Control of movements and temporal discounting of reward

A 6-minute protocol, combining mental imagery practices and breathing exercises, promotes hand-grip strength in firefighters: a series of "N-of-1" trials

BACKGROUND

To carry out their victim rescue and fire-fighting missions, firefighters perform high levels of physical exertion and among them strenuous muscular activity. A specific mental preparation protocol that could induce better strength performance throughout their 24-hour schedule is a major issue for firefighters.

OBJECTIVE

This case report aims to examine whether a 6-minute Intervention combining mental imagery practices and breathing exercises, specifically designed to be used while travelling between the fire station and the mission site, would be able to promote maximum strength performance.

METHODS

A series of three Single Case Experimental Designs (SCED) was conducted in single blind design to investigate the effects of repeated challenge-withdrawals between the Intervention and the Baseline on the maximum voluntary isometric contraction (MVIC) strength of the hand-grip.

RESULTS

Data analyses revealed that 62.5% to 100% of the hand-grip strength values during the Intervention periods were greater than or equal to the maximum data point recorded in the Baseline periods. The effect sizes of these highlighted increases of the hand-grip strength performance revealed by the percentage of non-overlapping data (PND) were 75% i.e., moderately effective on average.

CONCLUSIONS

Such a "psyching-up" practice before an upcoming muscular activity can promote muscular strength in firefighters. These results have led French firefighter departments to integrate the teaching of these practices into the initial instruction of firefighters, and remains to be confirmed by a randomised control trial.

Intermuscular coherence reveals that affective emotional pictures modulate neural control mechanisms during the initiation of arm pointing movements

Introduction

Several studies in psychology provided compelling evidence that emotions significantly impact motor control. Yet, these evidences mostly rely on behavioral investigations, whereas the underlying neurophysiological processes remain poorly understood.

Methods

Using a classical paradigm in motor control, we tested the impact of affective pictures associated with positive, negative or neutral valence on the kinematics and patterns of muscle activations of arm pointing movements performed from a standing position. The hand reaction and movement times were measured and electromyography (EMG) was used to measure the activities from 10 arm, leg and trunk muscles that are involved in the postural maintenance and arm displacement in pointing movements. Intermuscular coherence (IMC) between pairs of muscles was computed to measure changes in patterns of muscle activations related to the emotional stimuli.

Results

The hand movement time increased when an emotional picture perceived as unpleasant was presented as compared to when the emotional picture was perceived as pleasant. When an unpleasant emotional picture was presented, beta (β, 15-35 Hz) and gamma (γ, 35-60 Hz) IMC decreased in the recorded pairs of postural muscles during the initiation of pointing movements. Moreover, a linear relationship between the magnitude of the intermuscular coherence in the pairs of posturo-focal muscles and the hand movement time was found in the unpleasant scenarios.

Discussion

These findings reveal that emotional stimuli can significantly affect the content of the motor command sent by the central nervous system to muscles when performing voluntary goal-directed movements.

On the perception of movement vigour

It is common to get the impression that someone moves rather slowly or quickly in everyday life. In motor control, the natural pace of movement is captured by the concept of vigour, which is often quantified from the speed or duration of goal-directed actions. A common phenomenon, here referred to as the vigour law, is that preferred speed and duration idiosyncratically increase with the magnitude of the motion. According to the direct-matching hypothesis, this vigour law could thus underlie the judgement of someone else's movement vigour. We conducted a series of three experiments (N = 80) to test whether the vigour law also exists in perception and whether it is linked to that of action. In addition to measuring participants' vigour, we also asked them to judge the quickness of stimuli representing horizontal arm reaching movements varying through amplitudes, speeds, and durations. Results showed that speed and duration of movements perceived as neither fast nor slow (i.e., natural pace) increased with amplitude, thereby indicating that the vigour law holds when an observer judges the natural pace of others' movements. Results also revealed that this judgement was population-based (related to the average vigour of all participants) rather than individual-based (participant's own vigour).

The value of time in the invigoration of human movements when interacting with a robotic exoskeleton

Time and effort are thought to be subjectively balanced during the planning of goal-directed actions, thereby setting the vigor of volitional movements. Theoretical models predicted that the value of time should then amount to high levels of effort. However, the time-effort trade-off has so far only been studied for a narrow range of efforts. To investigate the extent to which humans can invest in a time-saving effort, we used a robotic exoskeleton to substantially vary the energetic cost associated with a certain vigor during reaching movements. In this situation, minimizing the time-effort trade-off should lead to high and low human efforts for upward and downward movements, respectively. Consistently, all participants expended substantial amounts of energy upward and remained essentially inactive by harnessing the work of gravity downward, while saving time in both cases. A common time-effort trade-off may therefore determine the vigor of reaching movements for a wide range of efforts.

Motor Decision-Making as a Common Denominator in Motor Pathology and a Possible Rehabilitation Target

Despite the substantial progress in motor rehabilitation, patient involvement and motivation remain major challenges. They are typically addressed with communicational and environmental strategies, as well as with improved goal-setting procedures. Here we suggest a new research direction and framework involving Neuroeconomics principles to investigate the role of Motor Decision-Making (MDM) parameters in motivational component and motor performance in rehabilitation. We argue that investigating NE principles could bring new approaches aimed at increasing active patient engagement in the rehabilitation process by introducing more movement choice, and adapting existing goal-setting procedures. We discuss possible MDM implementation strategies and illustrate possible research directions using examples of stroke and psychiatric disorders.

The effect of the preferred hand on drawing movement

The observation that different effectors can execute the same movement suggests functional equivalences driven by limb independent representation of action in the central nervous system. A common invariant motor behavior is the speed and curvature coupling (the 1/3 power law), a low dimensional (abstract) descriptor of movement which is resilient to different sensorimotor contexts. Our purpose is to verify the consistency of such motor equivalence during a drawing task, by testing the effect of manual dominance and movement speed on motor performance. We hypothesize that abstract kinematic variables are not the most resistant to speed or limb effector changes. The results show specific effects of speed and hand side on the drawing task. Movement duration, speed-curvature covariation, and maximum velocity were not significantly affected by hand side, while geometrical features were strongly speed and limb dependent. However, intra-trial analysis performed over the successive drawing movements reveals a significant hand side effect on the variability of movement vigor and velocity-curvature relationship (the 1/3 PL). The identified effects of speed and hand dominance on the kinematic parameters suggest different neural strategies, in a pattern that does not go from the most abstract to the least abstract component, as proposed by the traditional hierarchical organization of the motor plan.

