Age-related differences in bimanual movements: A systematic review and meta-analysis

Use of a physiological profile to document upper limb motor impairment in ageing and in neurological conditions

Profiling performance in the physiological domains underpinning upper limb function (such as strength, sensation, coordination) provides insight into an individual's specific impairments. This compliments the traditional medical 'diagnosis' model that is currently used in contemporary medicine. From an initial battery of 13 tests in which data were collected across the adult lifespan (n = 367, 20-95 years) and in those with neurological conditions (specifically, multiple sclerosis (n = 40), Parkinson's disease (n = 34), and stroke (n = 50)), six tests were selected to comprise a core upper limb physiological profile assessment (PPA). This comprised measures of handgrip strength, simple reaction time, finger dexterity, tactile sensation, bimanual coordination, and a functional task. Individual performance in each of these tests can be compared to a reference population score (devised from our database of healthy individuals aged under 60 years), informing the researcher or clinician how to best direct an intervention or treatment for the individual based on their specific impairment(s). Lastly, a composite score calculated from the average performance across the six tests provides a broad overview of an individual's overall upper limb function. Collectively, the upper limb PPA highlights specific impairments that are prevalent within distinct pathologies and reveals the magnitude of upper limb motor impairment specific to each condition.

Altered Bimanual Kinetic and Kinematic Motor Control Capabilities in Older Women

Older women may experience critical neuromuscular impairments interfering with controlling successful bimanual motor actions. Our study aimed to investigate altered bimanual motor performances in older women compared with younger women by focusing on kinetic and kinematic motor properties. Twenty-two older women and 22 younger women performed bimanual kinetic and kinematic motor tasks. To estimate bimanual kinetic functions, we calculated bimanual maximal voluntary contractions (i.e., MVC) and force control capabilities (i.e., mean force, accuracy, variability, and regularity of the total force produced by two hands) during bimanual hand-grip submaximal force control tasks. For bimanual kinematic performances, we assessed the scores of the Purdue Pegboard Test (i.e., PPT) in both hands and assembly tasks, respectively. For the bimanual MVC and PPT, we conducted an independent t-test between two groups. The bimanual force control capabilities were analyzed using two-way mixed ANOVAs (Group × Force Level; 2 × 2). Our findings revealed that the older women showed less bimanual MVC (p = 0.046) and submaximal force outputs (p = 0.036) and greater changes in bimanual force control capabilities as indicated by a greater force variability (p = 0.017) and regularity (p = 0.014). Further, the older women revealed lower scores of PPT in both the hands condition (p < 0.001) and assembly task condition (p < 0.001). The additional correlation analyses for the older women showed that lower levels of skeletal muscle mass were related to less bimanual MVC (r = 0.591; p = 0.004). Furthermore, a higher age was related to lower scores in the bimanual PPT assembly task (r = -0.427; p = 0.048). These findings suggested that older women experience greater changes in bimanual motor functions compared with younger women.

Quantitatively assessing aging effects in rapid motor behaviours: a cross-sectional study

BACKGROUND

An individual's rapid motor skills allow them to perform many daily activities and are a hallmark of physical health. Although age and sex are both known to affect motor performance, standardized methods for assessing their impact on upper limb function are limited.

METHODS

Here we perform a cross-sectional study of 643 healthy human participants in two interactive motor tasks developed to quantify sensorimotor abilities, Object-Hit (OH) and Object-Hit-and-Avoid (OHA). The tasks required participants to hit virtual objects with and without the presence of distractor objects. Velocities and positions of hands and objects were recorded by a robotic exoskeleton, allowing a variety of parameters to be calculated for each trial. We verified that these tasks are viable for measuring performance in healthy humans and we examined whether any of our recorded parameters were related to age or sex.

RESULTS

Our analysis shows that both OH and OHA can assess rapid motor behaviours in healthy human participants. It also shows that while some parameters in these tasks decline with age, those most associated with the motor system do not. Three parameters show significant sex-related effects in OH, but these effects disappear in OHA.

CONCLUSIONS

This study suggests that the underlying effect of aging on rapid motor behaviours is not on the capabilities of the motor system, but on the brain's capacity for processing inputs into motor actions. Additionally, this study provides a baseline description of healthy human performance in OH and OHA when using these tasks to investigate age-related declines in sensorimotor ability.

