Manipulation of a fragile object by elderly individuals

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.

Inverse Saxophone—A Device to Study the Role of Individual Finger Perturbations on Grasp Stability

The efficient coordination of fingertip forces to maintain static equilibrium while grasping an object continues to intrigue scientists. While many studies have explored this coordination, most of these studies assumed that interactions of hands primarily occur with rigid inanimate objects. Instead, our daily interactions with living and nonliving entities involve many dynamic, compliant, or fragile bodies. This paper investigates the fingertip force coordination on a manipulandum that changes its shape while grasping it. We designed a five-finger perturbation system with linear actuators at positions corresponding to each finger that would protrude outward from the center of the handle or retract toward the center of the handle as programmed. The behavior of the perturbed fingers and the other fingers while grasping this device was studied. Based on previous experiments on expanding and contracting handles, we hypothesized that each finger would exhibit a comparable response to similar horizontal perturbations. However, the response of the little finger was significantly different from the other fingers. We speculate that the central nervous system demonstrates preferential recruitment of some fingers over others while performing a task.

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.

Grip Force Control During Virtual Interaction With Deformable and Rigid Objects Via a Haptic Gripper

Most studies of grip force control focus on the manipulation of rigid objects. However, in virtual and teleoperation applications, objects are often elastic in the pinch degree-of-freedom, and are manipulated using a handle that presents haptic feedback to the user. When designing controllers for haptic grippers, it is crucial to understand how grip force is controlled when manipulating rigid and deformable objects. Here, we used a virtual teleoperation setup with a haptic gripper interface to investigate grip force control in virtual environments. Ten participants lifted virtual objects and performed vertical, cyclic motions using a haptic gripper. We manipulated the control signal to the virtual interface, the haptic properties of the gripper, and the visual properties of the virtual objects to test their effect on the grip force control. We found that participants modulated their grip force as a function of the anticipated load force in all of the experimental conditions. The control signal and properties of the haptic gripper, but not the visual properties of the objects, affected the baseline and the extent of the grip force modulation. These results can provide design guidelines for haptic grippers that elicit natural grasping in virtual and bilateral teleoperation applications.

Intention to be force efficient improves high-level anticipatory coordination of finger positions and forces in young and elderly adults

Successful object manipulation requires anticipatory high-level control of finger positions and forces to prevent object slip and tilt. Unlike young adults, who efficiently scale grip forces (GFs) according to surface conditions, old adults were reported to exert excessive grip forces. In this study, we theoretically show how grip force economy depends on the modulation of the centers of pressure on opposing grip surfaces (ΔCoP) according to object properties. In a grasp-to-lift study with young and elderly participants, we investigated how the instruction to lift the object with efficient GF influences the anticipation of torques, ΔCoP and GF control during complex variations of mass distributions and surface properties. Provision of the explicit instruction to strive for force efficiency prompted both age groups to optimize their ΔCoP modulation, although to a lesser degree in the elderly, and also led to a refinement of torque anticipation for a right-sided weight distribution in the young, but not the elderly participants. Consequently, marked drops in GF levels resulted. Furthermore, participants enhanced ΔCoP modulation and lowered GF safety ratios in challenging surface conditions. Higher GF in the elderly was due to decreased skin-surface friction but also worse ΔCoP modulation for lateralized mass distributions when trying to be force efficient. In contrast, safety margins were not elevated in the elderly, suggesting preserved GF control. Our findings demonstrate how task goals influence high-level motor control of object manipulation differentially in young and elderly participants and highlight the necessity to control for both instructions and friction when investigating GF control.NEW & NOTEWORTHY Previous studies have shown that forces are covaried as a function of centers of pressure (CoPs) to exert adequate torques. Here, we demonstrate that force-efficient object manipulation requires the modulation of CoPs and show that providing the instruction to be force efficient and challenging surface conditions elicits a GF safety ratio reduction as well as an optimization of anticipatory CoP modulation and torques in the young and, to a lesser degree, in the elderly.

