revealed a good reliability (ICC(2,1) = 0.73) for assessing proprioception of the impaired hand of participants with stroke. Assessments showed similar task execution characteristics (e.g., number of trials and duration per trial) between participants with stroke and controls and a short administration time of approximately 12 min. A difference in proprioceptive function could be found between participants with a right hemisphere stroke and control subjects (p<0.001). Furthermore, we observed larger proprioceptive deficits in participants with a right hemisphere stroke compared to a left hemisphere stroke (p=0.028), despite the exclusion of participants with neglect. No meaningful correlation could be established with clinical scales for different modalities of somatosensation. We hypothesize that this is due to their low resolution and ceiling effects.

CONCLUSIONS

This study has demonstrated the assessment's applicability in the impaired population and promising integration into clinical routine. In conclusion, the proposed assessment has the potential to become a powerful tool to investigate proprioceptive deficits in longitudinal studies as well as to inform and adjust sensorimotor rehabilitation to the patient's deficits.

Optimal use of limb mechanics distributes control during bimanual tasks

Bimanual tasks involve the coordination of both arms, which often offers redundancy in the ways a task can be completed. The distribution of control across limbs is often considered from the perspective of handedness. In this context, although there are differences across dominant and nondominant arms during reaching control ( Sainburg 2002 ), previous studies have shown that the brain tends to favor the dominant arm when performing bimanual tasks ( Salimpour and Shadmehr 2014 ). However, biomechanical factors known to influence planning and control in unimanual tasks may also generate limb asymmetries in force generation, but their influence on bimanual control has remained unexplored. We investigated this issue in a series of experiments in which participants were instructed to generate a 20-N force with both arms, with or without perturbation of the target force during the trial. We modeled the task in the framework of optimal feedback control of a two-link model with six human-like muscles groups. The biomechanical model predicted a differential contribution of each arm dependent on the orientation of the target force and joint configuration that was quantitatively matched by the participants' behavior, regardless of handedness. Responses to visual perturbations were strongly influenced by the perturbation direction, such that online corrections also reflected an optimal use of limb biomechanics. These results show that the nervous system takes biomechanical constraints into account when optimizing the distribution of forces generated across limbs during both movement planning and feedback control of a bimanual task. NEW & NOTEWORTHY Here, we studied a bimanual force production task to examine the effects of biomechanical constraints on the distribution of control across limbs. Our findings show that the central nervous system optimizes the distribution of force across the two arms according to the joint configuration of the upper limbs. We further show that the underlying mechanisms influence both movement planning and online corrective responses to sudden changes in the target force.

Asymmetric neuromodulation of motor circuits in Parkinson's disease: The role of subthalamic deep brain stimulation

Whereas hemispheric dominance is well-established for appendicular motor control in humans, the evidence for dominance in axial motor control is still scarce. In Parkinson's disease (PD), unilateral (UL) onset of appendicular motor symptoms corresponds with asymmetric neurodegeneration predominantly affecting contralateral nigrostriatal circuits. Disease progression yields bilateral and axial motor symptoms but the initial appendicular asymmetry usually persists. Furthermore, there is evidence for hemispheric dominance for axial motor dysfunction in some of these patients. Dopaminergic medications improve appendicular symptoms but can also produce motor complications over time. Once these complications develop, bilateral (BL) deep brain stimulation (DBS) of the subthalamic nuclei (STN) can significantly improve appendicular symptoms while reducing medication doses and motor complications. Conversely, axial motor symptoms remain a significant source of disability, morbidity, and mortality for patients with PD. These axial symptoms do not necessarily improve with dopaminergic therapy, might not respond, and could even worsen after BL-DBS. In contrast to medications, DBS provides the opportunity to modify stimulation parameters for each cerebral hemisphere. Identical, BL-DBS of motor circuits with hemispheric dominance in PD might produce overstimulation on one side and/or understimulation on the other side, which could contribute to motor dysfunction. Several studies based on asymmetry of appendicular motor symptoms already support an initial UL rather than BL approach to DBS in some patients. The response of axial motor symptoms to UL versus BL-DBS remains unclear. Nonetheless, UL-DBS, staged BL-DBS, or asymmetric programming of BL-DBS could also be considered in patients with PD.

Knee position sense: does the time interval at the target angle affect position accuracy?