How the motor system copes with aging: a quantitative meta-analysis of the effect of aging on motor function control

Motor cognitive functions and their neurophysiology evolve and degrade along the lifespan in a dramatic fashion. Current models of how the brain adapts to aging remain inspired primarily by studies on memory or language processes. Yet, aging is strongly associated with reduced motor independence and the associated degraded interaction with the environment: accordingly, any neurocognitive model of aging not considering the motor system is, ipso facto, incomplete. Here we present a meta-analysis of forty functional brain-imaging studies to address aging effects on motor control. Our results indicate that motor control is associated with aging-related changes in brain activity, involving not only motoric brain regions but also posterior areas such as the occipito-temporal cortex. Notably, some of these differences depend on the specific nature of the motor task and the level of performance achieved by the participants. These findings support neurocognitive models of aging that make fewer anatomical assumptions while also considering tasks-dependent and performance-dependent manifestations. Besides the theoretical implications, the present data also provide additional information for the motor rehabilitation domain, indicating that motor control is a more complex phenomenon than previously understood, to which separate cognitive operations can contribute and decrease in different ways with aging.

Many aspects of neuronal control degrade with ageing, including motor control. Using a meta-analysis of functional MRI images, it is made apparent that the ageing brain relies more on visual strategies than sensory stimuli to maintain motor function.

Age-related differences in bimanual coordination performance

Purpose. The purpose of this article was to determine how characteristics of bimanual coordination tasks affect the quality of performance and to determine the impact of these characteristics on muscular activation of the upper limbs, with consideration of age-related differences. Methods. The research was carried out on two groups consisting of 25 people aged 20-30 and 60-67 years. The subjects performed seven tasks that varied in coordination mode, tracking mode and outline-tracing. The main measures of task performance were calculated on the basis of the difference between the position of the target and tracing cursors. Cohen's d value was calculated to show differences in measures between groups. Results. There were higher values of error and variability measures for elderly people compared to young. Complex tasks showed the largest difficulty, which suggests that, when performed, such tasks have the greatest potential to improve coordination skills. Tasks during which both limbs contribute to the movement of one cursor proved the most appropriate. Conclusion. The tracking mode is of great importance for the quality of performance in motor coordination tasks, while the performance of tasks with imposed speed is much more strongly age-sensitive than performance with a freely chosen speed.

Effectiveness of bimanual coordination tasks performance in improving coordination skills and cognitive functions in elderly

Background

The purpose of the study was to determine the impact of the performance of bimanual coordination tasks with specific characteristics on the changes in quality of coordination, musculoskeletal load of the upper limbs and cognitive functions.

Methods and findings

A group of 26 people aged 60–67 years performed 6 sessions of bimanual coordination training. Each session included set of tasks that varied depending on the shape in which the cursor moved, the coordination mode (in-phase, anti-phase, complex) and the tracking mode (imposed or freely chosen speed). Performance was assessed by: Error, Variability and Execution. The load of upper limb muscles was expressed with the value of the normalized EMG amplitude. Cognitive functions were evaluated using the Vienna Test System. The Variability and Error values obtained during the sixth training session decreased by more than 50% of the initial values. Tasks with freely chosen speed showed changes from 15% to 34% for Error and from 45% to 50% for Variability. For tasks with imposed speed and coordination mode anti-phase or complex it was between 51% and 58% for Error and between 58% and 68% for Variability. Statistically significant differences between load during the sixth training session compared to the first session occurred in three out of four muscles and were between 9% to 39%. There were statistically significant differences in motor time and no differences in variables describing attention and working memory.

Conclusions

Coordination mode is meaningful for improving coordination skills; tasks in the anti-phase and complex are recommended. Tracking mode also plays a role, tasks with an imposed cursor movement speed have greater potential to improve coordination skills than tasks with freely chosen. Improved control skills resulted in the reduction of upper limb musculoskeletal load. It can be assumed that an increase in coordination skills with the use of appropriate training can help to reduce musculoskeletal load.

Reduced Modulation of Task-Related Connectivity Mediates Age-Related Declines in Bimanual Performance

Aging is accompanied by marked changes in motor behavior and its neural correlates. At the behavioral level, age-related declines in motor performance manifest, for example, as a reduced capacity to inhibit interference between hands during bimanual movements, particularly when task complexity increases. At the neural level, aging is associated with reduced differentiation between distinct functional systems. Functional connectivity (FC) dedifferentiation is characterized by more homogeneous connectivity patterns across various tasks or task conditions, reflecting a reduced ability of the aging adult to modulate brain activity according to changing task demands. It is currently unknown, however, how whole-brain dedifferentiation interacts with increasing task complexity. In the present study, we investigated age- and task-related FC in a group of 96 human adults across a wide age range (19.9-74.5 years of age) during the performance of a bimanual coordination task of varying complexity. Our findings indicated stronger task complexity-related differentiation between visuomotor- and nonvisuomotor-related networks, though modulation capability decreased with increasing age. Decreased FC modulation mediated larger complexity-related increases in between-hand interference, reflective of worse bimanual coordination. Thus, the ability to maintain high motor performance levels in older adults is related to the capability to properly segregate and modulate functional networks.

