Ipsilateral motor activation during unimanual and bimanual motor tasks

Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review

BACKGROUND

Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions.

METHOD

An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles.

RESULTS

Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period.

CONCLUSION

Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.

Modulation of ipsilateral motor evoked potentials during bimanual coordination tasks

Introduction

Ipsilateral motor evoked potentials (iMEPs) are difficult to obtain in distal upper limb muscles of healthy participants but give a direct insight into the role of ipsilateral motor control.

Methods

We tested a new high-intensity double pulse transcranial magnetic stimulation (TMS) protocol to elicit iMEPs in wrist extensor and flexor muscles during four different bimanual movements (cooperative-asymmetric, cooperative-symmetric, non-cooperative-asymmetric and non-cooperative-symmetric) in 16 participants.

Results

Nine participants showed an iMEP in the wrist extensor in at least 20% of the trials in each of the conditions and were classified as iMEP+ participants. iMEP persistence was greater for cooperative (50.5 ± 28.8%) compared to non-cooperative (31.6 ± 22.1%) tasks but did not differ between asymmetric and symmetric tasks. Area and amplitude of iMEPs were also increased during cooperative (area = 5.41 ± 3.4 mV × ms; amplitude = 1.60 ± 1.09 mV) compared to non-cooperative (area = 3.89 ± 2.0 mV × ms; amplitude = 1.12 ± 0.56 mV) tasks and unaffected by task-symmetry.

Discussion

The upregulation of iMEPs during common-goal cooperative tasks shows a functional relevance of ipsilateral motor control in bimanual movements. The paired-pulse TMS protocol is a reliable method to elicit iMEPs in healthy participants and can give new information about neural control of upper limb movements. With this work we contribute to the research field in two main aspects. First, we describe a reliable method to elicit ipsilateral motor evoked potentials in healthy participants which will be useful in further advancing research in the area of upper limb movements. Second, we add new insight into the motor control of bimanual movements. We were able to show an upregulation of bilateral control represented by increased ipsilateral motor evoked potentials in cooperative, object-oriented movements compared to separate bimanual tasks. This result might also have an impact on neurorehabilitation after stroke.

Motor-Related Mu/Beta Rhythm in Older Adults: A Comprehensive Review

Mu rhythm, also known as the mu wave, occurs on sensorimotor cortex activity at rest, and the frequency range is defined as 8-13Hz, the same frequency as the alpha band. Mu rhythm is a cortical oscillation that can be recorded from the scalp over the primary sensorimotor cortex by electroencephalogram (EEG) and magnetoencephalography (MEG). The subjects of previous mu/beta rhythm studies ranged widely from infants to young and older adults. Furthermore, these subjects were not only healthy people but also patients with various neurological and psychiatric diseases. However, very few studies have referred to the effect of mu/beta rhythm with aging, and there was no literature review about this theme. It is important to review the details of the characteristics of mu/beta rhythm activity in older adults compared with young adults, focusing on age-related mu rhythm changes. By comprehensive review, we found that, compared with young adults, older adults showed mu/beta activity change in four characteristics during voluntary movement, increased event-related desynchronization (ERD), earlier beginning and later end, symmetric pattern of ERD and increased recruitment of cortical areas, and substantially reduced beta event-related desynchronization (ERS). It was also found that mu/beta rhythm patterns of action observation were changing with aging. Future work is needed in order to investigate not only the localization but also the network of mu/beta rhythm in older adults.

Comparison of Electroencephalogram Power Spectrum Characteristics of Left and Right Dragon Boat Athletes after 1 km of Rowing

Purpose: This study aimed to detect differences in post-exercise brain activity between the left and right paddlers due to exercise by analyzing the resting-state electroencephalogram (EEG) power spectrum before and after exercise. Methods: Twenty-one right paddlers and twenty-two left paddlers completed a 1 km all-out test on a dragon boat ergometer, and their heart rate and exercise time were recorded. EEG signals were collected from superficial brain layers before and after exercise; then, the EEG power spectrum was extracted and compared in different frequency bands. In addition, the degree of lateralization in each brain region was assessed by the asymmetry index. Results: There was no significant difference in the power spectrum values and asymmetry indices between the left and right paddlers before rowing (p ˃ 0.05). However, after rowing, the left-paddlers group had significantly higher spectral power values in θ and α bands than the right-paddlers group (p < 0.05), and brain lateralization in both groups of athletes occurred mainly in the ipsilateral hemisphere of the frontal and central regions. Conclusion: The 1 km of rowing induced more brain activation in the left paddlers, and both left and right paddlers showed functional aggregation of hemispheric lateralization.

Left hemisphere dominance for bilateral kinematic encoding in the human brain

Neurophysiological studies in humans and nonhuman primates have revealed movement representations in both the contralateral and ipsilateral hemispheres. Inspired by clinical observations, we ask if this bilateral representation differs for the left and right hemispheres. Electrocorticography was recorded in human participants during an instructed-delay reaching task, with movements produced with either the contralateral or ipsilateral arm. Using a cross-validated kinematic encoding model, we found stronger bilateral encoding in the left hemisphere, an effect that was present during preparation and was amplified during execution. Consistent with this asymmetry, we also observed better across-arm generalization in the left hemisphere, indicating similar neural representations for right and left arm movements. Notably, these left hemisphere electrodes were centered over premotor and parietal regions. The more extensive bilateral encoding in the left hemisphere adds a new perspective to the pervasive neuropsychological finding that the left hemisphere plays a dominant role in praxis.

