Proprioceptive deficits in inactive older adults are not reflected in fast targeted reaching movements

Slowing of Movements in Healthy Aging as a Rational Economic Response to an Elevated Effort Landscape

Why do we move slower as we grow older? The reward circuits of the brain, which tend to invigorate movements, decline with aging, raising the possibility that reduced vigor is due to the diminishing value that our brain assigns to movements. However, as we grow older, it also becomes more effortful to make movements. Is age-related slowing principally a consequence of increased effort costs from the muscles, or reduced valuation of reward by the brain? Here, we first quantified the cost of reaching via metabolic energy expenditure in human participants (male and female), and found that older adults consumed more energy than the young at a given speed. Thus, movements are objectively more costly for older adults. Next, we observed that when reward increased, older adults, like the young, responded by initiating their movements earlier. Yet, unlike the young, they were unwilling to increase their movement speed. Was their reluctance to reach quicker for rewards due to the increased effort costs, or because they ascribed less value to the movement? Motivated by a mathematical model, we next made the young experience a component of aging by making their movements more effortful. Now the young responded to reward by reacting faster but chose not to increase their movement speed. This suggests that slower movements in older adults are partly driven by an adaptive response to an elevated effort landscape. Moving slower may be a rational economic response the brain is making to mitigate the elevated effort costs that accompany aging.

Proprioceptive short-term memory in passive motor learning

A physical trainer often physically guides a learner's limbs to teach an ideal movement, giving the learner proprioceptive information about the movement to be reproduced later. This instruction requires the learner to perceive kinesthetic information and store the instructed information temporarily. Therefore, (1) proprioceptive acuity to accurately perceive the taught kinesthetics and (2) short-term memory to store the perceived information are two critical functions for reproducing the taught movement. While the importance of proprioceptive acuity and short-term memory has been suggested for active motor learning, little is known about passive motor learning. Twenty-one healthy adults (mean age 25.6 years, range 19-38 years) participated in this study to investigate whether individual learning efficiency in passively guided learning is related to these two functions. Consequently, learning efficiency was significantly associated with short-term memory capacity. In particular, individuals who could recall older sensory stimuli showed better learning efficiency. However, no significant relationship was observed between learning efficiency and proprioceptive acuity. A causal graph model found a direct influence of memory on learning and an indirect effect of proprioceptive acuity on learning via memory. Our findings suggest the importance of a learner's short-term memory for effective passive motor learning.

The differential effect of age on upper limb sensory processing, proprioception, and motor function

Sensory processing consists in the integration and interpretation of somatosensory information. It builds upon proprioception but is a distinct function requiring complex processing by the brain over time. Currently little is known about the effect of aging on sensory processing ability or the influence of other covariates such as motor function, proprioception, or cognition. In this study, we measured upper limb passive and active sensory processing, motor function, proprioception, and cognition in 40 healthy younger adults and 54 older adults. We analyzed age differences across all measures and evaluated the influence of covariates on sensory processing through regression. Our results showed larger effect sizes for age differences in sensory processing (r = 0.38) compared with motor function (r = 0.18-0.22) and proprioception (r = 0.10-0.27) but smaller than for cognition (r = 0.56-0.63). Aside from age, we found no evidence that sensory processing performance was related to motor function or proprioception, but active sensory processing was related to cognition (β = 0.30-0.42). In conclusion, sensory processing showed an age-related decline, whereas some proprioceptive and motor abilities were preserved across age.NEW & NOTEWORTHY Sensory processing consists in the integration and interpretation of sensory information by the brain over time and can be affected by lesion while proprioception remains intact. We investigated how sensory processing can be used to reproduce and identify shapes. We showed that the effect of age on sensory processing is more pronounced than its effect on proprioception or motor function. Age and cognition are related to sensory processing, not proprioception or motor function.

Effort cost of reaching prompts vigor reduction in older adults

As people age, they move slower. Is age-related reduction in vigor a reflection of a reduced valuation of reward by the brain, or a consequence of increased effort costs by the muscles? Here, we quantified cost of movements objectively via the metabolic energy that young and old participants consumed during reaching and found that in order reach at a given speed, older adults expended more energy than the young. We next quantified how reward modulated movements in the same populations and found that like the young, older adults responded to increased reward by initiating their movements earlier. Yet, their movements were less sensitive to increased reward, resulting in little or no modulation of reach speed. Lastly, we quantified the effect of increased effort on how reward modulated movements in young adults. Like the effects of aging, when faced with increased effort the young adults responded to reward primarily by reacting faster, with little change in movement speed. Therefore, reaching required greater energetic expenditure in the elderly, suggesting that the slower movements and reactions exhibited in aging are partly driven by an adaptive response to an elevation in the energetic landscape of effort. That is, moving slower appears to be a rational economic consequence of aging.

