Hand digit control in children: age-related changes in hand digit force interactions during maximum flexion and extension force production tasks

A novel tablet-based motor coordination test performs on par with the Beery VMI subtest and offers superior temporal metrics: findings from children with pediatric acute-onset neuropsychiatric syndrome

Neuropsychiatric and neurodevelopmental disorders are often associated with coordination problems. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) constitutes a specific example of acute and complex symptomatology that includes difficulties with motor control. The present proof-of-concept study aimed at testing a new, bespoke tablet-based motor coordination test named SpaceSwipe, providing fine-grained measures that could be used to follow-up on symptoms evolution in PANS. This test enables computationally precise and objective metrics of motor coordination, taking into account both directional and spatial features continuously. We used SpaceSwipe to assess motor coordination in a group of children with PANS (n = 12, assessed on in total of 40 occasions) and compared it against the motor coordination subtest from the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) 6th edition, traditionally used to follow-up symptomatology. Using a bivariate linear regression, we found that 33 s of the directional offset from tracking a moving target in SpaceSwipe could predict the Beery VMI motor coordination (VMI MC) raw scores (mean absolute error: 1.75 points). Positive correlations between the predicted scores and the VMI MC scores were found for initial testing (r_adj = 0.87) and for repeated testing (r_adj = 0.79). With its short administration time and its close prediction to Beery VMI scores, this proof-of-concept study demonstrates the potential for SpaceSwipe as a patient-friendly tool for precise, objective assessment of motor coordination in children with neurodevelopmental or neuropsychiatric disorders.

Exploring Kinetic and Kinematic Finger Individuation Capability in Children With Hemiplegic Cerebral Palsy

While fine manual dexterity develops over time, the extent to which children show independent control of their digits in each hand and the impact of perinatal brain injury on this individuation have not been well quantified. Our goal in this study was to assess and compare finger force and movement individuation in 8-14 year old children with hemiplegic cerebral palsy (hCP; n = 4) and their typically developing peers (TD; n = 10). We evaluated finger force individuation with five independent load cells and captured joint movement individuation with video tracking. We observed no significant differences in individuation indices between the dominant and non-dominant hands of TD children, but individuated force and movement were substantially reduced in the paretic versus non paretic hands of children with hCP (p < 0.001). In TD participants, the thumb tended to have the greatest level of independent control. This small sample of children with hCP showed substantial loss of individuation in the paretic hand and some deficits in the non-paretic hand, suggesting possible benefit from targeted training of digit independence in both hands for children with CP.

Engagement of the contralateral limb can enhance the facilitation of motor output by loud acoustic stimuli

When intense sound is presented during light muscle contraction, inhibition of the corticomotoneuronal pathway is observed. During action preparation, this effect is reversed, with sound resulting in excitation of the corticomotoneuronal pathway. We investigated how combined maintenance of a muscle contraction during preparation for a ballistic action impacts the magnitude of the facilitation of motor output by a loud acoustic stimulus (LAS) - a phenomenon known as the StartReact effect. Participants executed ballistic wrist flexion movements and a LAS was presented simultaneously with the imperative signal in a subset of trials. We examined whether the force level or muscle used to maintain a contraction during preparation for the ballistic response impacted reaction time and/or the force of movements triggered by the LAS. These contractions were sustained either ipsilaterally or contralaterally to the ballistic response. The magnitude of facilitation by the LAS was greatest when low force flexion contractions were maintained in the limb contralateral to the ballistic response during preparation. There was little change in facilitation when contractions recruited the contralateral extensor muscle, or when they were sustained in the same limb that executed the ballistic response. We conclude that a larger network of neurons which may be engaged by a contralateral sustained contraction prior to initiation may be recruited by the LAS, further contributing to the motor output of the response. These findings may be particularly applicable in stroke rehabilitation where engagement of the contralesional side may increase the benefits of a LAS to the functional recovery of movement.