Unimanual sensorimotor learning-A simultaneous EEG-fMRI aging study

Sensorimotor coordination requires orchestrated network activity in the brain, mediated by inter‐ and intra‐hemispheric interactions that may be affected by aging‐related changes. We adopted a theoretical model, according to which intra‐hemispheric inhibition from premotor to primary motor cortex is mandatory to compensate for inter‐hemispheric excitation through the corpus callosum. To test this as a function of age we acquired electroencephalography (EEG) simultaneously with functional magnetic resonance imaging (fMRI) in two groups of healthy adults (younger N = 13: 20–25 year and older N = 14: 59–70 year) while learning a unimanual motor task. On average, quality of performance of older participants stayed significantly below that of the younger ones. Accompanying decreases in motor‐event‐related EEG β‐activity were lateralized toward contralateral motor regions, albeit more so in younger participants. In this younger group, the mean β‐power during motor task execution was significantly higher in bilateral premotor areas compared to the older adults. In both groups, fMRI blood oxygen level dependent (BOLD) signals were positively correlated with source‐reconstructed β‐amplitudes: positive in primary motor and negative in premotor cortex. This suggests that β‐amplitude modulation is associated with primary motor cortex “activation” (positive BOLD response) and premotor “deactivation” (negative BOLD response). Although the latter results did not discriminate between age groups, they underscore that enhanced modulation in primary motor cortex may be explained by a β‐associated excitatory crosstalk between hemispheres.

Anodal tDCS accelerates on-line learning of dart throwing

Transcranial direct current stimulation (tDCS) has been shown to enhance or block online learning of motor skills, depending on the current direction. However, most research on the use of tDCS has been limited to the study of relatively simple motor tasks. The purpose of the present study was to examine the influence of anodal (a-tDCS) and cathodal (c-tDCS) direct current stimulation on the online learning during a single session of dart throwing. Fifty-eight young adults were randomized to a-tDCS, c-tDCS, or SHAM groups and completed a pre-test block of dart throws, a 20-minute practice block of throws while receiving their stimulation condition, and a post-test block of dart throws. The results showed that a-tDCS accelerated the skill learning of dart throwing more than SHAM and c-tDCS conditions. The SHAM and c-tDCS conditions were not different. We conclude that a-tDCS may have a positive effect in a single training session which would be ideal in a recreational game environment where repeated practice is not common.

Behavioural and cerebral asymmetries of mirror movements are specific to rhythmic task and related to higher attentional and executive control

Mirror movements (MM) refer to the involuntary movements or contractions occurring in homologous muscles contralateral to the unilateral voluntary movements. This behavioural manifestation increases in elderly. In right-handed adults, some studies report asymmetry in MM production, with greater MM in the right dominant hand during voluntary movements of the left non-dominant hand than the opposite. However, other studies report contradictory results, suggesting that MM asymmetry could depend on the characteristics of the task. The present study investigates the behavioural asymmetry of MM and its associated cerebral correlates during a rhythmic task and a non-rhythmic task using low-force contractions (i.e., 25 % MVC). We determined the quantity and the intensity of MM using electromyography (EMG) and cerebral correlates through electroencephalography (EEG) in right-handed healthy young and middle-aged adults during unimanual rhythmic vs. non-rhythmic tasks. Overall, results revealed (1) behavioural asymmetry of MM specific to the rhythmic task and irrespective of age, (2) cerebral asymmetry of motor activations specific to the rhythmic task and irrespective of age and (3) greater attentional and executive activations in the rhythmic task compared to the non-rhythmic task. In line with our hypotheses, behavioural and cerebral motor asymmetries of MM seem to be specific to the rhythmic task. Results are discussed in terms of cognitive-motor interactions: greater attentional and executive control required in the rhythmic tasks could contribute to the increased occurrence of involuntary movements in both young and middle-aged adults.

Role of the Ipsilateral Primary Motor Cortex in the Visuo-Motor Network During Fine Contractions and Accurate Performance

It is widely recognized that continuous sensory feedback plays a crucial role in accurate motor control in everyday life. Feedback information is used to adapt force output and to correct errors. While primary motor cortex contralateral to the movement (cM1) plays a dominant role in this control, converging evidence supports the idea that ipsilateral primary motor cortex (iM1) also directly contributes to hand and finger movements. Similarly, when visual feedback is available, primary visual cortex (V1) and its interactions with the motor network also become important for accurate motor performance. To elucidate this issue, we performed and integrated behavioral and electroencephalography (EEG) measurements during isometric compression of a compliant rubber bulb, at 10% and 30% of maximum voluntary contraction, both with and without visual feedback. We used a semi-blind approach (functional source separation (FSS)) to identify separate functional sources of mu-frequency (8-13[Formula: see text]Hz) EEG responses in cM1, iM1 and V1. Here for the first time, we have used orthogonal FSS to extract multiple sources, by using the same functional constraint, providing the ability to extract different sources that oscillate in the same frequency range but that have different topographic distributions. We analyzed the single-trial timecourses of mu power event-related desynchronization (ERD) in these sources and linked them with force measurements to understand which aspects are most important for good task performance. Whilst the amplitude of mu power was not related to contraction force in any of the sources, it was able to provide information on performance quality. We observed stronger ERDs in both contralateral and ipsilateral motor sources during trials where contraction force was most consistently maintained. This effect was most prominent in the ipsilateral source, suggesting the importance of iM1 to accurate performance. This ERD effect was sustained throughout the duration of visual feedback trials, but only present at the start of no feedback trials, consistent with more variable performance in the absence of feedback. Overall, we found that the behavior of the ERD in iM1 was the most informative aspect concerning the accuracy of the contraction performance, and the ability to maintain a steady level of contraction. This new approach of using FSS to extract multiple orthogonal sources provides the ability to investigate both contralateral and ipsilateral nodes of the motor network without the need for additional information (e.g. electromyography). The enhanced signal-to-noise ratio provided by FSS opens the possibility of extracting complex EEG features on an individual trial basis, which is crucial for a more nuanced understanding of fine motor performance, as well as for applications in brain-computer interfacing.