A Trade-Off between Complexity and Interaction Quality for Upper Limb Exoskeleton Interfaces

Exoskeletons are among the most promising devices dedicated to assisting human movement during reeducation protocols and preventing musculoskeletal disorders at work. However, their potential is currently limited, partially because of a fundamental contradiction impacting their design. Indeed, increasing the interaction quality often requires the inclusion of passive degrees of freedom in the design of human-exoskeleton interfaces, which increases the exoskeleton's inertia and complexity. Thus, its control also becomes more complex, and unwanted interaction efforts can become important. In the present paper, we investigate the influence of two passive rotations in the forearm interface on sagittal plane reaching movements while keeping the arm interface unchanged (i.e., without passive degrees of freedom). Such a proposal represents a possible compromise between conflicting design constraints. The in-depth investigations carried out here in terms of interaction efforts, kinematics, electromyographic signals, and subjective feedback of participants all underscored the benefits of such a design. Therefore, the proposed compromise appears to be suitable for rehabilitation sessions, specific tasks at work, and future investigations into human movement using exoskeletons.

Modulation of Motor Vigor by Expectation of Reward Probability Trial-by-Trial Is Preserved in Healthy Ageing and Parkinson's Disease Patients

Motor improvements, such as faster movement times or increased velocity, have been associated with reward magnitude in deterministic contexts. Yet whether individual inferences on reward probability influence motor vigor dynamically remains undetermined. We investigated how dynamically inferring volatile action-reward contingencies modulated motor performance trial-by-trial. We conducted three studies that coupled a reversal learning paradigm with a motor sequence task and used a validated hierarchical Bayesian model to fit trial-by-trial data. In Study 1, we tested healthy younger [HYA; 37 (24 females)] and older adults [HOA; 37 (17 females)], and medicated Parkinson's disease (PD) patients [20 (7 females)]. We showed that stronger predictions about the tendency of the action-reward contingency led to faster performance tempo, commensurate with movement time, on a trial-by-trial basis without robustly modulating reaction time (RT). Using Bayesian linear mixed models, we demonstrated a similar invigoration effect on performance tempo in HYA, HOA, and PD, despite HOA and PD being slower than HYA. In Study 2 [HYA, 39 (29 females)], we additionally showed that retrospective subjective inference about credit assignment did not contribute to differences in motor vigor effects. Last, Study 3 [HYA, 33 (27 females)] revealed that explicit beliefs about the reward tendency (confidence ratings) modulated performance tempo trial-by-trial. Our study is the first to reveal that the dynamic updating of beliefs about volatile action-reward contingencies positively biases motor performance through faster tempo. We also provide robust evidence for a preserved sensitivity of motor vigor to inferences about the action-reward mapping in aging and medicated PD.SIGNIFICANCE STATEMENT Navigating a world rich in uncertainty relies on updating beliefs about the probability that our actions lead to reward. Here, we investigated how inferring the action-reward contingencies in a volatile environment modulated motor vigor trial-by-trial in healthy younger and older adults, and in Parkinson's disease (PD) patients on medication. We found an association between trial-by-trial predictions about the tendency of the action-reward contingency and performance tempo, with stronger expectations speeding the movement. We additionally provided evidence for a similar sensitivity of performance tempo to the strength of these predictions in all groups. Thus, dynamic beliefs about the changing relationship between actions and their outcome enhanced motor vigor. This positive bias was not compromised by age or Parkinson's disease.

The Cost of Imagined Actions in a Reward-Valuation Task

Growing evidence suggests that humans and other animals assign value to a stimulus based not only on its inherent rewarding properties, but also on the costs of the action required to obtain it, such as the cost of time. Here, we examined whether such cost also occurs for mentally simulated actions. Healthy volunteers indicated their subjective value for snack foods while the time to imagine performing the action to obtain the different stimuli was manipulated. In each trial, the picture of one food item and a home position connected through a path were displayed on a computer screen. The path could be either large or thin. Participants first rated the stimulus, and then imagined moving the mouse cursor along the path from the starting position to the food location. They reported the onset and offset of the imagined movements with a button press. Two main results emerged. First, imagery times were significantly longer for the thin than the large path. Second, participants liked significantly less the snack foods associated with the thin path (i.e., with longer imagery time), possibly because the passage of time strictly associated with action imagery discounts the value of the reward. Importantly, such effects were absent in a control group of participants who performed an identical valuation task, except that no action imagery was required. Our findings hint at the idea that imagined actions, like real actions, carry a cost that affects deeply how people assign value to the stimuli in their environment.

Evidence for a cost of time in the invigoration of isometric reaching movements

How the brain determines the vigor of goal-directed movements is a fundamental question in neuroscience. Recent evidence has suggested that vigor results from a trade-off between a cost related to movement production (cost of movement) and a cost related to our brain's tendency to temporally discount the value of future reward (cost of time). However, whether it is critical to hypothesize a cost of time to explain the vigor of basic reaching movements with intangible reward is unclear because the cost of movement may be theoretically sufficient for this purpose. Here we directly address this issue by designing an isometric reaching task whose completion can be accurate and effortless in prefixed durations. The cost of time hypothesis predicts that participants should be prone to spend energy to save time even if the task can be accomplished at virtually no motor cost. Accordingly, we found that all participants generated substantial amounts of force to invigorate task accomplishment, especially when the prefixed duration was long enough. Remarkably, the time saved by each participant was linked to their original vigor in the task and predicted by an optimal control model balancing out movement and time costs. Taken together, these results supports the existence of an idiosyncratic, cognitive cost of time that underlies the invigoration of basic isometric reaching movements.

Adaptive aspects of impulsivity and interactions with effects of catecholaminergic agents in the 5-choice serial reaction time task: implications for ADHD

BACKGROUND

Work in humans has shown that impulsivity can be advantageous in certain settings. However, evidence for so-called functional impulsivity is lacking in experimental animals.

AIMS

This study investigated the contexts in which high impulsive (HI) rats show an advantage in performance compared with mid- (MI) and low impulsive (LI) rats. We also assessed the effects of dopaminergic and noradrenergic agents to investigate underlying neurotransmitter mechanisms.