Intentional Switching Between Bimanual Coordination Patterns in Older Adults: Is It Mediated by Inhibition Processes?

The study investigated the consequences of age-related decline in inhibition processes on intentional switching between bimanual coordination patterns. Fifteen young (24±2.8 years) and 20 older adults (69±5.3 years) performed Stroop tasks and bimanual coordination tasks. Stroop tasks included neutral, congruent, and incongruent conditions. Response time and error rate were measured. Bimanual coordination tasks consisted of performing in-phase (IP) and anti-phase (AP) patterns. Participants were requested to switch as quickly as possible from one pattern to the other, resulting in two different switching directions (AP to IP; IP to AP). Mean and standard deviation (SD) of the continuous relative phase (CRP) were calculated pre- and post-switching for each participant. Total switching time (TST) was measured. The switching phase was also decomposed into reaction time (RT) and reversal time (REvT). Pearson correlation analyses were performed to test for correlations between: (i) SD of CRP and response time in Stroop tasks, and (ii) switching times (TST, RT, RevT) and response time in Stroop task, respectively. In addition, parallel mediation analyses were conducted. Results showed that: (i) the AP pattern was less stable than the IP pattern in both young and older adults, (ii) coordination patterns were less stable in older adults, (iii) response times in Stroop task were longer in the incongruent condition, and (iv) RespTs were longer in older than in young participants, whatever the condition. In the bimanual coordination task, RT, RevT, and TST increased with age. The stability of the IP pattern was correlated with the response times observed in neutral and congruent conditions, while the stability of the AP pattern was correlated with response time observed in the incongruent condition. Correlation and mediation analyses showed that, in the AP to IP switching direction, RT and RevT were both significantly correlated with response times observed in the incongruent condition of Stroop task. These findings suggest that inhibition processes are involved in switching between bimanual coordination patterns, at least to trigger the early phase of switching. They also support the hypothesis that inhibition processes are more involved in maintaining the AP pattern and switching to the IP pattern. Finally, age-related changes in switching times seem to be prominently mediated by alterations of inhibition processes.

Fiber-specific variations in anterior transcallosal white matter structure contribute to age-related differences in motor performance

Age-related differences in bimanual motor performance have been extensively documented, but their underlying neural mechanisms remain less clear. Studies applying diffusion MRI in the aging population have revealed evidence for age-related white matter variations in the corpus callosum (CC) which are related to bimanual motor performance. However, the diffusion tensor model used in those studies is confounded by partial volume effects in voxels with complex fiber geometries which are present in up to 90% of white matter voxels, including the bilateral projections of the CC. A recently developed whole-brain analysis framework, known as fixel-based analysis (FBA), enables comprehensive statistical analyses of white matter quantitative measures in the presence of such complex fiber geometries. To investigate the contribution of age-related fiber-specific white matter variations to age-related differences in bimanual performance, a cross-sectional lifespan sample of healthy human adults (N ​= ​95; 20-75 years of age) performed a bimanual tracking task. Furthermore, diffusion MRI data were acquired and the FBA metrics associated with fiber density, cross-section, and combined fiber density and cross-section were estimated. Whole-brain FBA revealed significant negative associations between age and fiber density, cross-section, and combined metrics of multiple white matter tracts, including the bilateral projections of the CC, indicative of white matter micro- and macrostructural degradation with age. More importantly, mediation analyses demonstrated that age-related variations in the combined (fiber density and cross-section) metric of the genu, but not splenium, of the CC contributed to the observed age-related differences in bimanual coordination performance. These findings highlight the contribution of variations in interhemispheric communication between prefrontal (non-motor) cortices to age-related differences in motor performance.

Harnessing smartphone technology and three dimensional printing to create a mobile rehabilitation system, mRehab: assessment of usability and consistency in measurement

BACKGROUND

Residual sensorimotor deficits are common following stroke. While it has been demonstrated that targeted practice can result in improvements in functional mobility years post stroke, there is little to support rehabilitation across the lifespan. The use of technology in home rehabilitation provides an avenue to better support self-management of recovery across the lifespan. We developed a novel mobile technology, capable of quantifying quality of movement with the purpose of providing feedback to augment rehabilitation and improve functional mobility. This mobile rehabilitation system, mRehab, consists of a smartphone embedded in three dimensional printed items representing functional objects found in the home. mRehab allows individuals with motor deficits to practice activities of daily living (ADLs) and receive feedback on their performance. The aim of this study was to assess the usability and consistency of measurement of the mRehab system.

