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Sheng Y, Wang J, Tan G, Chang H, Xie Q, Liu H. Muscle Synergy Plasticity in Motor Function Recovery After Stroke. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1657-1667. [PMID: 38619941 DOI: 10.1109/tnsre.2024.3389022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
In certain neurological disorders such as stroke, the impairment of upper limb function significantly impacts daily life quality and necessitates enhanced neurological control. This poses a formidable challenge in the realm of rehabilitation due to its intricate nature. Moreover, the plasticity of muscle synergy proves advantageous in assessing the enhancement of motor function among stroke patients pre and post rehabilitation training intervention, owing to the modular control strategy of central nervous system. It also facilitates the investigation of long-term alterations in remodeling of muscle functional performance among patients undergoing clinical rehabilitation, aiming to establish correlations between changes in muscle synergies and stroke characteristics such as type, stage, and sites. In this study, a three-week rehabilitation monitoring experiment was conducted to assess the motor function of stroke patients at different stages of rehabilitation based on muscle synergy performance. Additionally, we aimed to investigate the correlation between clinical scale scores, rehabilitation stages, and synergy performance in order to provide a more comprehensive understanding of stroke patient recovery. The results of 7 healthy controls and 16 stroke patients showed that high-functioning patients were superior to low-functioning patients in terms of motor function plasticity towards healthy individuals. Moreover, there was a high positive correlation between muscle synergies and clinical scale scores in high-functioning patients, and the significance gradually emerged with treatment, highlighting the potential of muscle synergy plasticity as a valuable tool for monitoring rehabilitation progress. The potential of this study was also demonstrated for elucidating the physiological mechanisms underlying motor function reconstruction within the central nervous system, which is expected to promote the further application of muscle synergy in clinical assessment.
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Bellitto A, De Luca A, Gamba S, Losio L, Massone A, Casadio M, Pierella C. Clinical, Kinematic and Muscle Assessment of Bilateral Coordinated Upper-Limb Movements Following Cervical Spinal Cord Injury. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3607-3618. [PMID: 37639412 DOI: 10.1109/tnsre.2023.3309539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Cervical spinal cord injury (cSCI) often results in bilateral impairment of the arms, leading to difficulties in performing daily activities. However, little is known about the neuromotor alterations that affect the ability of individuals with cSCI to perform coordinated movements with both arms. To address this issue, we developed and tested a functional assessment that integrates clinical, kinematic, and muscle activity measures, including the evaluation of bilateral arm movements. Twelve subjects with a C5-C7 spinal lesion and six unimpaired subjects underwent an evaluation that included three tests: the Manual Muscle Test, Range Of Motion test and Arm stabilisation test, a subsection of the "Van Lieshout arm/hand function test". During the latter, we recorded kinematic and muscle activity data from the upper-body during the execution of a set of movements that required participants to stabilize both arms against gravity at different configurations. Analytical methods, including muscle synergies, spinal maps, and Principal Component Analysis, were used to analyse the data. Clinical tests detected limitations in shoulder abduction-flexion of cSCI participants and alterations in elbows-wrists motor function. The instrumented assessment provided insight into how these limitations impacted the ability of cSCI participants to perform bilateral movements. They exhibited severe difficulty in performing movements involving over-the-shoulder motion and shoulder internal rotation due to altered patterns of activity of the scapular stabilizer muscles, latissimus dorsi, pectoralis, and triceps. Our findings shed light on the bilateral neuromotor changes that occur post-cSCI addressing not only motor deficits, but also the underlying abnormal, weak, or silent muscle activations.