The Nature of Finger Enslaving: New Results and Their Implications

We present a review on the phenomenon of unintentional finger action seen when other fingers of the hand act intentionally. This phenomenon (enslaving) has been viewed as a consequence of both peripheral (e.g., connective tissue links and multifinger muscles) and neural (e.g., projections of corticospinal pathways) factors. Recent studies have shown relatively large and fast drifts in enslaving toward higher magnitudes, which are not perceived by subjects. These and other results emphasize the defining role of neural factors in enslaving. We analyze enslaving within the framework of the theory of motor control with spatial referent coordinates. This analysis suggests that unintentional finger force changes result from drifts of referent coordinates, possibly reflecting the spread of cortical excitation.

Differential plasticity of extensor and flexor motor cortex representations following visuomotor adaptation

Representations within the primary motor cortex (M1) are capable of rapid functional changes following motor learning, known as use-dependent plasticity. GABAergic inhibition plays a role in use-dependent plasticity. Evidence suggests a different capacity for plasticity of distal and proximal upper limb muscle representations. However, it is unclear whether the motor cortical representations of forearm flexor and extensor muscles also have different capacities for plasticity. The current study used transcranial magnetic stimulation to investigate motor cortex excitability and inhibition of forearm flexor and extensor representations before and after performance of a visuomotor adaptation task that primarily targeted flexors and extensors separately. There was a decrease in extensor and flexor motor-evoked potential (MEP) amplitude after performing the extensor adaptation, but no change in flexor and extensor MEP amplitude after performing the flexor adaptation. There was also a decrease in motor cortical inhibition in the extensor following extensor adaptation, but no change in motor cortical inhibition in the flexor muscle following flexor adaptation or either of the non-prime mover muscles. Findings suggest that the forearm extensor motor cortical representation exhibits plastic change following adaptive motor learning, and broadly support the distinct neural control of forearm flexor and extensor muscles.

Performance drifts in two-finger cyclical force production tasks performed by one and two actors

We explored changes in the cyclical two-finger force performance task caused by turning visual feedback off performed either by the index and middle fingers of the dominant hand or by two index fingers of two persons. Based on an earlier study, we expected drifts in finger force amplitude and midpoint without a drift in relative phase. The subjects performed two rhythmical tasks at 1 Hz while paced by an auditory metronome. One of the tasks required cyclical changes in total force magnitude without changes in the sharing of the force between the two fingers. The other task required cyclical changes in the force sharing without changing total force magnitude. Subjects were provided with visual feedback, which showed total force magnitude and force sharing via cursor motion along the vertical and horizontal axes, respectively. Further, visual feedback was turned off, first on the variable that was not required to change and then on both variables. Turning visual feedback off led to a mean force drift toward lower magnitudes while force amplitude increased. There was a consistent drift in the relative phase in the one-hand task with the index finger leading the middle finger. No consistent relative phase drift was seen in the two-person tasks. The shape of the force cycle changed without visual feedback reflected in the lower similarity to a perfect cosine shape and in the higher time spent at lower force magnitudes. The data confirm findings of earlier studies regarding force amplitude and midpoint changes, but falsify predictions of an earlier proposed model with respect to the relative phase changes. We discuss factors that could contribute to the observed relative phase drift in the one-hand tasks including the leader-follower pattern generalized for two-effector tasks performed by one person.

Multi-Finger Interaction and Synergies in Finger Flexion and Extension Force Production

The aim of this study was to discover finger interaction indices during single-finger ramp tasks and multi-finger coordination during a steady state force production in two directions, flexion, and extension. Furthermore, the indices of anticipatory adjustment of elemental variables (i.e., finger forces) prior to a quick pulse force production were quantified. It is currently unknown whether the organization and anticipatory modulation of stability properties are affected by force directions and strengths of in multi-finger actions. We expected to observe a smaller finger independency and larger indices of multi-finger coordination during extension than during flexion due to both neural and peripheral differences between the finger flexion and extension actions. We also examined the indices of the anticipatory adjustment between different force direction conditions. The anticipatory adjustment could be a neural process, which may be affected by the properties of the muscles and by the direction of the motions. The maximal voluntary contraction (MVC) force was larger for flexion than for extension, which confirmed the fact that the strength of finger flexor muscles (e.g., flexor digitorum profundus) was larger than that of finger extensor (e.g., extensor digitorum). The analysis within the uncontrolled manifold (UCM) hypothesis was used to quantify the motor synergy of elemental variables by decomposing two sources of variances across repetitive trials, which identifies the variances in the uncontrolled manifold (V_UCM) and that are orthogonal to the UCM (V_ORT). The presence of motor synergy and its strength were quantified by the relative amount of V_UCM and V_ORT. The strength of motor synergies at the steady state was larger in the extension condition, which suggests that the stability property (i.e., multi-finger synergies) may be a direction specific quantity. However, the results for the existence of anticipatory adjustment; however, no difference between the directional conditions suggests that feed-forward synergy adjustment (changes in the stability property) may be at least independent of the magnitude of the task-specific apparent performance variables and its direction (e.g., flexion and extension forces).