METHODS

We tested rats on a variable inter-trial interval (ITI) version of the 5-choice serial reaction time task (5CSRTT). Rats received systemic injections of methylphenidate (MPH, 1 mg/kg and 3 mg/kg), atomoxetine (ATO, 0.3 mg/kg and 1 mg/kg), amphetamine (AMPH, 0.2 mg/kg), the alpha-2a adrenoceptor antagonist atipamezole (ATI, 0.3 mg/kg) and the alpha-1 adrenoceptor agonist phenylephrine (PHEN, 1 mg/kg) prior to behavioural testing.

RESULTS

Unlike LI rats, HI rats exhibited superior performance, earning more reinforcers, on short ITI trials, when the task required rapid responding. MPH, AMPH and ATI improved performance on short ITI trials and increased impulsivity in long ITI trials, recapitulating the behavioural profile of HI. In contrast, ATO and PHEN impaired performance on short ITI trials and decreased impulsivity, thus mimicking the behavioural profile of LI rats. The effects of ATO were greater on MI rats and LI rats.

CONCLUSIONS

These findings indicate that impulsivity can be advantageous when rapid focusing and actions are required, an effect that may depend on increased dopamine neurotransmission. Conversely, activation of the noradrenergic system, with ATO and PHEN, led to a general inhibition of responding.

Using metabolic energy to quantify the subjective value of physical effort

Economists have known for centuries that to understand an individual's decisions, we must consider not only the objective value of the goal at stake, but its subjective value as well. However, achieving that goal ultimately requires expenditure of effort. Surprisingly, despite the ubiquitous role of effort in decision-making and movement, we currently do not understand how effort is subjectively valued in daily movements. Part of the difficulty arises from the lack of an objective measure of effort. Here, we use a physiological approach to address this knowledge gap. We quantified objective effort costs by measuring metabolic cost via expired gas analysis as participants performed a reaching task against increasing resistance. We then used neuroeconomic methods to quantify each individual's subjective valuation of effort. Rather than the diminishing sensitivity observed in reward valuation, effort was valued objectively, on average. This is significantly less than the near-quadratic sensitivity to effort observed previously in force-based motor tasks. Moreover, there was significant inter-individual variability with many participants undervaluing or overvaluing effort. These findings demonstrate that in contrast with monetary decisions in which subjective value exhibits diminishing marginal returns, effort costs are valued more objectively in low-effort reaching movements common in daily life.

Stochastic optimal feedforward-feedback control determines timing and variability of arm movements with or without vision

Human movements with or without vision exhibit timing (i.e. speed and duration) and variability characteristics which are not well captured by existing computational models. Here, we introduce a stochastic optimal feedforward-feedback control (SFFC) model that can predict the nominal timing and trial-by-trial variability of self-paced arm reaching movements carried out with or without online visual feedback of the hand. In SFFC, movement timing results from the minimization of the intrinsic factors of effort and variance due to constant and signal-dependent motor noise, and movement variability depends on the integration of visual feedback. Reaching arm movements data are used to examine the effect of online vision on movement timing and variability, and test the model. This modelling suggests that the central nervous system predicts the effects of sensorimotor noise to generate an optimal feedforward motor command, and triggers optimal feedback corrections to task-related errors based on the available limb state estimate.

Muscles Reduce Neuronal Information Load: Quantification of Control Effort in Biological vs. Robotic Pointing and Walking

It is hypothesized that the nonlinear muscle characteristic of biomechanical systems simplify control in the sense that the information the nervous system has to process is reduced through off-loading computation to the morphological structure. It has been proposed to quantify the required information with an information-entropy based approach, which evaluates the minimally required information to control a desired movement, i.e., control effort. The key idea is to compare the same movement but generated by different actuators, e.g., muscles and torque actuators, and determine which of the two morphologies requires less information to generate the same movement. In this work, for the first time, we apply this measure to numerical simulations of more complex human movements: point-to-point arm movements and walking. These models consider up to 24 control signals rendering the brute force approach of the previous implementation to search for the minimally required information futile. We therefore propose a novel algorithm based on the pattern search approach specifically designed to solve this constraint optimization problem. We apply this algorithm to numerical models, which include Hill-type muscle-tendon actuation as well as ideal torque sources acting directly on the joints. The controller for the point-to-point movements was obtained by deep reinforcement learning for muscle and torque actuators. Walking was controlled by proprioceptive neural feedback in the muscular system and a PD controller in the torque model. Results show that the neuromuscular models consistently require less information to successfully generate the movement than the torque-driven counterparts. These findings were consistent for all investigated controllers in our experiments, implying that this is a system property, not a controller property. The proposed algorithm to determine the control effort is more efficient than other standard optimization techniques and provided as open source.

Perceived effort affects choice of limb and reaction time of movements

The decision regarding which arm to use to perform a task reflects a complex process that can be influenced by many factors, including effort requirements of acquiring the goal. In this study, we considered a virtual reality environment in which people reached to a visual target in three-dimensional space. To vary the cost of reaching, we altered the visual feedback associated with motion of one arm but not the other. This altered the extent of motion that was required to reach, thus changing the effort required to acquire the goal. We then measured how that change in effort affected the decision regarding which arm to use, as well as the preparation time for the movement that ensued. As expected, with increased visual amplification of one arm (reduced effort to reach the goal), subjects increased the probability of choosing that arm. Surprisingly, however, the reaction times to start these movements were also reduced: despite constancy of the visual representation of the target, reaction times were shorter for movements with less effort. Thus, as the perceived effort associated with accomplishing a goal was reduced for a given limb, the decision-making process was biased toward use of that limb. Furthermore, movements that were perceived to be less effortful were performed with shorter reaction times. These results suggest that visual amplification can alter the perceived effort associated with using a limb, thus increasing frequency of use. This may provide a useful method to increase use of a limb during rehabilitation.NEW & NOTEWORTHY We report that visual amplification may serve as an effective means to alter the perceived effort associated with use of a limb. This method may provide an effective tool with which use of the affected limb can be encouraged noninvasively after neurological injury.

Visual-reward driven changes of movement during action execution

Motor decision-making is often described as a sequential process, beginning with the assessment of available options and leading to the execution of a selected movement. While this view is likely to be accurate for decisions requiring significant deliberation, it would seem unfit for choices between movements in dynamic environments. In this study, we examined whether and how non-selected motor options may be considered post-movement onset. We hypothesized that a change in reward at any point in time implies a dynamic reassessment of options, even after an initial decision has been made. To test this, we performed a decision-making task in which human participants were instructed to execute a reaching movement from an origin to a rectangular target to attain a reward. Reward depended on arrival precision and on the specific distribution of reward presented along the target. On a third of trials, we changed the initial reward distribution post-movement onset. Our results indicated that participants frequently change their initially selected movements when a change is associated with an increase in reward. This process occurs quicker than overall, average reaction times. Finally, changes in movement are not only dependent on reward but also on the current state of the motor apparatus.