Step length synergy is weaker in older adults during obstacle crossing

Community ambulation requires gait adaptations to navigate environmental obstacles. It is well known that while crossing obstacles, variables quantifying the gait pattern are controlled relative to the obstacle's position. However, the stability of these gait variables is underexplored. We measured foot positions relative to an obstacle as young and older adults stepped over it. We report secondary analysis of this data in which we quantified the stability of the step length when the two feet are placed on either side of the obstacle. We employed the uncontrolled manifold approach to test the hypotheses that (1) synergistic across-trial co-variation in the distances of the front and the back heel from the obstacle edge will stabilize the step length, and (2) older adults will display weaker synergies (i.e., lower step length stability). We observed that the front and back heel distances relative to the obstacle's edge co-varied synergistically to stabilize the step length for both age groups. Therefore, foot placement during obstacle navigation is controlled not only with reference to a feature of the environment (i.e. the obstacle), but also to stabilize the step length, presumably to control COM motion. The synergy index was 38% lower for older adults than young adults. This decline may be associated with aging-related functional deficits and tripping-related falls.

Age-related changes to motor synergies in multi-joint and multi-finger manipulative skills: a meta-analysis

Purpose

The aim of the current meta-analysis was to examine the extent to which there are differences in upper extremity motor synergies across different age groups in manipulative tasks.

Methods

The studies that used the uncontrolled manifold method to examine the effect of age on motor synergies in multi-joint and multi-finger tasks were selected. Sixteen relevant studies from 1154 articles were selected for the meta-analysis—4 and 12 studies considered multi-joint kinematics and multi-finger kinetic tasks respectively.

Results

The results of the meta-analysis suggested reduced strength of synergies in multi-finger task in older adults, but this was not the case for synergies in multi-joint task. Part of this age-related difference in finger function is related to the increased variability in total force in grasping tasks. However, reductions in the strength of multi-finger synergies in hand functions following ageing appear to depend on the characteristics of the task.

Conclusions

These findings indicate that the cooperation among fingers to stabilise the total required force to apply for grasping and other fine motor skills is less efficient in older adults that might affect the quality of manipulative tasks.

Get a grip: individual variations in grip strength are a marker of brain health

Demonstrations that grip strength has predictive power in relation to a range of health conditions-even when these are assessed decades later-has motivated claims that hand-grip dynamometry has the potential to serve as a "vital sign" for middle-aged and older adults. Central to this belief has been the assumption that grip strength is a simple measure of physical performance that provides a marker of muscle status in general, and sarcopenia in particular. It is now evident that while differences in grip strength between individuals are influenced by musculoskeletal factors, "lifespan" changes in grip strength within individuals are exquisitely sensitive to integrity of neural systems that mediate the control of coordinated movement. The close and pervasive relationships between age-related declines in maximum grip strength and expressions of cognitive dysfunction can therefore be understood in terms of the convergent functional and structural mediation of cognitive and motor processes by the human brain. In the context of aging, maximum grip strength is a discriminating measure of neurological function and brain health.

Improving Fine Control of Grasping Force during Hand-Object Interactions for a Soft Synergy-Inspired Myoelectric Prosthetic Hand

The concept of postural synergies of the human hand has been shown to potentially reduce complexity in the neuromuscular control of grasping. By merging this concept with soft robotics approaches, a multi degrees of freedom soft-synergy prosthetic hand [SoftHand-Pro (SHP)] was created. The mechanical innovation of the SHP enables adaptive and robust functional grasps with simple and intuitive myoelectric control from only two surface electromyogram (sEMG) channels. However, the current myoelectric controller has very limited capability for fine control of grasp forces. We addressed this challenge by designing a hybrid-gain myoelectric controller that switches control gains based on the sensorimotor state of the SHP. This controller was tested against a conventional single-gain (SG) controller, as well as against native hand in able-bodied subjects. We used the following tasks to evaluate the performance of grasp force control: (1) pick and place objects with different size, weight, and fragility levels using power or precision grasp and (2) squeezing objects with different stiffness. Sensory feedback of the grasp forces was provided to the user through a non-invasive, mechanotactile haptic feedback device mounted on the upper arm. We demonstrated that the novel hybrid controller enabled superior task completion speed and fine force control over SG controller in object pick-and-place tasks. We also found that the performance of the hybrid controller qualitatively agrees with the performance of native human hands.