Excitability of the Ipsilateral Primary Motor Cortex During Unilateral Goal-Directed Movement

Introduction

Previous transcranial magnetic stimulation (TMS) studies have revealed that the activity of the primary motor cortex ipsilateral to an active hand (ipsi-M1) plays an important role in motor control. The aim of this study was to investigate whether the ipsi-M1 excitability would be influenced by goal-directed movement and laterality during unilateral finger movements.

Method

Ten healthy right-handed subjects performed four finger tapping tasks with the index finger: (1) simple tapping (Tap) task, (2) Real-word task, (3) Pseudoword task, and (4) Visually guided tapping (VT) task. In the Tap task, the subject performed self-paced simple tapping on a touch screen. In the real-word task, the subject tapped letters displayed on the screen one by one to create a Real-word (e.g., apple). Because the action had a specific purpose (i.e., creating a word), this task was considered to be goal-directed as compared to the Tap task. In the Pseudoword task, the subject tapped the letters to create a pseudoword (e.g., gdiok) in the same manner as in the Real-word task; however, the word was less meaningful. In the VT task, the subject was required to touch a series of illuminated buttons. This task was considered to be less goal-directed than the Pseudoword task. The tasks were performed with the right and left hand, and a rest condition was added as control. Single- and paired-pulse TMS were applied to the ipsi-M1 to measure corticospinal excitability and short- and long-interval intracortical inhibition (SICI and LICI) in the resting first dorsal interosseous (FDI) muscle.

Results

We found the smaller SICI in the ipsi-M1 during the VT task compared with the resting condition. Further, both SICI and LICI were smaller in the right than in the left M1, regardless of the task conditions.

Discussion

We found that SICI in the ipsi-M1 is smaller during visual illumination-guided finger movement than during the resting condition. Our finding provides basic data for designing a rehabilitation program that modulates the M1 ipsilateral to the moving limb, for example, for post-stroke patients with severe hemiparesis.

BDNF Val66Met polymorphism is associated with altered activity-dependent modulation of short-interval intracortical inhibition in bilateral M1

The BDNF Val66Met polymorphism is associated with impaired short-term plasticity in the motor cortex, short-term motor learning, and intermanual transfer of a procedural motor skill. Here, we investigated the impact of the Val66Met polymorphism on the modulation of cortical excitability and interhemispheric inhibition through sensorimotor practice of simple dynamic skills with the right and left first dorsal interosseous (FDI) muscles. To that end, we compared motor evoked potentials (MEP) amplitudes and short-interval intracortical inhibition (SICI) in the bilateral representations of the FDI muscle in the primary motor cortex (M1), and interhemispheric inhibition (IHI) from the left to right M1, before and after right and left FDI muscle training in an alternated sequence. Val66Met participants did not differ from their Val66Val counterparts on motor performance at baseline and following motor training, or on measures of MEP amplitude and IHI. However, while the Val66Val group displayed significant SICI reduction in the bilateral M1 in response to motor training, SICI remained unchanged in the Val66Met group. Further, Val66Val group's SICI decrease in the left M1, which was also observed following unimanual training with the right hand in the Control Right group, was correlated with motor improvement with the left hand. The potential interaction between left and right M1 activity during bimanual training and the implications of altered activity-dependent cortical excitability on short-term motor learning in Val66Met carriers are discussed.

Action Video Game Playing Is Reflected In Enhanced Visuomotor Performance and Increased Corticospinal Excitability

Action video game playing is associated with improved visuomotor performance; however, the underlying neural mechanisms associated with this increased performance are not well understood. Using the Serial Reaction Time Task in conjunction with Transcranial Magnetic Stimulation, we investigated if improved visuomotor performance displayed in action video game players (actionVGPs) was associated with increased corticospinal plasticity in primary motor cortex (M1) compared to non-video game players (nonVGPs). Further, we assessed if actionVGPs and nonVGPs displayed differences in procedural motor learning as measured by the SRTT. We found that at the behavioral level, both the actionVGPs and nonVGPs showed evidence of procedural learning with no significant difference between groups. However, the actionVGPs displayed higher visuomotor performance as evidenced by faster reaction times in the SRTT. This observed enhancement in visuomotor performance amongst actionVGPs was associated with increased corticospinal plasticity in M1, as measured by corticospinal excitability changes pre- and post- SRTT and corticospinal excitability at rest before motor practice. Our results show that aVGPs, who are known to have better performance on visual and motor tasks, also display increased corticospinal excitability after completing a novel visuomotor task.