METHODS

To assess usability of the mRehab system, four older adults and four individuals with stroke were recruited to use the system, and complete surveys to discuss their opinions on the user interface of the smartphone app and the design of the 3D printed items. To assess the consistency of measurement by the mRehab system, 12 young adults were recruited and performed mRehab ADLs in three lab sessions within 1 week. Young adults were chosen for their expected high level of consistency in motor performance.

RESULTS

Usability ratings from older adults and individuals with stroke led us to modify the design of the 3D printed items and improve the clarity of the mRehab app. The modified mRehab system was assessed for consistency of measurement and six ADLs resulted in coefficient of variation (CV) below 10%. This is a commonly used CV goal for consistency. Two ADLs ranged between 10 and 15% CV. Only two ADLs demonstrated high CV.

CONCLUSIONS

mRehab is a client-centered technology designed for home rehabilitation that consistently measures performance. Development of the mRehab system provides a support for individuals working on recovering functional upper limb mobility that they can use across their lifespan.

Age-related deficits in bilateral motor synergies and force coordination

Background

Ageing may cause impairments in executing bilateral movement control. This study investigated age-related changes in interlimb force coordination across multiple trials by quantifying bilateral motor synergies based on the uncontrolled manifold hypothesis. Participants completed the trials with and without visual feedback.

Methods

Twenty healthy individuals (10 older adults and 10 young adults) performed 12 isometric force control trials for the two vision conditions at 5% of maximal voluntary contraction. All dependent variables were analyzed in two-way mixed model (Group × Vision Condition; 2 × 2) ANOVAs with repeated measures on the last factor.

Results

The analyses revealed that older adults had greater mean force produced by two hands in both vision conditions (i.e., yes and no visual feedback). Across both vision conditions, the older adult group showed greater asymmetrical force variability (i.e., standard deviation of non-dominant hand > standard deviation of dominant hand) and revealed more positive correlation coefficients between forces produced by two hands as compared with the young adult group. Finally, an index of bilateral motor synergies was significantly greater in young adults than older adults when visual feedback was available.

Conclusion

The current findings indicate that deficits in interlimb force coordination across multiple trials appeared in older adults.

Imitation of meaningless gestures in normal aging

While imitation of meaningless gestures is a gold standard in the assessment of apraxia in patients with either stroke or neurodegenerative diseases, little is known about potential age-related effects on this measure. A significant body of literature has indicated that different mechanisms (i.e., executive functioning, visuospatial skills, sensory integration, body knowledge, categorical apprehension) may underlie the performance depending on imitation conditions (i.e., finger/hand, uni-/bimanual, symmetric/asymmetric, crossed/uncrossed configurations). However, neither the effects of these conditions on performance, nor the contribution of the abovementioned mechanisms to imitation have been explored in normal aging. The aim of the present study was to fill this gap. To do so, healthy adults (n = 103) aged 50 to 89 were asked to imitate 45 meaningless gestures. The authors controlled for general cognitive function, motor function, visual-spatial skills, executive function, sensory integration, body knowledge, and mechanical problem-solving skills. The results showed that asymmetry, body-midline crossing and, to a lesser extent, bimanual activity added an additional layer of difficulty to imitation tasks. After controlling for motor speed and cognitive function, age had an effect on imitation skills after 70 years old. This may reflect a decline in body knowledge, sensory integration, and executive functions. In contrast, the visuospatial and mechanical problem-solving hypotheses were ruled out. An additional motor simulation hypothesis is proposed. These findings may prove useful for clinicians working in memory clinics by providing insights on how to interpret imitation deficits. Lower performance after 70 years old should not be considered abnormal in a systematic manner.

Individual differences in processing resources modulate bimanual interference in pointing

Coordinating both hands during bimanual reaching is a complex task that can generate interference during action preparation as often indicated by prolonged reaction times for movements that require moving the two hands at different amplitudes. Individual processing constraints are thought to contribute to this interference effect. Most importantly, however, the amount of interference seems to depend considerably on overall task demands suggesting that interference increases as the available processing resources decrease. Here, we further investigated this idea by comparing performance in a simple direct cueing and a more difficult symbolic cueing task between three groups of participants that supposedly vary in their processing resources, i.e., musicians, young adults and older adults. We found that the size of interference effects during symbolic cueing varied in the tested groups: musicians showed the smallest and older adults the largest interference effects. More importantly, a regression model, using processing speed and processing capacity as predictor variables, revealed a clear link between the available processing resources and the size of the interference effect during symbolic cueing. In the easier direct cueing task, no reliable interference was observed on a group level. We propose that the susceptibility to bimanual interference is modulated by the task-specific processing requirements in relation with the available processing resources of an individual.