How Prior Expectations Influence Older Adults’ Perception and Action During Object Interaction

The apparent size of an object can influence how we interact with and perceive the weight of objects in our environment. Little is known, however, about how this cue affects behaviour across the lifespan. Here, in the context of the size–weight illusion, we examined how visual size cues influenced the predictive application of fingertip forces and perceptions of heaviness in a group of older participants. We found that our older sample experienced a robust size–weight illusion, which did not differ from that experienced by younger participants. Older and young participants also experienced a real weight difference to a similar degree. By contrast, compared to younger participants our older group showed no evidence that size cues influenced the way they initially gripped and lifted the objects. These results highlight a unique dissociation between how perception and action diverge across the lifespan, and suggest that deficits in the ability to use prediction to guide actions might underpin some of the manual interaction difficulties experienced by the older adults.

Coefficient of Friction at the Fingertips in Type II Diabetics Compared to Healthy Adults

Clinical observations suggest that type II diabetes patients are more susceptible to skin changes, which may be associated with reduced coefficient of friction at the fingertips. Reduced coefficient of friction may explain recent reports of fine motor dysfunction in diabetic patients. Coefficient of friction was evaluated using slip force evaluation in a cross-sectional cohort of diabetic patients and age- and sex-matched healthy controls. Covariates of tactile sensation, disease duration, glycated hemoglobin, and clinical diagnosis of peripheral neuropathy were also assessed. A significant decrease in fingertip coefficient of friction in the diabetic group was found as compared to controls. Health state covariates did not alter the strength of between-group differences in statistical analyses. This finding of between-group differences for fingertip frictional properties suggests that causative factors of reported manual motor dysfunction lie in both the distal and proximal portions of the nervous system.

Contribution of tactile dysfunction to manual motor dysfunction in type II diabetes

INTRODUCTION

Changes in sensory and motor functions of the hand in type II diabetes (T2D) patients have been reported; there is speculation that these changes are driven by tactile dysfunction. The purpose of this study was to evaluate the effects of tactile feedback on manual function in T2D patients.

METHODS

T2D patients and healthy controls underwent median nerve blocks at the wrist and elbow. All participants underwent traditional timed motor evaluations, force dynamometry, laboratory-based kinetic evaluations, and sensory evaluation.

RESULTS

Tactile sensation in the T2D group at baseline was found to be equivalent to tactile function of the control group after median nerve block. Traditional timed evaluation results were negatively impacted by anesthesia, but more sensitive kinetic measures were not impacted.

CONCLUSIONS

These data suggest that mechanisms outside of tactile dysfunction play a significant role in motor dysfunction in T2D. Muscle Nerve 54: 895-902, 2016.

Using Nonlinear Tools to Evaluate Movement of Fragile Objects

We investigated the movement strategies of young, healthy participants (7 men/7 women) during the movement of a fragile object using nonlinear analysis. The kinematic variables of position, velocity, and acceleration were quantified using largest Lyapunov exponent (LyE) and approximate entropy (ApEn) analysis to identify the structure of their movement variability and movement predictability, respectively. Subjects performed a total of 15 discrete trials of an upper extremity movement task without crushing the object at each fragility condition, using each hand (left/right). We tested four fragility conditions hypothesizing that an increase in fragility would result in higher movement predictability and decreased temporal variability. Comparisons between the structure of movement variability and movement predictability were based on fragility condition, handedness, and kinematic measures. In this specific population, object fragility and participant handedness did not significantly impact the structure of movement variability (LyE) in the primary direction of movement (Z direction), although some effects were observed in the anterior/posterior directions. ApEn values were minimized across conditions, showing increased movement predictability, and is suggested for the analysis of discrete kinematic movements. In healthy populations, the results of this study suggest minimal effects on task performance and movement predictability as a result of object fragility.