Lateralized motor control processes determine asymmetry of interlimb transfer

This experiment tested the hypothesis that interlimb transfer of motor performance depends on recruitment of motor control processes that are specialized to the hemisphere contralateral to the arm that is initially trained. Right-handed participants performed a single-joint task, in which reaches were targeted to 4 different distances. While the speed and accuracy was similar for both hands, the underlying control mechanisms used to vary movement speed with distance were systematically different between the arms: the amplitude of the initial acceleration profiles scaled greater with movement speed for the right-dominant arm, while the duration of the initial acceleration profile scaled greater with movement speed for the left-non-dominant arm. These two processes were previously shown to be differentially disrupted by left and right hemisphere damage, respectively. We now hypothesize that task practice with the right arm might reinforce left-hemisphere mechanisms that vary acceleration amplitude with distance, while practice with the left arm might reinforce right-hemisphere mechanisms that vary acceleration duration with distance. We thus predict that following right arm practice, the left arm should show increased contributions of acceleration amplitude to peak velocities, and following left arm practice, the right arm should show increased contributions of acceleration duration to peak velocities. Our findings support these predictions, indicating that asymmetry in interlimb transfer of motor performance, at least in the task used here, depends on recruitment of lateralized motor control processes.

Effects of dopaminergic treatment on functional cortico-cortical connectivity in Parkinson's disease

Interactions between dorsal premotor cortex (PMd) and primary motor cortex (M1) and interhemispheric inhibition (IHI) between M1 are impaired in Parkinson's disease (PD). We used dual-site transcranial magnetic stimulation to compare effects of first-time levodopa application with chronic dopaminergic therapy on these interactions in PD. Twelve untreated PD patients were studied before and after their first-ever intake of levodopa. The effects of chronic dopaminergic medication were evaluated in 11 patients who had received regular dopaminergic medication for approximately 3 years. Nine of these patients were also measured after overnight withdrawal of medication. For IHI, conditioning stimuli (CS) were applied to left M1 followed by test stimuli (TS) over right M1 and vice versa in separate blocks at interstimulus intervals (ISI) of 6-10 ms. Next, CS were applied to left PMd at subthreshold intensity followed by TS over left M1 at ISIs of 4 and 6 ms. Results were compared to 17 age- and gender-matched controls. In de novo PD patients, levodopa reduced left-to-right IHI, but did not alter PMd-M1 connectivity. In contrast, inhibitory PMd-M1 connectivity was present in early disease patients under chronic dopaminergic stimulation, but not in de novo PD patients at low stimulus intensities at an ISI of 4 ms. First-time exposure to levodopa exerts different effects on cortico-cortical pathways than chronic dopaminergic stimulation in PD, suggesting a change in the responsiveness of cortico-cortical circuits during the course of PD.

BDNF Val66Met polymorphism is associated with abnormal interhemispheric transfer of a newly acquired motor skill

Recent data suggest that the Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene can alter cortical plasticity within the motor cortex of carriers, which exhibits abnormally low rates of cortical reorganization after repetitive motor tasks. To verify whether long-term retention of a motor skill is also modulated by the presence of the polymorphism, 20 participants (10 Val66Val, 10 Val66Met) were tested twice at a 1-wk interval. During each visit, excitability of the motor cortex was measured by transcranial magnetic stimulations (TMS) before and after performance of a procedural motor learning task (serial reaction time task) designed to study sequence-specific learning of the right hand and sequence-specific transfer from the right to the left hand. Behavioral results showed a motor learning effect that persisted for at least a week and task-related increases in corticospinal excitability identical for both sessions and without distinction for genetic group. Sequence-specific transfer of the motor skill from the right hand to the left hand was greater in session 2 than in session 1 only in the Val66Met genetic group. Further analysis revealed that the sequence-specific transfer occurred equally at both sessions in the Val66Val genotype group. In the Val66Met genotype group, sequence-specific transfer did not occur at session 1 but did at session 2. These data suggest a limited impact of Val66Met polymorphism on the learning and retention of a complex motor skill and its associated changes in corticospinal excitability over time, and a possible modulation of the interhemispheric transfer of procedural learning.

Hemispheric asymmetry of ipsilateral motor cortex activation in motor skill learning

In this study, we investigated how ipsilateral motor cortex (M1) activation during unimanual hand movements and hemispheric asymmetry changed after motor skill learning. Eleven right-handed participants preformed a two-ball-rotation motor task with the right and the left hand, separately, in all experimental sessions. Before and after exercise sessions, the degree of ipsilateral M1 activation during brief execution of the motor task was measured as changes in the size of motor-evoked potentials (MEPs) of the thenar and the first dorsal interosseous muscle of the nontask hand using transcranial magnetic stimulation. Before exercise, MEPs of the nontask hand were significantly facilitated on both sides during the motor task. After exercise, facilitation of MEPs of the nontask hand during the motor task was significantly reduced for the right hand (thenar: P=0.014, first dorsal interosseous: P=0.022) but not for the left hand. We conclude that ipsilateral M1 activation, associated with a complex motor task, is first symmetrical in both hemispheres. However, on exercise, ipsilateral activation is reduced only in left M1, indicating a stronger learning-dependent modification of motor networks within the left hemisphere.