Vigor of reaching, walking, and gazing movements: on the consistency of interindividual differences

Movement vigor is an important feature of motor control that is thought to originate from cortico-basal ganglia circuits and processes shared with decision-making, such as temporal reward discounting. Accordingly, vigor may be related to one's relationship with time, which may, in turn, reflect a general trait-like feature of individuality. While significant interindividual differences of vigor have been typically reported for isolated motor tasks, little is known about the consistency of such differences across tasks and movement effectors. Here, we assessed interindividual consistency of vigor across reaching (both dominant and nondominant arm), walking, and gazing movements of various distances within the same group of 20 participants. Given distinct neural pathways and biomechanical specificities of each movement modality, a significant consistency would corroborate the trait-like aspect of vigor. Vigor scores for dominant and nondominant arm movements were found to be highly correlated across individuals. Vigor scores of reaching and walking were also significantly correlated across individuals, indicating that people who reach faster than others also tend to walk faster. At last, vigor scores of saccades were uncorrelated with those of reaching and walking, reaffirming that the vigor of stimulus-elicited eye saccades is distinct. These findings highlight the trait-like aspect of vigor for reaching movements with either arms and, to a lesser extent, walking.NEW & NOTEWORTHY Robust interindividual differences of movement vigor have been reported for arm reaching and saccades. Beyond biomechanics, personality trait-like characteristics have been proposed to account for those differences. Here, we examined for the first time the consistency of interindividual differences of vigor during dominant/nondominant arm reaching, walking, and gazing to assess the trait-like aspect of vigor. We found a significant consistency of vigor within our group of individuals for all tested tasks/effectors except saccades.

Error-related Persistence of Motor Activity in Resting-state Networks

The relationship between neural activation during movement training and the plastic changes that survive beyond movement execution is not well understood. Here we ask whether the changes in resting-state functional connectivity observed following motor learning overlap with the brain networks that track movement error during training. Human participants learned to trace an arched trajectory using a computer mouse in an MRI scanner. Motor performance was quantified on each trial as the maximum distance from the prescribed arc. During learning, two brain networks were observed, one showing increased activations for larger movement error, comprising the cerebellum, parietal, visual, somatosensory, and cortical motor areas, and the other being more activated for movements with lower error, comprising the ventral putamen and the OFC. After learning, changes in brain connectivity at rest were found predominantly in areas that had shown increased activation for larger error during task, specifically the cerebellum and its connections with motor, visual, and somatosensory cortex. The findings indicate that, although both errors and accurate movements are important during the active stage of motor learning, the changes in brain activity observed at rest primarily reflect networks that process errors. This suggests that error-related networks are represented in the initial stages of motor memory formation.

Vigour of self-paced reaching movement: cost of time and individual traits

People usually move at a self-selected pace in everyday life. Yet, the principles underlying the formation of human movement vigour remain unclear, particularly in view of intriguing inter-individual variability. It has been hypothesized that how the brain values time may be the cornerstone of such differences, beyond biomechanics. Here, we focused on the vigour of self-paced reaching movement and assessed the stability of vigour via repeated measurements within participants. We used an optimal control methodology to identify a cost of time (CoT) function underlying each participant’s vigour, considering a model of the biomechanical cost of movement. We then tested the extent to which anthropometric or psychological traits, namely boredom proneness and impulsivity, could account for a significant part of inter-individual variance in vigour and CoT parameters. Our findings show that the vigour of reaching is largely idiosyncratic and tend to corroborate a relation between the relative steepness of the identified CoT and boredom proneness, a psychological trait relevant to one’s relationship with time in decision-making.

Perceived effort for motor control and decision-making

How effort is internally quantified and how it influences both movement generation and decisions between potential movements are 2 difficult questions to answer. Physical costs are known to influence motor control and decision-making, yet we lack a general, principled characterization of how the perception of effort operates across tasks and conditions. Morel and colleagues introduce an insightful approach to that end, assessing effort indifference points and presenting a quadratic law between perceived effort and force production.

The Basal Ganglia Do Not Select Reach Targets but Control the Urgency of Commitment

Prominent theories of decision making suggest that the basal ganglia (BG) play a causal role in deliberation between action choices. An alternative hypothesis is that deliberation occurs in cortical regions, while the BG control the speed-accuracy trade-off (SAT) between committing to a choice versus continuing to deliberate. Here, we test these hypotheses by recording activity in the internal and external segments of the globus pallidus (GPi/GPe) while monkeys perform a task dissociating the process of deliberation, the moment of commitment, and adjustment of the SAT. Our data suggest that unlike premotor and motor cortical regions, pallidal output does not contribute to the process of deliberation but instead provides a time-varying signal that controls the SAT and reflects the growing urgency to commit to a choice. Once a target is selected by cortical regions, GP activity confirms commitment to the decision and invigorates the subsequent movement.

Rapid target foraging with reach or gaze: The hand looks further ahead than the eye

Real-world tasks typically consist of a series of target-directed actions and often require choices about which targets to act on and in what order. Such choice behavior can be assessed from an optimal foraging perspective whereby target selection is shaped by a balance between rewards and costs. Here we evaluated such decision-making in a rapid movement foraging task. On a given trial, participants were presented with 15 targets of varying size and value and were instructed to harvest as much reward as possible by either moving a handle to the targets (hand task) or by briefly fixating them (eye task). The short trial duration enabled participants to harvest about half the targets, ensuring that total reward was due to choice behavior. We developed a probabilistic model to predict target-by-target harvesting choices that considered the rewards and movement-related costs (i.e., target distance and size) associated with the current target as well as future targets. In the hand task, in comparison to the eye task, target choice was more strongly influenced by movement-related costs and took into account a greater number of future targets, consistent with the greater costs associated with arm movement. In both tasks, participants exhibited near-optimal behaviour and in a constrained version of the hand task in which choices could only be based on target positions, participants consistently chose among the shortest movement paths. Our results demonstrate that people can rapidly and effectively integrate values and movement-related costs associated with current and future targets when sequentially harvesting targets.