Age-related changes of grip force control in physically active adults

The age-related changes for controlling grip force in adults who practice regular and supervised physical activity have not been investigated. Fifty-five physically active adults ages 50 years and older and a group of 20 young adults (18-30 years old) performed a task of grasping and lifting an object. The grip force and the object's acceleration were recorded and used to calculate the parameters of grip force control. The levels of daily physical activities were also examined in all age groups. There were no differences in grip force control between the age groups. Conversely, the group over 76 years old used stronger grip force and increased latency (the time from grip force application to the time the object is lifted off the table) to manipulate the object. The results of this study suggest that middle-aged and older adults who exercise regularly can reduce or delay the possible grip force control deficits associated with aging.

Impaired Object Handling during Bimanual Task Performance in Multiple Sclerosis

We investigated the kinetic features of manual dexterity and fine motor control during a task that resembles an activity of daily living in 30 persons with relapsing-remitting multiple sclerosis (PwMS). Specifically, a novel two-transducer system was used to measure time and grip-load forces during a bimanual task that is similar to opening and closing a jar. We hypothesized that PwMS would have increased grip force production, deteriorations in kinetic timing, and preserved grip-load coupling indices compared to healthy controls (i.e., young and older adults). Increased grip force production and deterioration in timing indices were confirmed in PwMS. Abnormal grip-load coupling was exhibited by PwMS, in contrast to healthy participants. The correlation between task time and self-reported disability scores suggests that objective measurement of impaired upper-extremity movements relates to perception of overall function.

Internal forces during static prehension: effects of age and grasp configuration

The authors studied effects of healthy aging on 3 components of the internal force vector during static prehensile tasks. Young and older subjects held an instrumented handle using a 5-digit prismatic grasp under different digit configurations and external torques. Across digit configurations, older subjects showed larger internal normal (grip) and tangential (load-resisting) digit force components and larger internal moment of force. In contrast to earlier reports, safety margin values were not higher in the older subjects. The results show that the increased grip force in older persons is a specific example of a more general age-related problem reflected in the generation of large internal force vectors in prehensile tasks. It is possible that the higher internal forces increase the apparent stiffness of the hand+handle system and, hence, contribute to its stability. This strategy, however, may be maladaptive, energetically wasteful, and inefficient in ensuring safety of hand-held objects.

Mechanical properties of the human hand digits: age-related differences

BACKGROUND

Mechanical properties of human digits may have significant implications for the hand function. We quantified several mechanical characteristics of individual digits in young and older adults.

METHODS

Digit tip friction was measured at several normal force values using a method of induced relative motion between the digit tip and the object surface. A modified quick-release paradigm was used to estimate digit apparent stiffness, damping, and inertial parameters. The subjects grasped a vertical handle instrumented with force/moment sensors using a prismatic grasp with four digits; the handle was fixed to the table. Unexpectedly, one of the sensors yielded leading to a quick displacement of the corresponding digit. A second-order, linear model was used to fit the force/displacement data.

FINDINGS

Friction of the digit pads was significantly lower in older adults. The apparent stiffness coefficient values were higher while the damping coefficients were lower in older adults leading to lower damping ratio. The damping ratio was above unity for most data in young adults and below unity for older adults. Quick release of a digit led to force changes in other digits of the hand, likely due to inertial hand properties. These phenomena of "mechanical enslaving" were smaller in older adults although no significant difference was found in the inertial parameter in the two groups.

INTERPRETATIONS

The decreased friction and damping ratio present challenges for the control of everyday prehensile tasks. They may lead to excessive digit forces and low stability of the grasped object.