Callosal disconnection and limb-kinetic apraxia

According to Liepmann, patients with limb-kinetic apraxia (LKA) have a loss of upper limb deftness-dexterity. Prior studies have revealed in right-handed patients that, whereas injury of the left hemisphere induces an ipsilesional LKA, injury to the right hemisphere does not induce an ipsilesional LKA. There are at least two possible means by which the left hemisphere may influence the deftness of the left hand, either by callosal connections or by ipsilesional corticospinal projections. The purpose of this study was to learn whether a patient with a focal lesion of the corpus callosum had a callosal disconnection LKA. This 57-year-old right-handed man had a memory impairment, and upon brain imaging, was found to have a septum pellucidum cyst, which was causing mild ventricular obstruction to the occipital and temporal horns. He underwent an endoscopic-assisted fenestration of the septum pellucidum. Postoperative imaging revealed a lesion of the mesial portion of his corpus callosum and an assessment of praxis revealed that he had both a limb-kinetic and ideomotor apraxia of his left but not his right hand. The observation that this man had a callosal disconnection LKA of his left hand suggests that in some people it is the left hemisphere's premotor or motor cortex that enables the right hemisphere's motor system to program deft movements of the left hand.

Characterizing the developmental profile of effort-induced motor overflow across a timed trial

Motor overflow is overt involuntary movement that accompanies voluntary movement. This study investigated the change in overflow production across a timed trial and the factors that affected this profile. Seventeen children (aged 8-11 years), 17 young adults (aged 18-35 years), and 17 older adults (aged 60-80 years) performed a 5-s finger pressing task by exerting 33% or 66% of their maximal force output using either index finger. Overflow was recorded as force from the alternative index finger. Young adult overflow remained stable over the 5 s. The rate of overflow increase over time was significantly greater for children than young adults. There was also a tendency for a greater overflow increase in older adults than in young adults. This overflow gradient was also greater in the right hand, particularly for children. These findings indicate that the neurological processes underlying overflow production are age dependent. Overflow progressed in a dynamic fashion over the course of a trial in children and older adults, probably because of increased bilateral cortical activation and the facilitation of motor task performance. This study is unique in quantitatively capturing the dynamic profile of overflow production in healthy participants across the life span.

Apraxia

Humans need to perform skilled movements to successfully interact with their environment as well as take care of themselves and others. These important skilled purposeful actions are primarily performed by the forelimb, and the loss of these skills is called apraxia. This review describes the means of testing, the pathophysiology, and the clinical characteristics that define five different general forms of forelimb apraxia including: (1) ideational apraxia, an inability to correctly sequence a series of acts leading to a goal; (2) conceptual apraxia, a loss of mechanical tool knowledge; (3) ideomotor apraxia, a loss of the knowledge of how when making transitive and intransitive movements to correctly posture and move the forelimb in space; (4) dissociation apraxia, a modality-specific deficit in eliciting learned skilled acts; and (5) limb-kinetic apraxia, a loss of hand-finger deftness.

Changes in interhemispheric inhibition from active to resting primary motor cortex during a fine-motor manipulation task

The effect of performance of a sensorimotor task on the interhemispheric inhibition (IHI) induced from the active primary motor cortex (M1) to the resting M1 was examined in 10 right-handed subjects. Transcranial magnetic stimulation (TMS) was performed to produce motor evoked potentials (MEP) in the resting right (Rt)-first dorsal interosseous (FDI). For the paired-TMS paradigm, a conditioning stimulus (CS) was delivered to the Rt-M1, and its intensity was adjusted from 0.6 to 1.4 times the resting motor threshold of the MEP in the left (Lt)-FDI in 0.2 steps. The test stimulus was delivered to the Lt-M1, and its intensity was adjusted to evoke similar MEP amplitudes in the Rt-FDI among the task conditions. The interstimulus interval was fixed at 10 ms. As a sensorimotor task, a fine-motor manipulation (FM) task (using chopsticks to pick up, transport, and release glass balls) was adopted. In addition, an isometric abduction (IA) task was also performed as a control task. These tasks were carried out with the left hand. The IHI from the active to the resting M1 observed during the FM task was markedly increased compared with that induced during the IA task, and this effect was not dependent on the MEP amplitude evoked in the active Lt-FDI by the CS. The present findings suggest that the increased IHI from the active to the resting M1 observed during the FM task was linked to reductions in the activity of the ipsilateral intracortical inhibitory circuit, as we reported previously.

The right inhibition? Callosal correlates of hand performance in healthy children and adolescents callosal correlates of hand performance

Numerous studies suggest that interhemispheric inhibition-relayed via the corpus callosum-plays an important role in unilateral hand motions. Interestingly, transcallosal inhibition appears to be indicative of a strong laterality effect, where generally the dominant hemisphere exerts inhibition on the nondominant one. These effects have been largely identified through functional studies in adult populations, but links between motor performance and callosal structure (especially during sensitive periods of neurodevelopment) remain largely unknown. We therefore investigated correlations between Purdue Pegboard performance (a test of motor function) and local callosal thickness in 170 right-handed children and adolescents (mean age: 11.5 ± 3.4 years; range, 6-17 years). Better task performance with the right (dominant) hand was associated with greater callosal thickness in isthmus and posterior midbody. Task performance using both hands yielded smaller and less significant correlations in the same regions, while task performance using the left (nondominant) hand showed no significant correlations with callosal thickness. There were no significant interactions with age and sex. These links between motor performance and callosal structure may constitute the neural correlate of interhemispheric inhibition, which is thought to be necessary for fast and complex unilateral motions and to be biased towards the dominant hand.