[Purpose] This study examined whether the interval at the target angle during knee joint position sense (JPS) affected reposition accuracy, and evaluated the consequence of this factor on test-retest reliability. [Subjects and Methods] Twenty healthy subjects participated in this study. Reposition ability was measured after the knee was placed at a target angle (ranging from 40° to 60°) for intervals of 3, 6, 9, and 12 seconds, in randomized order. Two trials were performed for each condition. The measurement was repeated after a week. The absolute error (AE) of each trial and average AE under each condition within the two measures were used for data analysis. [Results] No significant difference was found in comparing the AE or the average AE during all trials and between the two measures. Fair-to-good reliability was found for the AE results of all trials under the conditions of 3, 6, and 12 seconds. Poor reliability was found with time interval of 9 seconds. [Conclusion] The length of time needed to memorize the target angle during knee JPS test might affect test reliability. Practitioners can use this information when collecting JPS data.

A new clinical test for sensorimotor function of the hand - development and preliminary validation

BACKGROUND

Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

METHODS

Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

RESULTS

The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC_2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.

CONCLUSIONS

The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

The effect of hand position on perceived finger orientation in left- and right-handers

In the absence of visual feedback, the perceived orientation of the fingers is systematically biased. In right-handers these biases are asymmetrical between the left and right hands in the horizontal plane and may reflect common functional postures for the two hands. Here we compared finger orientation perception in right- and left-handed participants for both hands, across various hand positions in the horizontal plane. Participants rotated a white line on a screen optically superimposed over their hand to indicate the perceived position of the finger that was rotated to one of seven orientations with the hand either aligned with the body midline, aligned with the shoulder, or displaced by twice the shoulder-to-midline distance from the midline. We replicated the asymmetric pattern of biases previously reported in right-handed participants (left hand biased towards an orientation ~30° inward, right hand ~10° inward). However, no such asymmetry was found for left-handers, suggesting left-handers may use different strategies when mapping proprioception to body or space coordinates and/or have less specialization of function between the hands. Both groups' responses rotated further outward as distance of the hand from the body midline increased, consistent with other research showing spatial orientation estimates diverge outward in the periphery. Finally, for right-handers, precision of responses was best when the hand was aligned with the shoulder compared to the other two conditions. These results highlight the unique role of hand dominance and hand position in perception of finger orientation, and provide insight into the proprioceptive position sense of the upper limbs.

Handedness and Reach-to-Place Kinematics in Adults: Left-Handers Are Not Reversed Right-Handers

The primary goal of this study was to examine the relations between limb control and handedness in adults. Participants were categorized as left or right handed for analyses using the Edinburgh Handedness Inventory. Three-dimensional recordings were made of each arm on two reach-to-place tasks: adults reached to a ball and placed it into the opening of a toy (fitting task), or reached to a Cheerio inside a cup, which they placed on a designated mark after each trial (cup task). We hypothesized that limb control and handedness were related, and we predicted that we would observe side differences favoring the dominant limb based on the dynamic dominance hypothesis of motor lateralization. Specifically, we predicted that the dominant limb would be straighter and smoother on both tasks compared with the nondominant limb (i.e., right arm in right-handers and left arm in left-handers). Our results only partially supported these predictions for right-handers, but not for left-handers. When differences between hands were observed, the right hand was favored regardless of handedness group. Our findings suggest that left-handers are not reversed right-handers when compared on interlimb kinematics for reach-to-place tasks, and reaffirm that task selection is critical when evaluating manual asymmetries.

Low-Cost Robotic Assessment of Visuo-Motor Deficits in Alzheimer's Disease

A low-cost robotic interface was used to assess the visuo-motor performance of patients with Alzheimer's disease (AD). Twenty AD patients and twenty age-matched controls participated in this work. The battery of tests included simple reaction times, position tracking, and stabilization tasks performed with both hands. The regularity, velocity, visual and haptic feedback were manipulated to vary movement complexity. Reaction times and movement tracking error were analyzed. Results show a marked group effect on a subset of conditions, in particular when the patients could not rely on the visual feedback of hand movement. The visuo-motor performance correlated with the measures of global cognitive functioning and with different memory-related abilities. Our results support the hypothesis that the ability to recall and use visuo-spatial associations might underlie the impairment in complex motor behavior that has been reported in AD patients. Importantly, the patients had preserved learning effects across sessions, which might relate to visuo-motor deficits being less evident in every-day life and clinical assessments. This robotic assessment, lasting less than 1 h, provides detailed information about the integrity of visuo-motor abilities. The data can aid the understanding of the complex pattern of deficits that characterizes this pervasive disease.