Contrasting effects of fatigue on multifinger coordination in young and older adults

We investigated the effects of fatigue produced by timed maximal voluntary contraction (MVC) of the index finger of the right hand on performance in MVC and accurate cyclic force production tasks in right-handed young (Young group) and strength-matched elderly (Elderly group) participants. We hypothesized that, before fatigue, the Elderly group would show weaker force-stabilizing synergies and smaller adaptive changes in the synergy index during fatigue. Synergies were defined as covaried adjustments of neural commands to fingers (finger modes) across trials that stabilize total force. Fatigue caused a significant reduction in the MVC, which was larger in the Young group compared with the Elderly group for both fatigued finger (index finger) and four fingers (index, middle, ring, and little fingers pressing together). Indexes of finger enslaving (lack of individuation) increased with fatigue in both groups. The index of force-stabilizing synergies was similar for the two groups before fatigue, while its increase with fatigue was significantly larger in the Elderly group compared with the Young group. We infer that changes in the indexes of finger interaction (enslaving) and coordination (synergy) with age seem to be correlated with changes in muscle strength. This correlation may be causally related to the progressive death of neurons at different levels of the neuromotor hierarchy. The surprisingly large changes in the synergy index with fatigue in older adults suggest that, by itself, aging does not necessarily lead to impairment in synergic control. Strength training may be a method to avoid age-related decrement in finger interaction and coordination.

Effects of aging on force coordination in bimanual task performance

We investigated within- and between-hands grip-load force coordination in both healthy young and older adult participants during bimanual tasks involving realistic actions. Age-related changes in manual behaviors such as grip force production and safety margins were expected in older adults. Within-hand grip-load coordination was expected to decrease with aging during the performance of dynamic actions, but not static actions. The effects of task and hand dominance on task performance were also evaluated. Grip force production increased with age; however, changes in fingertip frictional properties with aging increased the risk of object slip. Indices of within-hand grip-load coordination did not alter with age, but such indices were affected by task goals. The action of connecting two independent objects, particularly with rotational action, was associated with declines in all indices of within- and between-hands force coordination, independent of age. Evidence of task-specific differences in within-hand grip-load coordination in the current data set suggests that individual hand specification emerges and persists with age in everyday bimanual prehension tasks, independent of the action role assigned to the dominant and non-dominant hands.

Effects of task complexity on grip-to-load coordination in bimanual actions

We investigated within- and between-hand grip and load force coordination in healthy young subjects during bimanual tasks involving realistic manual actions. Actions involving disparate actions of the two hands (bimanual asymmetry) were expected to result in lower overall measures of within- and between-hand measures of grip and load force coordination. As dissociation between two hands performing disparate actions may be expected, it was also hypothesized that increased task asymmetry would result in a shift toward higher within-hand force coordination. Features such as object rotation were found to reduce some, but not all indices of both within- and between-hand force coordination. The action of connecting two independent objects was associated with declines in all indices of within- and between-hand force coordination. Evidence of task-specific differences in force application timing and a trend toward within-hand grip-load coordination differences in the current data set suggest that individual hand specification emerges naturally in everyday bimanual prehension tasks, independent of the action role of the assigned to the dominant and non-dominant hands.

Dynamical degrees of freedom and correlations in isometric finger force production

Prior research has concluded that the correlations of isometric finger forces represent the extent to which the fingers are controlled as a single unit. If this is the case, finger force correlations should be consistent with estimates of the controlled (dynamical) degrees of freedom in finger forces. The present study examined the finger force correlations and the dynamical degrees of freedom in four isometric force tasks. The tasks were to produce a preferred level of force with the (a) Index, (b) Ring, (c) Both fingers and also to (d) Rest the fingers on the load cells. Dynamical degrees of freedom in finger forces were lowest in the Both finger force task and progressively higher in the Ring, Index and Resting finger force tasks. The finger force correlations were highest in the Resting and lowest in the Index and Ring finger tasks. The results for the dynamical degrees of freedom in finger forces were consistent with a reduction in degrees of freedom in response to the degrees of freedom problem and the task constraints. The results for the finger force correlations were inconsistent with a reduction in the dynamical degrees of freedom. These findings indicate that finger force correlations do not necessarily reflect the coupling of finger forces. The findings also highlight the value of time-domain analyses to reveal the organization of control in isometric finger forces.