The activity of the primary motor cortex ipsilateral to the exercising hand decreases during repetitive handgrip exercise

The brain function controlling muscle force production is not yet fully understood. The purpose of this study was to examine bilateral primary motor cortex (M1) oxygenation during static-handgrip exercises performed with the right hand (60% maximal voluntary contraction; 10 s exercise/75 s rest; five sets). Twelve healthy, right-handed male subjects participated in this study. Near-infrared spectroscopy probes were positioned over the bilateral M1 to measure cortical oxygenation during handgrip exercises. The maximum values of the changes in concentrations of oxyhemoglobin (HbO(2)) and deoxyhemoglobin (Hb) across the trials (i) did not change significantly during the contralateral M1 activation (p > 0.05), whereas (ii) in the case of the ipsilateral M1 activation a significant (p < 0.05) decrease in HbO(2) and a significant (p < 0.01) decrease in Hb could be measured. The activation in ipsilateral M1 at the fifth trial was significantly decreased compared with that in the first trial (HbO(2): p < 0.001; Hb: p < 0.001). The present results suggest that the ipsilateral M1 is recruited during the motor task in compensation for the contralateral M1 and the habituation to motor task might alter the efficiency for interaction of the ipsilateral M1 to the contralateral M1. The interhemispheric interaction might change due to habituation to motor task.

Probing for hemispheric specialization for motor skill learning: a transcranial direct current stimulation study

Convergent findings point to a left-sided specialization for the representation of learned actions in right-handed humans, but it is unknown whether analogous hemispheric specialization exists for motor skill learning. In the present study, we explored this question by comparing the effects of anodal transcranial direct current stimulation (tDCS) over either left or right motor cortex (M1) on motor skill learning in either hand, using a tDCS montage to better isolate stimulation to one hemisphere. Results were compared with those previously found with a montage more commonly used in the field. Six groups trained for three sessions on a visually guided sequential pinch force modulation task with their right or left hand and received right M1, left M1, or sham tDCS. A linear mixed-model analysis for motor skill showed a significant main effect for stimulation group (left M1, right M1, sham) but not for hand (right, left) or their interaction. Left M1 tDCS induced significantly greater skill learning than sham when hand data were combined, a result consistent not only with the hypothesized left hemisphere specialization for motor skill learning but also with possible increased left M1 responsiveness to tDCS. The unihemispheric montage effect size was one-half that of the more common montage, and subsequent power analysis indicated that 75 subjects per group would be needed to detect differences seen with only 12 subjects with the customary bihemispheric montage.

Enhanced left-finger deftness following dominant upper- and lower-limb amputation

BACKGROUND

After amputation, the sensorimotor cortex reorganizes, and these alterations might influence motor functions of the remaining extremities.

OBJECTIVE

The authors examined how amputation of the dominant or nondominant upper or lower extremity alters deftness in the intact limbs.

METHODS

The participants were 32 unilateral upper- or lower-extremity amputees and 6 controls. Upper-extremity deftness was tested by coin rotation (finger deftness) and pegboard (arm, hand, and finger deftness) tasks.

RESULTS

Following right-upper- or right-lower-extremity amputation, the left hand's finger movements were defter than the left-hand fingers of controls. In contrast, with left-upper- or left-lower-extremity amputation, the right hand's finger performance was the same as that of the controls.

CONCLUSIONS

Although this improvement might be related to increased use (practice), the finding that right-lower-extremity amputation also improved the left hand's finger deftness suggests an alternative mechanism. Perhaps in right-handed persons the left motor cortex inhibits the right side of the body more than the right motor cortex inhibits the left side, and the physiological changes induced by right-sided amputation reduced this inhibition.

Handedness, dexterity, and motor cortical representations

Motor system organization varies with handedness. However, previous work has focused almost exclusively on direction of handedness (right or left) as opposed to degree of handedness (strength). In the present study, we determined whether measures of interhemispheric interactions and degree of handedness are related to contra- and ipsilateral motor cortical representations. Participants completed a battery of handedness assessments including both handedness preference measures and behavioral measures of intermanual differences in dexterity, a computerized version of the Poffenberger paradigm (PP) to estimate interhemispheric transfer time (IHTT), and they underwent transcranial magnetic stimulation (TMS) mapping of both motor cortices while we recorded muscle activity from the first dorsal interosseous muscle bilaterally. A greater number of ipsilateral motor evoked potentials (iMEPs) were elicited in less lateralized individuals with the number of iMEPs correlated with IHTT. There were no relationships between handedness or lateralization of dexterity and symmetry of contralateral motor representations, although this symmetry was related to IHTT. Finally, IHTT was positively correlated with multiple measures of laterality and handedness. These findings demonstrate that degree of laterality of dexterity is related to the propensity for exhibiting iMEPs and the speed of interhemispheric interactions. However, it is not clear whether iMEPs are directly mediated via ipsilateral corticospinal projections or are transcallosally transmitted.

Effects of unilateral voluntary movement on motor imagery of the contralateral limb

OBJECTIVE

To investigate whether unilateral voluntary movement affects voluntary drive of motor imagery for the contralateral limb.