Many natural tasks involve a series of decisions about which target to acquire next, either with our gaze or hand. We examined the factors influencing such decisions using a task in which targets of varying value and size are sequentially acquired by eye or hand movements. By developing a probabilistic model of decision-making behavior we show that eye movement decisions are made in isolation, independent of potential future targets, and are primarily determined by target value. In contrast, hand movement decisions consider multiple future targets and are strongly shaped by movement-related costs. By examining decision-making in sequential actions, our results and model represent a significant advance over previous work that has focused primarily on decisions about single actions.

Synchrony in Joint Action Is Directed by Each Participant's Motor Control System

In this work, we ask how the probability of achieving synchrony in joint action is affected by the choice of motion parameters of each individual. We use the mirror game paradigm to study how changes in leader's motion parameters, specifically frequency and peak velocity, affect the probability of entering the state of co-confidence (CC) motion: a dyadic state of synchronized, smooth and co-predictive motions. In order to systematically study this question, we used a one-person version of the mirror game, where the participant mirrored piece-wise rhythmic movements produced by a computer on a graphics tablet. We systematically varied the frequency and peak velocity of the movements to determine how these parameters affect the likelihood of synchronized joint action. To assess synchrony in the mirror game we used the previously developed marker of co-confident (CC) motions: smooth, jitter-less and synchronized motions indicative of co-predicative control. We found that when mirroring movements with low frequencies (i.e., long duration movements), the participants never showed CC, and as the frequency of the stimuli increased, the probability of observing CC also increased. This finding is discussed in the framework of motor control studies showing an upper limit on the duration of smooth motion. We confirmed the relationship between motion parameters and the probability to perform CC with three sets of data of open-ended two-player mirror games. These findings demonstrate that when performing movements together, there are optimal movement frequencies to use in order to maximize the possibility of entering a state of synchronized joint action. It also shows that the ability to perform synchronized joint action is constrained by the properties of our motor control systems.

Age-related differences in processes organizing goal-directed locomotion toward emotional pictures

Previous studies yielded evidence for an interaction between age and valence in numerous cognitive processes. But, to date, no research has been conducted in the field of motor skills. In this study, we examined the age-related differences in the organization of an emotionally goal-directed locomotion task. Faced with a pleasant, unpleasant, or neutral picture displayed to the side of a stop button, younger and older adults were instructed to walk toward the button (intermediate goal) and push it to turn-off the picture (final goal). Kinematic and ground reaction forces were recorded. The main findings indicated that older adults' response times (RTs) did not differ across the valence picture. The fastest RTs were found in younger adults when faced with pleasant pictures, suggesting that older people may focus either on intermediate or final goals, depending on their value of pleasantness, and prioritize positive goals. We also found that the spatial coding of locomotion (trajectory and final body position) was affected in the same way by the valence of the intermediate goal in both age groups. Taken together, these findings provide new perspectives regarding the potential role of the emotional valence of the intermediate and final goals on the cognitive processes involved in action coding, such as in mental representations of action in older adults.

Habit outweighs planning in grasp selection for object manipulation

Object-directed grasping movements are adapted to intended interactions with an object. We address whether adjusting the grasp for object manipulation is controlled habitually, based on past experiences, or by goal-directed planning, based on an evaluation of the expected action outcomes. Therefore, we asked participants to grasp and rotate a dial. In such tasks, participants typically grasp the dial with an excursed, uncomfortable arm posture, which then allows to complete the dial rotation in a comfortable end-state. We extended this task by manipulating the contingency between the orientation of the grasp and the resulting end-state of the arm. A one-step (control) group rotated the dial to a single target. A two-step group rotated the dial to an initial target and then in the opposite direction. A three-step group rotated the dial to the initial target, then in the opposite direction, and then back to the initial target. During practice, the two-step and three-step groups reduced the excursion of their grasps, thus avoiding overly excursed arm postures after the second rotation. When the two-step and three-step groups were asked to execute one-step rotations, their grasps resembled those that were acquired during the two-step and three-step rotations, respectively. However, the carry-over was not complete. This suggests that adjusting grasps for forthcoming object manipulations is controlled by a mixture of habitual and goal-directed processes. In the present experiment, the former contributed approximately twice as much to grasp selection than the latter.

A new motor synergy that serves the needs of oculomotor and eye lid systems while keeping the downtime of vision minimal

The purpose of blinks is to keep the eyes hydrated and to protect them. Blinks are rarely noticed by the subject as blink-induced alterations of visual input are blanked out without jeopardizing the perception of visual continuity, features blinks share with saccades. Although not perceived, the blink-induced disconnection from the visual environment leads to a loss of information. Therefore there is critical need to minimize it. Here we demonstrate evidence for a new type of eye movement serving a distinct oculomotor demand, namely the resetting of eye torsion, likewise inevitably causing a loss of visual information. By integrating this eye movement into blinks, the inevitable down times of vision associated with each of the two behaviors are synchronized and the overall downtime minimized.

Why Don't We Move Slower? The Value of Time in the Neural Control of Action

To want something now rather than later is a common attitude that reflects the brain's tendency to value the passage of time. Because the time taken to accomplish an action inevitably delays task achievement and reward acquisition, this idea was ported to neural movement control within the "cost of time" theory. This theory provides a normative framework to account for the underpinnings of movement time formation within the brain and the origin of a self-selected pace in human and animal motion. Then, how does the brain exactly value time in the control of action? To tackle this issue, we used an inverse optimal control approach and developed a general methodology allowing to squarely sample infinitesimal values of the time cost from experimental motion data. The cost of time underlying saccades was found to have a concave growth, thereby confirming previous results on hyperbolic reward discounting, yet without making any prior assumption about this hypothetical nature. For self-paced reaching, however, movement time was primarily valued according to a striking sigmoidal shape; its rate of change consistently presented a steep rise before a maximum was reached and a slower decay was observed. Theoretical properties of uniqueness and robustness of the inferred time cost were established for the class of problems under investigation, thus reinforcing the significance of the present findings. These results may offer a unique opportunity to uncover how the brain values the passage of time in healthy and pathological motor control and shed new light on the processes underlying action invigoration.