Formation of social and household skills in children with hand defects

PURPOSE

The aim of this study was to consider the peculiarities of forming social and household skills, and the criteria for their evaluation, as well as an assessment of functional capacity, in children with hand defects both before and after surgical treatment and rehabilitation courses using a system of games.

METHODS

We elaborated and implemented a program of social rehabilitation of preschool children with congenital and acquired hand defects for the development of their functional capabilities and the formation of social and household skills after surgical treatment and prosthetics using play therapy methods. As part of this work, 140 preschool children aged 3-7 years underwent social rehabilitation. Most of the children had congenital hand defects-122 children (87 %): 96 children (79 %) with ectrodactylia, adactylia, hypoplasia, aplasia, hand splitting, club hand, or partial gigantism; 26 children (21 %) with congenital syndactylism and constricted bonds and 18 children (13 %) with acquired defects (burn deformity, amputation). 110 children (79 %) had reached the stage of surgical correction; 30 children (21 %) reached the stage of prosthetics. Most of the children participating in the experiment (78 children, 56 %) had defects of fingers on one hand. The program aimed at solving specific rehabilitation tasks: formation and improvement of all possible types of grip under the existing defect including those after surgery and prosthetics; development of tactile sensations in fingers; development of fine motor skills; increase in range of motion in all joints of the damaged hand; development of attention and concentration; formation of social and household skills appropriate to age; and development of the ability to achieve the set task.

RESULTS

Analysis of the level of social and household skills of children with hand defects undergoing rehabilitation treatment at the hospital depending on the age prior to medical and social rehabilitation showed that preschool children with hand defects in the age category of 3 years demonstrated the highest results in the level of social and household skills (31 %) as compared with children in other age categories. The indicators for children aged 4 and 5 years were slightly lower, 25 and 26 %, respectively. The lowest values were recorded among children aged 6: 20 %.

CONCLUSION

Statistically significant parameters of the level of functional capacity of hand grip and social and household skills in children with hand defects obtained in the course of the investigation indicated that the use of play therapy measures significantly increased the effect of medical treatment irrespective of the type of defect. These data indicate that play therapy measures given immediately after surgery or prosthetics can significantly increase the efficiency of rehabilitation even in its early stages.

Stability of multifinger action in different state spaces

We investigated stability of action by a multifinger system with three methods: analysis of intertrial variance, application of transient perturbations, and analysis of the system's motion in different state spaces. The "inverse piano" device was used to apply transient (lifting-and-lowering) perturbations to individual fingers during single- and two-finger accurate force production tasks. In each trial, the perturbation was applied either to a finger explicitly involved in the task or one that was not. We hypothesized that, in one-finger tasks, task-specific stability would be observed in the redundant space of finger forces but not in the nonredundant space of finger modes (commands to explicitly involved fingers). In two-finger tasks, we expected that perturbations applied to a nontask finger would not contribute to task-specific stability in mode space. In contrast to our expectations, analyses in both force and mode spaces showed lower stability in directions that did not change total force output compared with directions that did cause changes in total force. In addition, the transient perturbations led to a significant increase in the enslaving index. We consider these results within a theoretical scheme of control with referent body configurations organized hierarchically, using multiple few-to-many mappings organized in a synergic way. The observed volatility of enslaving, greater equifinality of total force compared with elemental variables, and large magnitude of motor equivalent motion in both force and mode spaces provide support for the concept of task-specific stability of performance and the existence of multiple neural loops, which ensure this stability.