METHODS

The subjects were asked to maintain the left index-finger movements with different directions (abduction and adduction, 5% of maximum voluntary contraction; MVC) and with different force levels (10% and 25% MVC). Under these conditions, transcranial magnetic stimulation was applied over the left motor cortex to record motor evoked potential (MEP) from the right first dorsal interosseous muscle with or without motor imagery of the right index-finger abduction.

RESULTS

Voluntary movement of the left index finger with isodirection, but not mirrored direction, to the imagined movement reduced the MEP enhancement induced by motor imagery. MEP was gradually increased depending on increment of the force level on the left side, while the motor imagery-induced MEP enhancement was consequently reduced.

CONCLUSIONS

Enhancement of the motor cortex excitability driven by motor imagery of the contralateral limb is interfered with by isodirection and forceful movement of the ipsilateral limb, which may be due to an increase in the transcallosal inhibitory effects.

SIGNIFICANCE

Using motor imagery as a therapeutic tool, the voluntary movements on the other side of the body should be taken into account.

Hemispheric asymmetries of motor versus nonmotor processes during (visuo)motor control

Language and certain aspects of motor control are typically served by the left hemisphere, whereas visuospatial and attentional control are lateralized to the right. Here a (visuo)motor tracing task was used to identify hemispheric lateralization beyond the general, contralateral organization of the motor system. Functional magnetic resonance imaging (fMRI) was applied in 40 male right-handers (19-30 yrs) during line tracing with dominant and nondominant hand, with and without visual guidance. Results revealed a network of areas activating more in the right than left hemisphere, irrespective of the effector. Inferior portions of frontal gyrus and parietal lobe overlapped largely with a previously described ventral attention network responding to unexpected or behaviourally relevant stimuli. This demonstrates a hitherto unreported functionality of this circuit that also seems to activate when spatial information is continuously exploited to adapt motor behaviour. Second, activation of left dorsal premotor and postcentral regions during tracing with the nondominant left hand was more pronounced than that in their right hemisphere homologues during tracing with the dominant right hand. These activation asymmetries of motor areas ipsilateral to the moving hand could not be explained by asymmetries in skill performance, the degree of handedness, or interhemispheric interactions. The latter was measured by a double-pulse transcranial magnetic stimulation paradigm, whereby a conditioning stimulus was applied over one hemisphere and a test stimulus over the other. We propose that the left premotor areas contain action representations strongly related to movement implementation which are also accessed during movements performed with the left body side.

Age effects on the asymmetry of the motor system: evidence from cortical oscillatory activity

Functional hemispheric asymmetry can be lost with aging. In this electroencephalographic study, we assessed hemispheric asymmetries in regulating motor responses by analyzing oscillatory brain activity during a go/nogo task in younger and older right-handed participants. Three conditions were embedded in the task: go, high-conflict and low-conflict nogo. The hand used to respond to go stimuli was varied block-wise. Independently of the go/nogo conditions and responding hand, young participants showed asymmetric desynchronizations in the mu (10 Hz) and beta (18-22 Hz) frequency bands that was stronger in the scalp sensorimotor region contralateral to the hand used for the go responses, while older adults showed a more symmetric pattern of desynchronization. These findings indicate that a loss of hemispheric asymmetry is a hallmark of the aging motor system, consistent with a decline of inter-hemispheric motor inhibition in normal aging.

Spectral changes of interhemispheric crosstalk during movement instabilities

Bimanual coordination requires the functional integration of the activity in various cortical, subcortical, spinal, and peripheral neural structures. We challenged this functional integration by destabilizing bimanual 5:8 tapping through an increase in movement tempo, while measuring brain and muscle activity using magnetoencephalography and electromyography. Movement instabilities were characterized by a drop in frequency locking. Time-frequency analysis revealed movement-related beta amplitude modulation in bilateral motor areas as well as movement-related corticospinal entrainment. Both of these synchronization patterns depended on movement tempo suggesting that the timescale needed for the upregulation and downregulation of beta synchrony in rhythmic tapping poses constraints on motor performance. Bilateral phase locking over movement cycles appeared to be mediated by beta-frequency oscillations and constrained by its phase dynamics. The timescale of beta synchrony thus seems to play a key role in achieving timed phase synchrony in the motor cortex and along the neural axis. Once event-related desynchronization-synchronization cycles cannot be build up properly, inhibition may become inadequate, resulting in a reduction of the stability of performance, which may eventually become unstable.

Cognitive disturbances in primary blepharospasm

The common belief that primary dystonia is a purely motor disorder with no anatomical substrate and no other accompanying neurological dysfunction has recently been challenged. In addition, there is increasing evidence that the basal ganglia besides motor control, plays a role in cognitive functioning. However, no systematic cognitive performance evaluation has been carried out in patients with primary blepharospasm (BS), one of the most common forms of adult dystonia. We evaluated a series of 20 patients with primary BS and a group of 17 controls matched by severity of mood symptoms, age, and sex. BS patients performed significantly worse on the Luria sequencing test, Purdue pegboard test, reciprocal coordination, tactile denomination, and reverse visuospatial span and the differences persisted after correction for age, duration of disease, severity of BS, and degree of depression. The Wisconsin card sorting test showed no statistical difference, but BS patients made more errors and more perseverative answers than expected according to population means, whereas the control group performed poorly but within normal parameters. Our findings suggest broad cortical involvement in focal dystonia that is not correlated with the severity or duration of dystonia.