SIGNIFICANCE STATEMENT

Movement time is a fundamental characteristic of neural motor control, but the principles underlying its formation remain little known. This work addresses that question within the inverse optimal control framework where the challenge is to uncover what optimality criterion underlies a system's behavior. Here we rely on the "cost of time" theory that finds its roots into the brain's tendency to discount the actual value of future reward. It asserts that the time elapsed until action completion entails a cost, thereby making slow moves nonoptimal. By means of a thorough theoretical analysis, the present article shows how to sample the infinitesimal values of the time cost without prior assumption about its hypothetical nature and emphasizes its sigmoidal shape for reaching.

Motivational state, reward value, and Pavlovian cues differentially affect skilled forelimb grasping in rats

Motor skills represent high-precision movements performed at optimal speed and accuracy. Such motor skills are learned with practice over time. Besides practice, effects of motivation have also been shown to influence speed and accuracy of movements, suggesting that fast movements are performed to maximize gained reward over time as noted in previous studies. In rodents, skilled motor performance has been successfully modeled with the skilled grasping task, in which animals use their forepaw to grasp for sugar pellet rewards through a narrow window. Using sugar pellets, the skilled grasping task is inherently tied to motivation processes. In the present study, we performed three experiments modulating animals’ motivation during skilled grasping by changing the motivational state, presenting different reward value ratios, and displaying Pavlovian stimuli. We found in all three studies that motivation affected the speed of skilled grasping movements, with the strongest effects seen due to motivational state and reward value. Furthermore, accuracy of the movement, measured in success rate, showed a strong dependence on motivational state as well. Pavlovian cues had only minor effects on skilled grasping, but results indicate an inverse Pavlovian-instrumental transfer effect on movement speed. These findings have broad implications considering the increasing use of skilled grasping in studies of motor system structure, function, and recovery after injuries.

On the nature of motor planning variables during arm pointing movement: Compositeness and speed dependence

The purpose of this study was to investigate the nature of the variables and rules underlying the planning of unrestrained 3D arm reaching. To identify whether the brain uses kinematic, dynamic and energetic values in an isolated manner or combines them in a flexible way, we examined the effects of speed variations upon the chosen arm trajectories during free arm movements. Within the optimal control framework, we uncovered which (possibly composite) optimality criterion underlays at best the empirical data. Fifteen participants were asked to perform free-endpoint reaching movements from a specific arm configuration at slow, normal and fast speeds. Experimental results revealed that prominent features of observed motor behaviors were significantly speed-dependent, such as the chosen reach endpoint and the final arm posture. Nevertheless, participants exhibited different arm trajectories and various degrees of speed dependence of their reaching behavior. These inter-individual differences were addressed using a numerical inverse optimal control methodology. Simulation results revealed that a weighted combination of kinematic, energetic and dynamic cost functions was required to account for all the critical features of the participants' behavior. Furthermore, no evidence for the existence of a speed-dependent tuning of these weights was found, thereby suggesting subject-specific but speed-invariant weightings of kinematic, energetic and dynamic variables during the motor planning process of free arm movements. This suggested that the inter-individual difference of arm trajectories and speed dependence was not only due to anthropometric singularities but also to critical differences in the composition of the subjective cost function.

The role of cognitive effort in subjective reward devaluation and risky decision-making

Motivation is underpinned by cost-benefit valuations where costs—such as physical effort or outcome risk—are subjectively weighed against available rewards. However, in many environments risks pertain not to the variance of outcomes, but to variance in the possible levels of effort required to obtain rewards (effort risks). Moreover, motivation is often guided by the extent to which cognitive—not physical—effort devalues rewards (effort discounting). Yet, very little is known about the mechanisms that underpin the influence of cognitive effort risks or discounting on motivation. We used two cost-benefit decision-making tasks to probe subjective sensitivity to cognitive effort (number of shifts of spatial attention) and to effort risks. Our results show that shifts of spatial attention when monitoring rapidly presented visual stimuli are perceived as effortful and devalue rewards. Additionally, most people are risk-averse, preferring safe, known amounts of effort over risky offers. However, there was no correlation between their effort and risk sensitivity. We show for the first time that people are averse to variance in the possible amount of cognitive effort to be exerted. These results suggest that cognitive effort sensitivity and risk sensitivity are underpinned by distinct psychological and neurobiological mechanisms.

Learning to expect the unexpected: rapid updating in primate cerebellum during voluntary self-motion

There is considerable evidence that the cerebellum has a vital role in motor learning by constructing an estimate of the sensory consequences of movement. Theory suggests that this estimate is compared with the actual feedback to compute the sensory prediction error. However, direct proof for the existence of this comparison is lacking. We carried out a trial-by-trial analysis of cerebellar neurons during the execution and adaptation of voluntary head movements and found that neuronal sensitivities dynamically tracked the comparison of predictive and feedback signals. When the relationship between the motor command and resultant movement was altered, neurons robustly responded to sensory input as if the movement was externally generated. Neuronal sensitivities then declined with the same time course as the concurrent behavioral learning. These findings demonstrate the output of an elegant computation in which rapid updating of an internal model enables the motor system to learn to expect unexpected sensory inputs.

Large-scale brain systems and subcortical relationships: the vertically organized brain

This article reviews the vertical organization of the brain. The cortico-basal ganglia and the cerebro-cerebellar circuitry systems are described as fundamental to cognitive and behavioral control. The basal ganglia anticipate and guide implicitly learned behaviors on the basis of experienced reward outcomes. The cerebellar-cortical network anticipates sensorimotor outcomes, allowing behaviors to be adapted across changing settings and across contexts. These vertically organized systems, operating together, represent the underpinning of cognitive control. The medial temporal lobe system, and its development, is also reviewed in order to better understand how brain systems interact for both implicit and explicit cognitive control.

Reward Pays the Cost of Noise Reduction in Motor and Cognitive Control

Speed-accuracy trade-off is an intensively studied law governing almost all behavioral tasks across species. Here we show that motivation by reward breaks this law, by simultaneously invigorating movement and improving response precision. We devised a model to explain this paradoxical effect of reward by considering a new factor: the cost of control. Exerting control to improve response precision might itself come at a cost--a cost to attenuate a proportion of intrinsic neural noise. Applying a noise-reduction cost to optimal motor control predicted that reward can increase both velocity and accuracy. Similarly, application to decision-making predicted that reward reduces reaction times and errors in cognitive control. We used a novel saccadic distraction task to quantify the speed and accuracy of both movements and decisions under varying reward. Both faster speeds and smaller errors were observed with higher incentives, with the results best fitted by a model including a precision cost. Recent theories consider dopamine to be a key neuromodulator in mediating motivational effects of reward. We therefore examined how Parkinson's disease (PD), a condition associated with dopamine depletion, alters the effects of reward. Individuals with PD showed reduced reward sensitivity in their speed and accuracy, consistent in our model with higher noise-control costs. Including a cost of control over noise explains how reward may allow apparent performance limits to be surpassed. On this view, the pattern of reduced reward sensitivity in PD patients can specifically be accounted for by a higher cost for controlling noise.