Increase in flexor but not extensor corticospinal motor outputs following ischemic nerve block

Human motor cortex is capable of rapid and long-lasting reorganization, evident globally, as shifts in body part representations, and at the level of individual muscles as changes in corticospinal excitability. Representational shifts provide an overview of how various body parts reorganize relative to each other but do not tell us whether all muscles in a given body part reorganize in the same manner and to the same extent. Transcranial magnetic stimulation (TMS) provides information about individual muscles and can therefore inform us about the uniformity of plastic changes within a body part. We used TMS to investigate changes in corticospinal excitability of forearm flexors and extensors after inflation of a tourniquet around the wrist. Motor evoked potential (MEP) amplitudes and input/output (I/O) curves were obtained from wrist flexors and extensors simultaneously before and during block. TMS was delivered to the optimal site for eliciting MEPs in flexors in experiment 1, extensors in experiment 2, and both flexors and extensors in experiment 3. In all experiments flexor MEP amplitude increased during block while extensor MEP amplitude showed no systematic change, and the slope of flexor but not extensor I/O curves increased. Flexor H-reflex amplitude normalized to maximal M wave showed negligible changes during block, suggesting that the increase in corticospinal excitability in the flexors cannot be completely explained by increased excitability at the spinal cord level. These findings show that forearm flexors and extensors differ in their potential for plastic changes, highlight the importance of investigating how experimentally induced plasticity affects anatomically close, but functionally distinct, muscle groups, and suggest that rehabilitation interventions aiming to alter cortical organization should consider the differential sensitivity of various muscle groups to plasticity processes.

Multi-finger pressing synergies change with the level of extra degrees of freedom

The purpose of this study was to test the principle of motor abundance, which has been hypothesized as the principle by which the central nervous system controls the excessive degrees of freedom of the human movements, in contrast to the traditional negative view of motor redundancy. This study investigated the changes in force stabilizing and moment stabilizing synergies for multi-finger pressing tasks involving different number of fingers. Twelve healthy subjects produced a constant pressing force while watching visual feedback of the total pressing force for the fingers involved in each task. Based on the principle of motor abundance, it was hypothesized that the multi-finger synergies for the total force stabilizing synergy and the total moment stabilizing synergy would be greater as the number of task finger increases. Force stabilizing and moment stabilizing synergies were quantified using the framework of the uncontrolled manifold analysis. It was found that strong force stabilizing synergies existed for all the finger combinations. The index of force stabilizing synergies was greater when the task involved more number of fingers. The index of moment stabilizing synergies was negative for the two-finger combination, representing moment destabilizing synergies. However, the index of moment stabilizing synergies was positive for three-finger and four-finger combinations, representing strong moment stabilizing synergies for these finger combinations. We interpret the findings as an evidence for the principle of abundance for stabilization of both, total force as well as total moment.

Finger force enslaving and surplus in spinal cord injury patients

This study investigated the phenomena of finger enslaving, involuntary finger actions by non-intended fingers, and force deficit, smaller maximum force by all four fingers than the sum of individual finger maximum forces in individuals with cervical spinal cord injuries (SCI). A total of 16 subjects participated in this study: 8 with a cervical spinal cord injury and 8 controls. Each of the injured subjects had one paralyzed finger. The results showed that the efforts to produce force using any individual finger induced force production in all other fingers, suggesting finger force enslaving. The maximum force during the four-finger task was greater than the sum of the individual finger forces during single-finger tasks in the SCI group, which was reflected by positive force deficit, "force surplus". One may utilize these findings for rehabilitation of paralyzed fingers caused by cervical spinal injuries.