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Geng Y, Chen Z, Zhao Y, Cheung VCK, Li G. Applying muscle synergy analysis to forearm high-density electromyography of healthy people. Front Neurosci 2022; 16:1067925. [PMID: 36605554 PMCID: PMC9807910 DOI: 10.3389/fnins.2022.1067925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Muscle synergy is regarded as a motor control strategy deployed by the central nervous system (CNS). Clarifying the modulation of muscle synergies under different strength training modes is important for the rehabilitation of motor-impaired patients. Methods To represent the subtle variation of neuromuscular activities from the smaller forearm muscles during wrist motion, we proposed to apply muscle synergy analysis to preprocessed high-density electromyographic data (HDEMG). Here, modulation of muscle synergies within and across the isometric and isotonic training modes for strengthening muscles across the wrist were investigated. Surface HDEMGs were recorded from healthy subjects (N = 10). Three different HDEMG electrode configurations were used for comparison and validation of the extracted muscle synergies. The cosine of principal angles (CPA) and the Euclidian distance (ED) between synergy vectors were used to evaluate the intra- and inter-mode similarity of muscle synergies. Then, how the activation coefficients modulate the excitation of specific synergy under each mode was examined by pattern recognition. Next, for a closer look at the mode-specific synergies and the synergies shared by the two training modes, k-means clustering was applied. Results We observed high similarity of muscle synergies across different tasks within each training mode, but decreased similarity of muscle synergies across different training modes. Both intra- and intermode similarity of muscle synergies were consistently robust to electrode configurations regardless of the similarity metric used. Discussion Overall, our findings suggest that applying muscle synergy analysis to HDEMG is feasible, and that the traditional muscle synergies defined by whole-muscle components may be broadened to include sub-muscle components represented by the HDEMG channels. This work may lead to an appropriate neuromuscular analysis method for motor function evaluation in clinical settings and provide valuable insights for the prescription of rehabilitation training therapies.
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Affiliation(s)
- Yanjuan Geng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Yanjuan Geng,
| | - Ziyin Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yang Zhao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Vincent C. K. Cheung
- School of Biomedical Sciences, The Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Guanglin Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,Guanglin Li,
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Pierella C, Pellegrino L, Muller M, Inglese M, Solaro C, Coscia M, Casadio M. Upper Limb Sensory-Motor Control During Exposure to Different Mechanical Environments in Multiple Sclerosis Subjects With No Clinical Disability. Front Neurorobot 2022; 16:920118. [PMID: 35898562 PMCID: PMC9309790 DOI: 10.3389/fnbot.2022.920118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease resulting in motor impairments associated with muscle weakness and lack of movement coordination. The goal of this work was to quantify upper limb motor deficits in asymptomatic MS subjects with a robot-based assessment including performance and muscle synergies analysis. A total of 7 subjects (MS: 3 M−4 F; 42 ± 10 years) with clinically definite MS according to McDonald criteria, but with no clinical disability, and 7 age- and sex-matched subjects without a history of neurological disorders participated in the study. All subjects controlled a cursor on the computer screen by moving their hand or applying forces in 8 coplanar directions at their self-selected speed. They grasped the handle of a robotic planar manipulandum that generated four different environments: null, assistive or resistive forces, and rigid constraint. Simultaneously, the activity of 15 upper body muscles was recorded. Asymptomatic MS subjects generated less smooth and less accurate cursor trajectories than control subjects in controlling a force profile, while the end-point error was significantly different also in the other environments. The EMG analysis revealed different muscle activation patterns in MS subjects when exerting isometric forces or when moving in presence of external forces generated by a robot. While the two populations had the same number and similar structure of muscle synergies, they had different activation profiles. These results suggested that a task requiring to control forces against a rigid environment allows better than movement tasks to detect early sensory-motor signs related to the onset of symptoms of multiple sclerosis and to differentiate between stages of the disease.