Behavioral modeling of human choices reveals dissociable effects of physical effort and temporal delay on reward devaluation

There has been considerable interest from the fields of biology, economics, psychology, and ecology about how decision costs decrease the value of rewarding outcomes. For example, formal descriptions of how reward value changes with increasing temporal delays allow for quantifying individual decision preferences, as in animal species populating different habitats, or normal and clinical human populations. Strikingly, it remains largely unclear how humans evaluate rewards when these are tied to energetic costs, despite the surge of interest in the neural basis of effort-guided decision-making and the prevalence of disorders showing a diminished willingness to exert effort (e.g., depression). One common assumption is that effort discounts reward in a similar way to delay. Here we challenge this assumption by formally comparing competing hypotheses about effort and delay discounting. We used a design specifically optimized to compare discounting behavior for both effort and delay over a wide range of decision costs (Experiment 1). We then additionally characterized the profile of effort discounting free of model assumptions (Experiment 2). Contrary to previous reports, in both experiments effort costs devalued reward in a manner opposite to delay, with small devaluations for lower efforts, and progressively larger devaluations for higher effort-levels (concave shape). Bayesian model comparison confirmed that delay-choices were best predicted by a hyperbolic model, with the largest reward devaluations occurring at shorter delays. In contrast, an altogether different relationship was observed for effort-choices, which were best described by a model of inverse sigmoidal shape that is initially concave. Our results provide a novel characterization of human effort discounting behavior and its first dissociation from delay discounting. This enables accurate modelling of cost-benefit decisions, a prerequisite for the investigation of the neural underpinnings of effort-guided choice and for understanding the deficits in clinical disorders characterized by behavioral inactivity.

One of the main functions of the brain is to select sequences of actions that lead to rewarding outcomes (e.g., food). However, such rewards are often not readily available; instead physical effort may be required to obtain them, or their arrival may be delayed. The ability to integrate the costs and benefits of potential courses of action is severely impaired in several common disorders, such as depression and schizophrenia. Mathematical models can describe how individuals depreciate rewards based on the costs associated with them. For example, models of how a reward loses appeal with increasing temporal delays can provide individual impulsivity scores, and can serve as a predictor of financial mismanagement. To date, there is no established model to describe accurately how humans depreciate rewards when obtaining them requires physical effort. This is surprising given the prevalence of disorders related to a diminished willingness to exert effort. Here we derive a biologically plausible mathematical model that can describe how healthy humans make decisions tied to physical efforts. We show that effort and delay influence reward valuation in different ways, contrary to common assumptions. Our model will be important for characterizing decision-making deficits in clinical disorders characterized by behavioral inactivity.

Context-dependent urgency influences speed-accuracy trade-offs in decision-making and movement execution

Speed-accuracy tradeoffs (SATs) exist in both decision-making and movement control, and are generally studied separately. However, in natural behavior animals are free to adjust the time invested in deciding and moving so as to maximize their reward rate. Here, we investigate whether shared mechanisms exist for SAT adjustment in both decisions and actions. Two monkeys performed a reach decision task in which they watched 15 tokens jump, one every 200 ms, from a central circle to one of two peripheral targets, and had to guess which target would ultimately receive the majority of tokens. The monkeys could decide at any time, and once a target was reached, the remaining token movements accelerated to either 50 ms ("fast" block) or 150 ms ("slow" block). Decisions were generally earlier and less accurate in fast than slow blocks, and in both blocks, the criterion of accuracy decreased over time within each trial. This could be explained by a simple model in which sensory information is combined with a linearly growing urgency signal. Remarkably, the duration of the reaching movements produced after the decision decreased over time in a similar block-dependent manner as the criterion of accuracy estimated by the model. This suggests that SATs for deciding and acting are influenced by a shared urgency/vigor signal. Consistent with this, we observed that the vigor of saccades performed during the decision process was higher in fast than in slow blocks, suggesting the influence of a context-dependent global arousal.

Monetary reward speeds up voluntary saccades

Past studies have shown that reward contingency is critical for sensorimotor learning, and reward expectation speeds up saccades in animals. Whether monetary reward speeds up saccades in human remains unknown. Here we addressed this issue by employing a conditional saccade task, in which human subjects performed a series of non-reflexive, visually-guided horizontal saccades. The subjects were (or were not) financially compensated for making a saccade in response to a centrally-displayed visual congruent (or incongruent) stimulus. Reward modulation of saccadic velocities was quantified independently of the amplitude-velocity coupling. We found that reward expectation significantly sped up voluntary saccades up to 30°/s, and the reward modulation was consistent across tests. These findings suggest that monetary reward speeds up saccades in human in a fashion analogous to how juice reward sped up saccades in monkeys. We further noticed that the idiosyncratic nasal-temporal velocity asymmetry was highly consistent regardless of test order, and its magnitude was not correlated with the magnitude of reward modulation. This suggests that reward modulation and the intrinsic velocity asymmetry may be governed by separate mechanisms that regulate saccade generation.

Movement speed is biased by prior experience

How does the motor system choose the speed for any given movement? Many current models assume a process that finds the optimal balance between the costs of moving fast and the rewards of achieving the goal. Here, we show that such models also need to take into account a prior representation of preferred movement speed, which can be changed by prolonged practice. In a time-constrained reaching task, human participants made 25-cm reaching movements within 300, 500, 700, or 900 ms. They were then trained for 3 days to execute the movement at either the slowest (900-ms) or fastest (300-ms) speed. When retested on the 4th day, movements executed under all four time constraints were biased toward the speed of the trained movement. In addition, trial-to-trial variation in speed of the trained movement was significantly reduced. These findings are indicative of a use-dependent mechanism that biases the selection of speed. Reduced speed variability was also associated with reduced errors in movement amplitude for the fast training group, which generalized nearly fully to a new movement direction. In contrast, changes in perpendicular error were specific to the trained direction. In sum, our results suggest the existence of a relatively stable but modifiable prior of preferred movement speed that influences the choice of movement speed under a range of task constraints.