Age-related changes in multi-finger interactions in adults during maximum voluntary finger force production tasks

This study aimed to continue our characterization of finger strength and multi-finger interactions across the lifespan to include those in their 60s and older. Building on our previous study of children, we examined young and elderly adults during isometric finger flexion and extension tasks. Sixteen young and 16 elderly, gender-matched participants produced maximum force using either a single finger or all four fingers in flexion and extension. The maximum voluntary finger force (MVF), the percentage contributions of individual finger forces to the sum of individual finger forces during four-finger MVF task (force sharing), and the non-task finger forces during a task finger MVF task (force enslaving), were computed as dependent variables. Force enslaving during finger extension was greater than during flexion in both young and elderly groups. The flexion-extension difference was greater in the elderly than the young adult group. The greater independency in flexion may result from more frequent use of finger flexion in everyday manipulation tasks. The non-task fingers closer to a task finger produced greater enslaving force than non-task fingers farther from the task finger. The force sharing pattern was not different between age groups. Our findings suggest that finger strength decreases over the aging process, finger independency for flexion increases throughout development, and force sharing pattern remains constant across the lifespan.

Finger inter-dependence: linking the kinetic and kinematic variables

We studied the dependence between voluntary motion of a finger and pressing forces produced by the tips of other fingers of the hand. Participants moved one of the fingers (task finger) of the right hand trying to follow a cyclic, ramp-like flexion-extension template at different frequencies. The other fingers (slave fingers) were restricted from moving; their flexion forces were recorded and analyzed. Index finger motion caused the smallest force production by the slave fingers. Larger forces were produced by the neighbors of the task finger; these forces showed strong modulation over the range of motion of the task finger. The enslaved forces were higher during the flexion phase of the movement cycle as compared to the extension phase. The index of enslaving expressed in N/rad was higher when the task finger moved through the more flexed postures. The dependence of enslaving on both range and direction of task finger motion poses problems for methods of analysis of finger coordination based on an assumption of universal matrices of finger interdependence.

Prehension synergies: principle of superposition and hierarchical organization in circular object prehension

This study tests the following hypotheses in multi-digit circular object prehension: the principle of superposition (i.e., a complex action can be decomposed into independently controlled sub-actions) and the hierarchical organization (i.e., individual fingers at the lower level are coordinated to generate a desired task-specific outcome of the virtual finger at the higher level). Subjects performed 25 trials while statically holding a circular handle instrumented with five six-component force/moment sensors under seven external torque conditions. We performed a principal component (PC) analysis on forces and moments of the thumb and virtual finger (VF: an imagined finger producing the same mechanical effects of all finger forces and moments combined) to test the applicability of the principle of superposition in a circular object prehension. The synergy indices, measuring synergic actions of the individual finger (IF) moments for the stabilization of the VF moment, were calculated to test the hierarchical organization. Mixed-effect ANOVAs were used to test the dependent variable differences for different external torque conditions and different fingers at the VF and IF levels. The PC analysis showed that the elemental variables were decoupled into two groups: one group related to grasping stability control (normal force control) and the other group associated with rotational equilibrium control (tangential force control), which supports the principle of superposition. The synergy indices were always positive, suggesting error compensations between IF moments for the VF moment stabilization, which confirms the hierarchical organization of multi-digit prehension.

Effect of kinetic redundancy on hand digit control in children with DCD

We investigated finger strength and the ability to control digit force/torque production in children with developmental coordination disorder (DCD) using manipulative tasks with different kinetic redundancies (KNR). Age-related changes in finger strength and finger force/torque control in typically developing (TD) children were also examined to provide a developmental landscape that allows a comparison with children with DCD. Forty-eight TD children (7-, 9-, and 11- year-olds) and sixteen 9-year-old children with DCD participated in the study. Three isometric tasks with different KNR were tested: constant index finger pressing force production (KNR=0), constant thumb-index finger pinching force production (KNR=1), and constant thumb-index finger torque production (KNR=5). Each subject performed two conditions for each isometric task: maximum voluntary force/torque production and constant force/torque control (40% of maximum force/torque). The results showed that the maximum force/torque production increased and the variability of constant force/torque control decreased with age in all tasks in TD children. Children with DCD showed larger variability than TD children in the constant thumb-index finger pinching torque production. These results suggest that children with DCD, as compared to TD children, are capable of producing the same level of maximum finger force, but have poor control in manipulation tasks with a large number of kinetic redundancies.