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Affiliation(s)
- Camilla Pierella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences (DINOGMI), University of Genoa, Genoa, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
- *Correspondence: Camilla Pierella
| | - Laura Pellegrino
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Margit Muller
- Department of Rehabilitation, C.R.R.F. “Mons. L. Novarese”, Moncrivello, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. “Mons. L. Novarese”, Moncrivello, Italy
| | | | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Pellegrino L, Coscia M, Giannoni P, Marinelli L, Casadio M. Stroke impairs the control of isometric forces and muscle activations in the ipsilesional arm. Sci Rep 2021; 11:18533. [PMID: 34535693 PMCID: PMC8448776 DOI: 10.1038/s41598-021-96329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
Stroke often impairs the control of the contralesional arm, thus most survivors rely on the ipsilesional arm to perform daily living activities that require an efficient control of movements and forces. Whereas the ipsilesional arm is often called 'unaffected' or 'unimpaired', several studies suggested that during dynamic tasks its kinematics and joint torques are altered. Is stroke also affecting the ability of the ipsilesional arm to produce isometric force, as when pushing or pulling a handle? Here, we address this question by analyzing behavioral performance and muscles' activity when subjects applied an isometric force of 10 N in eight coplanar directions. We found that stroke affected the ability to apply well-controlled isometric forces with the ipsilesional arm, although to a minor extent compared to the contralesional arm. The spinal maps, the analysis of single muscle activities and the organization of muscle synergies highlighted that this effect was mainly associated with abnormal activity of proximal muscles with respect to matched controls, especially when pushing or pulling in lateral directions.
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Affiliation(s)
- Laura Pellegrino
- Dept. Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia 13, 16145, Genoa, Italy
| | - Martina Coscia
- Bertarelli Foundation Chair in Translational Neuroengineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland.,Wyss Center for Bio- and Neuroengineering, Geneva, Switzerland
| | - Psiche Giannoni
- Dept. Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia 13, 16145, Genoa, Italy
| | - Lucio Marinelli
- Division of Clinical Neurophysiology, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maura Casadio
- Dept. Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Via Opera Pia 13, 16145, Genoa, Italy.
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Irastorza-Landa N, García-Cossio E, Sarasola-Sanz A, Brötz D, Birbaumer N, Ramos-Murguialday A. Functional synergy recruitment index as a reliable biomarker of motor function and recovery in chronic stroke patients. J Neural Eng 2021; 18. [PMID: 33530072 DOI: 10.1088/1741-2552/abe244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Objective. Stroke affects the expression of muscle synergies underlying motor control, most notably in patients with poorer motor function. The majority of studies on muscle synergies have conventionally approached this analysis by assuming alterations in the inner structures of synergies after stroke. Although different synergy-based features based on this assumption have to some extent described pathological mechanisms in post-stroke neuromuscular control, a biomarker that reliably reflects motor function and recovery is still missing.Approach. Based on the theory of muscle synergies, we alternatively hypothesize that functional synergy structures are physically preserved and measure the temporal correlation between the recruitment profiles of healthy modules by paretic and healthy muscles, a feature hereafter reported as the FSRI. We measured clinical scores and extracted the muscle synergies of both ULs of 18 chronic stroke survivors from the electromyographic activity of 8 muscles during bilateral movements before and after 4 weeks of non-invasive BMI controlled robot therapy and physiotherapy. We computed the FSRI as well as features quantifying inter-limb structural differences and evaluated the correlation of these synergy-based measures with clinical scores.Main results. Correlation analysis revealed weak relationships between conventional features describing inter-limb synergy structural differences and motor function. In contrast, FSRI values during specific or combined movement data significantly correlated with UL motor function and recovery scores. Additionally, we observed that BMI-based training with contingent positive proprioceptive feedback led to improved FSRI values during the specific trained finger extension movement.Significance. We demonstrated that FSRI can be used as a reliable physiological biomarker of motor function and recovery in stroke, which can be targeted via BMI-based proprioceptive therapies and adjuvant physiotherapy to boost effective rehabilitation.