Significance statement

Healthy aging coincides with a reduction in speed, or vigor, of walking, reaching, and eye movements. Here we focused on disentangling two opposing sources of aging-related movement slowing: reduced reward sensitivity due to loss of dopaminergic tone, or increased energy expenditure movements related to mitochondrial or muscular inefficiencies. Through a series of three experiments and construction of a computational model, here we demonstrate that transient changes in reaction time and movement speed together offer a quantifiable metric to differentiate between reward- and effort-based alterations in movement vigor. Further, we suggest that objective increases in the metabolic cost of moving, not reductions in reward valuation, are driving much of the movement slowing occurring alongside healthy aging.

Increased upper-limb sensory attenuation with age

The pressure of our own finger on the arm feels differently than the same pressure exerted by an external agent: the latter involves just touch, whereas the former involves a combination of touch and predictive output from the internal model of the body. This internal model predicts the movement of our own finger and hence the intensity of the sensation of the finger press is decreased. A decrease in intensity of the self-produced stimulus is called sensory attenuation. It has been reported that, due to decreased proprioception with age and an increased reliance on the prediction of the internal model, sensory attenuation is increased in older adults. In this study, we used a force-matching paradigm to test if sensory attenuation is also present over the arm and if aging increases sensory attenuation. We demonstrated that, while both young and older adults overestimate a self-produced force, older adults overestimate it even more showing an increased sensory attenuation. In addition, we also found that both younger and older adults self-produce higher forces when activating the homologous muscles of the upper limb. While this is traditionally viewed as evidence for an increased reliance on internal model function in older adults because of decreased proprioception, proprioception appeared unimpaired in our older participants. This begs the question of whether an age-related decrease in proprioception is really responsible for the increased sensory attenuation observed in older people.

Does proprioceptive acuity influence the extent of implicit sensorimotor adaptation in young and older adults?

The ability to adjust movements to changes in the environment declines with aging. This age-related decline is caused by the decline of explicit adjustments. However, implicit adaptation remains intact and might even be increased with aging. Since proprioceptive information has been linked to implicit adaptation, it might well be that an age-related decline in proprioceptive acuity might be linked to the performance of older adults in implicit adaptation tasks. Indeed, age-related proprioceptive deficits could lead to altered sensory integration with an increased weighting of the visual sensory-prediction error. Another possibility is that reduced proprioceptive acuity results in an increased reliance on predicted sensory consequences of the movement. Both these explanations led to our preregistered hypothesis: we expected a relation between the decline of proprioception and the amount of implicit adaptation across ages. However, we failed to support this hypothesis. Our results question the existence of reliability-based integration of visual and proprioceptive signals during motor adaptation.

Assessing kinesthetic proprioceptive function of the upper limb: a novel dynamic movement reproduction task using a robotic arm

Background

Proprioception refers to the perception of motion and position of the body or body segments in space. A wide range of proprioceptive tests exists, although tests dynamically evaluating sensorimotor integration during upper limb movement are scarce. We introduce a novel task to evaluate kinesthetic proprioceptive function during complex upper limb movements using a robotic device. We aimed to evaluate the test–retest reliability of this newly developed Dynamic Movement Reproduction (DMR) task. Furthermore, we assessed reliability of the commonly used Joint Reposition (JR) task of the elbow, evaluated the association between both tasks, and explored the influence of visual information (viewing arm movement or not) on performance during both tasks.

Methods

During the DMR task, participants actively reproduced movement patterns while holding a handle attached to the robotic arm, with the device encoding actual position throughout movement. In the JR task, participants actively reproduced forearm positions; with the final arm position evaluated using an angle measurement tool. The difference between target movement pattern/position and reproduced movement pattern/position served as measures of accuracy. In study 1 (N = 23), pain-free participants performed both tasks at two test sessions, 24-h apart, both with and without visual information available (i.e., vision occluded using a blindfold). In study 2 (N = 64), an independent sample of pain-free participants performed the same tasks in a single session to replicate findings regarding the association between both tasks and the influence of visual information.

Results

The DMR task accuracy showed good-to-excellent test–retest reliability, while JR task reliability was poor: measurements did not remain sufficiently stable over testing days. The DMR and JR tasks were only weakly associated. Adding visual information (i.e., watching arm movement) had different performance effects on the tasks: it increased JR accuracy but decreased DMR accuracy, though only when the DMR task started with visual information available (i.e., an order effect).

Discussion

The DMR task’s highly standardized protocol (i.e., largely automated), precise measurement and involvement of the entire upper limb kinetic chain (i.e., shoulder, elbow and wrist joints) make it a promising tool. Moreover, the poor association between the JR and DMR tasks indicates that they likely capture unique aspects of proprioceptive function. While the former mainly captures position sense, the latter appears to capture sensorimotor integration processes underlying kinesthesia, largely independent of position sense. Finally, our results show that the integration of visual and proprioceptive information is not straightforward: additional visual information of arm movement does not necessarily make active movement reproduction more accurate, on the contrary, when movement is complex, vision appears to make it worse.