The influence of emotions on cognitive control: feelings and beliefs-where do they meet?

The influence of emotion on higher-order cognitive functions, such as attention allocation, planning, and decision-making, is a growing area of research with important clinical applications. In this review, we provide a computational framework to conceptualize emotional influences on inhibitory control, an important building block of executive functioning. We first summarize current neuro-cognitive models of inhibitory control and show how Bayesian ideal observer models can help reframe inhibitory control as a dynamic decision-making process. Finally, we propose a Bayesian framework to study emotional influences on inhibitory control, providing several hypotheses that may be useful to conceptualize inhibitory control biases in mental illness such as depression and anxiety. To do so, we consider the neurocognitive literature pertaining to how affective states can bias inhibitory control, with particular attention to how valence and arousal may independently impact inhibitory control by biasing probabilistic representations of information (i.e., beliefs) and valuation processes (e.g., speed-error tradeoffs).

Why skill matters

Maximizing rewards per unit time is ideal for success and survival in humans and animals. This goal can be approached by speeding up behavior aiming at rewards and this is done most efficiently by acquiring skills. Importantly, reward-directed skills consist of two components: finding a good object (i.e., object skill) and acting on the object (i.e., action skill), which occur sequentially. Recent studies suggest that object skill is based on high-capacity memory for object-value associations. When a learned object is encountered the corresponding memory is quickly expressed as a value-based gaze bias, leading to the automatic acquisition or avoidance of the object. Object skill thus plays a crucial role in increasing rewards per unit time.

Learning where to look for a hidden target

Survival depends on successfully foraging for food, for which evolution has selected diverse behaviors in different species. Humans forage not only for food, but also for information. We decide where to look over 170,000 times per day, approximately three times per wakeful second. The frequency of these saccadic eye movements belies the complexity underlying each individual choice. Experience factors into the choice of where to look and can be invoked to rapidly redirect gaze in a context and task-appropriate manner. However, remarkably little is known about how individuals learn to direct their gaze given the current context and task. We designed a task in which participants search a novel scene for a target whose location was drawn stochastically on each trial from a fixed prior distribution. The target was invisible on a blank screen, and the participants were rewarded when they fixated the hidden target location. In just a few trials, participants rapidly found the hidden targets by looking near previously rewarded locations and avoiding previously unrewarded locations. Learning trajectories were well characterized by a simple reinforcement-learning (RL) model that maintained and continually updated a reward map of locations. The RL model made further predictions concerning sensitivity to recent experience that were confirmed by the data. The asymptotic performance of both the participants and the RL model approached optimal performance characterized by an ideal-observer theory. These two complementary levels of explanation show how experience in a novel environment drives visual search in humans and may extend to other forms of search such as animal foraging.

The mixed instrumental controller: using value of information to combine habitual choice and mental simulation

Instrumental behavior depends on both goal-directed and habitual mechanisms of choice. Normative views cast these mechanisms in terms of model-free and model-based methods of reinforcement learning, respectively. An influential proposal hypothesizes that model-free and model-based mechanisms coexist and compete in the brain according to their relative uncertainty. In this paper we propose a novel view in which a single Mixed Instrumental Controller produces both goal-directed and habitual behavior by flexibly balancing and combining model-based and model-free computations. The Mixed Instrumental Controller performs a cost-benefits analysis to decide whether to chose an action immediately based on the available "cached" value of actions (linked to model-free mechanisms) or to improve value estimation by mentally simulating the expected outcome values (linked to model-based mechanisms). Since mental simulation entails cognitive effort and increases the reward delay, it is activated only when the associated "Value of Information" exceeds its costs. The model proposes a method to compute the Value of Information, based on the uncertainty of action values and on the distance of alternative cached action values. Overall, the model by default chooses on the basis of lighter model-free estimates, and integrates them with costly model-based predictions only when useful. Mental simulation uses a sampling method to produce reward expectancies, which are used to update the cached value of one or more actions; in turn, this updated value is used for the choice. The key predictions of the model are tested in different settings of a double T-maze scenario. Results are discussed in relation with neurobiological evidence on the hippocampus - ventral striatum circuit in rodents, which has been linked to goal-directed spatial navigation.

The modulatory influence of end-point controllability on decisions between actions

Recent work has shown that human subjects are able to predict the biomechanical ease of potential reaching movements and use these predictions to influence their choices. Here, we examined how reach decisions are influenced by specific biomechanical factors related to the control of end-point stability, such as aiming accuracy or stopping control. Human subjects made free choices between two potential reaching movements that varied in terms of path distance and biomechanical cost in four separate blocks that additionally varied two constraints: the width of the targets (narrow or wide) and the requirement of stopping in them. When movements were unconstrained (very wide targets and no requirement of stopping), subjects' choices were strongly biased toward directions aligned with the direction of maximal mobility. However, as the movements became progressively constrained, factors related to the control of the end point gained relevance, thus reducing this bias. This demonstrates that, before movement onset, constraints such as stopping and aiming participate in a remarkably adaptive and flexible action selection process that trades off the advantage of moving along directions of maximal mobility for unconstrained movements against exploiting biomechanical anisotropies to facilitate control of end-point stability whenever the movement constraints require it. These results support a view of decision making between motor actions as a highly context-dependent gradual process in which the subjective desirability of potential actions is influenced by their dynamic properties in relation to the intrinsic properties of the motor apparatus.

Fast versus slow: different saccadic behavior in cerebellar ataxias

Spinocerebellar ataxia type 2 (SCA2) is a genetic neurodegenerative disorder primarily characterized by involvement of the brainstem and cerebellum, basal ganglia, spinal cord, cerebral cortex, but white matter is also involved. In late-onset cerebellar ataxia (LOCA), the cerebellum is mainly involved, as demonstrated by clinical and neuroradiological findings. These neurodegenerative diseases are often associated with progressive abnormalities in eye movement control, particularly saccadic changes. We recorded saccadic eye movements in eight SCA2 patients and 10 LOCA patients. Here, we suggest that abnormalities in saccadic parameters differ in the two groups of patients according to specific anatomical substrates. The different saccadic behavior observed in these two clinically distinct degenerative cerebellar diseases offers the opportunity to simplify some general mechanisms of saccadic motor control. Like his mentor Fred Plum, John Leigh strongly encouraged younger neuroscientists to tackle neurological problems by investigating "pathological physiology." With this teaching in mind, we studied patients with rare neurometabolic and neurodegenerative diseases.