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Affiliation(s)
- Nerea Irastorza-Landa
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | | | - Andrea Sarasola-Sanz
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - Doris Brötz
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Niels Birbaumer
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Ander Ramos-Murguialday
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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Effects of Hemispheric Stroke Localization on the Reorganization of Arm Movements within Different Mechanical Environments. Life (Basel) 2021; 11:life11050383. [PMID: 33922668 PMCID: PMC8145329 DOI: 10.3390/life11050383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023] Open
Abstract
This study investigated how stroke’s hemispheric localization affects motor performance, spinal maps and muscle synergies while performing planar reaching with and without assistive or resistive forces. A lesion of the right hemisphere affected performance, reducing average speed and smoothness and augmenting lateral deviation in both arms. Instead, a lesion of the left hemisphere affected the aiming error, impairing the feedforward control of the ipsilesional arm. The structure of the muscle synergies had alterations dependent on the lesion side in both arms. The applied force fields reduced the differences in performance and in muscle activations between arms and among populations. These results support the hypotheses of hemispheric specialization in movement control and identify potential significant biomarkers for the design of more effective and personalized rehabilitation protocols.
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Botzheim L, Laczko J, Torricelli D, Mravcsik M, Pons JL, Oliveira Barroso F. Effects of gravity and kinematic constraints on muscle synergies in arm cycling. J Neurophysiol 2021; 125:1367-1381. [PMID: 33534650 DOI: 10.1152/jn.00415.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Arm cycling is a bimanual motor task used in medical rehabilitation and in sports training. Understanding how muscle coordination changes across different biomechanical constraints in arm cycling is a step toward improved rehabilitation approaches. This exploratory study aims to get new insights on motor control during arm cycling. To achieve our main goal, we used the muscle synergies analysis to test three hypotheses: 1) body position with respect to gravity (sitting and supine) has an effect on muscle synergies; 2) the movement size (crank length) has an effect on the synergistic behavior; 3) the bimanual cranking mode (asynchronous and synchronous) requires different synergistic control. Thirteen able-bodied volunteers performed arm cranking on a custom-made device with unconnected cranks, which allowed testing three different conditions: body position (sitting vs. supine), crank length (10 cm vs. 15 cm), and cranking mode (synchronous vs. asynchronous). For each of the eight possible combinations, subjects cycled for 30 s while electromyography of eight muscles (four from each arm) were recorded: biceps brachii, triceps brachii, anterior deltoid, and posterior deltoid. Muscle synergies in this eight-dimensional muscle space were extracted by nonnegative matrix factorization. Four synergies accounted for over 90% of muscle activation variances in all conditions. Results showed that synergies were affected by body position and cranking mode but practically unaffected by movement size. These results suggest that the central nervous system may employ different motor control strategies in response to external constraints such as cranking mode and body position during arm cycling.NEW & NOTEWORTHY Recent studies analyzed muscle synergies in lower limb cycling. Here, we examine upper limb cycling and specifically the effect of body position with respect to gravity, movement size, and cranking mode on muscle coordination during arm cranking tasks. We show that altered body position and cranking mode affects modular organization of muscle activities. To our knowledge, this is the first study assessing motor control through muscle synergies framework during upper limb cycling with different constraints.
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Affiliation(s)
- Lilla Botzheim
- Department of Information Technology and Biorobotics, Institute of Mathematics and Informatics, Faculty of Sciences, University of Pecs, Pecs, Hungary.,Neurorehabilitation and Motor Control Research Group, Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Jozsef Laczko
- Department of Information Technology and Biorobotics, Institute of Mathematics and Informatics, Faculty of Sciences, University of Pecs, Pecs, Hungary.,Neurorehabilitation and Motor Control Research Group, Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary.,Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Mariann Mravcsik
- Department of Information Technology and Biorobotics, Institute of Mathematics and Informatics, Faculty of Sciences, University of Pecs, Pecs, Hungary.,Neurorehabilitation and Motor Control Research Group, Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Jose L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain.,Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
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Synergistic Activation Patterns of Hand Muscles in Left-and Right-Hand Dominant Individuals. J Hum Kinet 2021; 76:89-100. [PMID: 33603927 PMCID: PMC7877284 DOI: 10.2478/hukin-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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.
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