Proprioceptive Acuity is Enhanced During Arm Movements Compared to When the Arm is Stationary: A Study of Young and Older Adults

Proprioception in old age is thought to be poorer due to degeneration of the central (CNS) and peripheral nervous systems (PNS). We tested whether community-dwelling older adults (65-83 years) make larger proprioceptive errors than young adults (18-22 years) using a natural reaching task. Subjects moved the right arm to touch the index fingertip to the stationary or moving left index fingertip. The range of locations of the target index fingertip was large, sampling the natural workspace of the human arm. The target arm was moved actively by the subject or passively by the experimenter and reaching arm movements towards the target were made under visual guidance, or with vision blocked (proprioceptive guidance). Subjects did not know the direction or speed of upcoming target hand motion in the passive conditions. Mean 3D distance errors between the right and left index finger tips were small in both groups and only slightly larger when vision was blocked than when allowed, but averaged 2-5 mm larger in older than in younger adults in moving (p = 0.002) and stationary (p = 0.07) conditions, respectively. Variable errors were small and similar in the two groups (p > 0.35). Importantly, clearly larger errors were observed for reaching to the stationary than to the moving index fingertip in both groups, demonstrating that dynamic proprioceptive information during movement permits more accurate localization of the endpoint of the moving arm. This novel finding demonstrates the importance of dynamic proprioceptive information in movement guidance and bimanual coordination.

Imaging Analysis of Prosthesis Angle after Hip Replacement with Direct Anterior Approach in Lateral Position

The use of lateral DAA-THA for the treatment of end-stage hip disorders has good recent clinical efficacy, does not require special surgical beds and traction equipment, uses traditional surgical instruments, reduces the requirements for surgical beds and surgical instruments, enters through the nerve and muscle anatomical gap without cutting any muscle or nerve tissue, is minimally invasive, and has good surgical maneuverability, low bleeding, low postoperative pain, short hospitalization time, and rapid recovery. It is a safe and effective minimally invasive procedure because of its light weight, short hospital stay, and rapid recovery. In this paper, we used imaging to observe the angle of the posterior prosthesis. And the results showed that hip arthroplasty using the direct anterior approach improved hip mobility in early stages compared with other approaches and reduced pain. The direct anterior approach and length between total hip arthroplasty using direct lateral and posterior lateral approach and partial data (surgical time, blood loss, etc.) were significantly worse than those using direct forward approach. In addition, the direct anterior approach to total hip arthroplasty is subject to a learning curve and requires at least 33 cases of experience to achieve a lower complication rate.

Adaptation of reach action to a novel force-field is not predicted by acuity of dynamic proprioception in either older or younger adults

Healthy ageing involves degeneration of the neuromuscular system which impacts movement control and proprioception. Yet the relationship between these sensory and motor deficits in upper limb reaching has not been examined in detail. Recently, we reported that age-related proprioceptive deficits were unrelated to accuracy in rapid arm movements, but whether this applied in motor tasks more heavily dependent on proprioceptive feedback was not clear. To address this, we have tested groups of younger and older adults on a force-field adaptation task under either full or limited visual feedback conditions and examined how performance was related to dynamic proprioceptive acuity. Adaptive performance was similar between the age groups, regardless of visual feedback condition, although older adults showed increased after-effects. Physically inactive individuals made larger systematic (but not variable) proprioceptive errors, irrespective of age. However, dynamic proprioceptive acuity was unrelated to adaptation and there was no consistent evidence of proprioceptive recalibration with adaptation to the force-field for any group. Finally, in spite of clear age-dependent loss of spatial working memory capacity, we found no relationship between memory capacity and adaptive performance or proprioceptive acuity. Thus, non-clinical levels of deficit in dynamic proprioception, due to age or physical inactivity, do not affect force-field adaptation, even under conditions of limited visual feedback that might require greater proprioceptive control.

The multiple process model of goal-directed aiming/reaching: insights on limb control from various special populations

Several years ago, our research group forwarded a model of goal-directed reaching and aiming that describes the processes involved in the optimization of speed, accuracy, and energy expenditure Elliott et al. (Psychol Bull 136:1023-1044, 2010). One of the main features of the model is the distinction between early impulse control, which is based on a comparison of expected to perceived sensory consequences, and late limb-target control that involves a spatial comparison of limb and target position. Our model also emphasizes the importance of strategic behaviors that limit the opportunity for worst-case or inefficient outcomes. In the 2010 paper, we included a section on how our model can be used to understand atypical aiming/reaching movements in a number of special populations. In light of a recent empirical and theoretical update of our model Elliott et al. (Neurosci Biobehav Rev 72:95-110, 2017), here we consider contemporary motor control work involving typical aging, Down syndrome, autism spectrum disorder, and tetraplegia with tendon-transfer surgery. We outline how atypical limb control can be viewed within the context of the multiple-process model of goal-directed reaching and aiming, and discuss the underlying perceptual-motor impairment that results in the adaptive solution developed by the specific group.