Low frequency (0.5Hz) rTMS over the right (non-dominant) motor cortex does not affect ipsilateral hand performance in healthy humans

Reduction of excitability of the dominant primary motor cortex (M1) improves ipsilateral hand function in healthy subjects. In analogy, inhibition of non-dominant M1 should also improve ipsilateral performance. In order to investigate this hypothesis, we have used slow repetitive transcranial magnetic stimulation (rTMS) and the Purdue Pegboard test. Twenty-eight volunteers underwent 10 minutes of either 0.5Hz rTMS over right M1 or sham rTMS (coil perpendicular to scalp). The motor task was performed before, immediately after, and 20 minutes after rTMS. In both groups, motor performance improved significantly throughout the sessions. rTMS inhibition of the non-dominant M1 had no significant influence over ipsilateral or contralateral manual dexterity, even though the results were limited by unequal performance between groups at baseline. This is in contrast to an improvement in left hand function previously described following slow rTMS over left M1, and suggests a less prominent physiological transcallosal inhibition from right to left M1.

Task complexity relates to activation of cortical motor areas during uni- and bimanual performance: a functional NIRS study

Hand motor tasks are frequently used to assess impaired motor function in neurology and neurorehabilitation. Assessments can be varied by means of hand laterality, i.e. unimanual or bimanual performance, as well as by means of task complexity, i.e. different degrees ranging from simple to complex sequence tasks. The resulting functional activation in human primary motor cortex (M1) has been studied intensively by traditional neuroimaging methods. Previous studies using functional near-infrared spectroscopy (fNIRS) investigated simple hand motor tasks. However, it is unknown whether fNIRS can also detect changes in response to increasing task complexity. Our hypothesis was to show that fNIRS could detect activation changes in relation to task complexity in uni- and bimanual tasks. Sixteen healthy right-handed subjects performed five finger-tapping tasks: unimanual left and right, simple and complex tasks as well as bimanual complex tasks. We found significant differences in oxy-hemoglobin (O(2)Hb) and deoxy-hemoglobin (HHb) concentration in the right hemisphere over M1. Largest O(2)Hb concentration changes were found during complex (0.351+/-0.051 micromol/l) and simple (0.275+/-0.054 micromol/l) right hand tasks followed by bimanual (0.249+/-0.047 micromol/l), complex (0.154+/-0.034 micromol/l) and simple (0.110+/-0.034 micromol/l) left hand tasks. Largest HHb concentration changes were found during bimanual (-0.138+/-0.006 micromol/l) tasks, followed by simple right hand (-0.12+/-0.016 micromol/l), complex left (-0.0875+/-0.007 micromol/l), complex right (-0.0863+/-0.005 micromol/l) and simple left (-0.0674+/-0.005 micromol/l) hand tasks. We report for the first time that fNIRS detects oxygenation changes in relation to task complexity during finger-tapping. The study aims to contribute to the establishment of fNIRS as a neuroimaging method to assess hand motor function in clinical settings where traditional neuroimaging methods cannot be applied.

Hemispheric asymmetry of frequency-dependent suppression in the ipsilateral primary motor cortex during finger movement: a functional magnetic resonance imaging study

Electrophysiological studies have suggested that the activity of the primary motor cortex (M1) during ipsilateral hand movement reflects both the ipsilateral innervation and the transcallosal inhibitory control from its counterpart in the opposite hemisphere, and that their asymmetry might cause hand dominancy. To examine the asymmetry of the involvement of the ipsilateral motor cortex during a unimanual motor task under frequency stress, we conducted block-design functional magnetic resonance imaging with 22 normal right-handed subjects. The task involved visually cued unimanual opponent finger movement at various rates. The contralateral M1 showed symmetric frequency-dependent activation. The ipsilateral M1 showed task-related deactivation at low frequencies without laterality. As the frequency of the left-hand movement increased, the left M1 showed a gradual decrease in the deactivation. This data suggests a frequency-dependent increased involvement of the left M1 in ipsilateral hand control. By contrast, the right M1 showed more prominent deactivation as the frequency of the right-hand movement increased. This suggests that there is an increased transcallosal inhibition from the left M1 to the right M1, which overwhelms the right M1 activation during ipsilateral hand movement. These results demonstrate the dominance of the left M1 in both ipsilateral innervation and transcallosal inhibition in right-handed individuals.

Human motor cortex oxygenation during exhaustive pinching task

There are few observations of the activity of the bilateral motor cortex during prolonged exhaustive motor tasks. Knowing how the motor cortex modulates muscle fatigue or how information about fatigue affects motor cortex activities in healthy humans may help explain why fatigue is so prevalent in patients with neurological disorders. The purpose of the present study was to investigate the time course of oxygenation of the bilateral motor cortex during an exhaustive pinching task. Eight healthy, right-handed subjects participated in the study. Near-infrared spectroscopy over the bilateral motor cortex was used to measure the activity throughout the pinching task. Subjects performed a sustained 50-60% of maximal voluntary contraction until voluntary exhaustion was reached. After the start of the motor task, the contralateral motor cortex oxygenation increased significantly compared with the resting value (P<0.05). However, with the passage of time, it decreased significantly compared with the resting value (P<0.05). In addition, ipsilateral motor cortex oxygenation decreased significantly at voluntary exhaustion compared with the resting value (P<0.05). These results suggest an interaction between the bilateral motor cortices during motor tasks.