Sensory Plasticity in Human Motor Learning

Somatosensory cortex and body representation: Updating the motor system during a visuo-proprioceptive cue conflict

The brain's representation of hand position is critical for voluntary movement. Representation is multisensory, relying on both visual and proprioceptive cues. When these cues conflict, the brain recalibrates its unimodal estimates, shifting them closer together to compensate. Converging lines of evidence from research in perception, behavior, and neurophysiology suggest that such updates to body representation must be communicated to the motor system to keep hand movements accurate. We hypothesized that primary somatosensory cortex (S1) plays a crucial role in conveying the proprioceptive aspects of the updated body representation to the motor system. We tested this hypothesis in two experiments. We predicted that proprioceptive, but not visual, recalibration would be associated with change in short latency afferent inhibition (SAI), a measure of sensorimotor integration (influence of sensory input on motor output) (Expt. 1). We further predicted that modulating S1 activity with repetitive transcranial magnetic stimulation (TMS) should affect variance and recalibration associated with the proprioceptive estimate of hand position, but have no effect on the visual estimate (Expt. 2). Our results are consistent with these predictions, supporting the idea that (1) S1 is indeed a key region in facilitating motor system updates based on changes in body representation, and (2) this function is mediated by unisensory (proprioceptive) processing, upstream of multisensory visuo-proprioceptive computations. Other aspects of the body representation (visual and multisensory) may be conveyed to the motor system via separate pathways, e.g. from posterior parietal regions to motor cortex.

Significance Statement

Representation of the hand, which is critical for accurate control of movement, comes from weighting and combining available proprioceptive and visual cues. Our results suggest that when the hand representation is modified, the motor system receives updates directly from the primary somatosensory cortex (S1). These updates are proprioceptive, having not yet been integrated with visual cues through interaction with high-level posterior parietal regions. This might provide advantages in terms of faster updates, for example, because multisensory integration likely adds processing time. Research seeking to manipulate motor control via multisensory perception (e.g., virtual reality or mirror training for motor rehabilitation) should therefore consider the parallel unisensory and multisensory pathways that affect the motor system.

Effects of gait retraining in knee joint position sense

BACKGROUND

Joint position sense (JPS) is crucial for maintaining posture, protecting joints, and carrying out daily activities such as walking. Studies show that exercises to strengthen muscles and improve proprioception can positively impact JPS during passive and less complex activities. Evidence suggests that motor training can effectively enhance sensory function, including JPS, due to the extensive connections between the motor cortex and somatosensory areas. Gait retraining using real-time feedback has improved outcomes among patients with musculoskeletal disorders. The effect of gait retraining on JPS has not been investigated. This study assessed the effects of gait retraining to reduce knee extension in joint position sense in individuals with knee hyperextension walking patterns.

METHODS

Ten women with asymptomatic knee hyperextension (KH) >5° during overground walking participated in this study. Sagittal-plane kinematics were assessed using a three-dimensional (3D) motion analysis system. The JPS was assessed using the Knee Position Active Reproduction Test. The knee with the highest hyperextension was the focus of the gait retraining intervention, which consisted of six 1-h sessions using verbal instructions and visual kinematic feedback. Comparisons of peak knee extension during walking and knee JPS overall error (RMSE) were made using a paired t-test.

RESULTS

Gait retraining intervention significantly reduced knee extension angle during walking (83.8 % change; p < 0.001; Cohen's d = -1.6) and improved knee JPS (62 % change; p = 0.023; Cohen's d = 0.8) post-training. In addition, the improvements in joint kinematics (36.7 % change; p = 0.005; Cohen's d = -1.2) and JPS (52.6 % change; p = 0.015; Cohen's d = 0.9) were observed in the untrained knee.

SIGNIFICANCE

Gait retraining can improve joint position sense. This study addresses a gap in our understanding of how gait retraining can influence JPS. Our results corroborate that gait retraining is an evolving and promising strategy for improving gait outcomes, particularly in individuals with KH walking patterns.

Double dissociation of visuomotor interaction mediated by visual feedback during continuous de novo motor learning

While the sensorimotor cortices are central neural substrates for motor control and learning, how the interaction between their subregions with visual cortices contributes to acquiring de novo visuomotor skills is poorly understood. We design a continuous visuomotor task in fMRI where participants control a cursor using their fingers while learning an arbitrary finger-to-cursor mapping. To investigate visuomotor interaction in the de novo motor task, we manipulate visual feedback of a cursor such that they learn to control using fingers under two alternating conditions: online cursor feedback is available or unavailable except when a target is reached. As a result, we find double dissociation of fMRI activity in subregions of the sensorimotor and visual cortices. Specifically, motor and late visual cortices are more active with online cursor feedback, and somatosensory and early visual cortices are more active without online cursor feedback. We also find a significant reduction in functional connectivity between somatosensory cortices and early visual cortices, which is highly correlated with performance improvement. These findings support the distinct interaction between subregions of sensorimotor cortices and visual cortices, while the connectivity analysis highlights the critical role of somatosensory cortices during de novo motor learning.

Comparative analysis of motor skill acquisition in a novel bimanual task: the role of mental representation and sensorimotor feedback

Introduction

This study investigates the multifaceted nature of motor learning in a complex bimanual task by examining the interplay between mental representation structures, biomechanics, tactile pressure, and performance. We developed a novel maze game requiring participants to maneuver a rolling sphere through a maze, exemplifying complex sequential coordination of vision and haptic control using both hands. A key component of this study is the introduction of cognitive primitives, fundamental units of cognitive and motor actions that represent specific movement patterns and strategies.

Methods

Participants were divided into two groups based on initial performance: poor performers (PPG) and good performers (GPG). The experimental setup employed motion capture and innovative tactile sensors to capture a detailed multimodal picture of the interaction process. Our primary aims were to (1) assess the effects of daily practice on task performance, biomechanics, and tactile pressure, (2) examine the relationship between changes in mental representation structures and skill performance, and (3) explore the interplay between biomechanics, tactile pressure, and cognitive representation in motor learning.

Results

Performance analysis showed that motor skills improved with practice, with the GPG outperforming the PPG in maze navigation efficiency. Biomechanical analysis revealed that the GPG demonstrated superior movement strategies, as indicated by higher peak velocities and fewer velocity peaks during task execution. Tactile feedback analysis showed that GPG participants applied more precise and focused pressure with their right-hand thumb, suggesting enhanced motor control. Cognitively, both groups refined their mental representation structures over time, but the GPG exhibited a more structured and sophisticated cognitive mapping of the task post-practice.

Discussion

The findings highlight the intertwined nature of biomechanical control, tactile feedback, and cognitive processing in motor skill acquisition. The results support established theories, such as the cognitive action architecture approach, emphasizing the role of mental representation in planning and executing motor actions. The integration of cognitive primitives in our analysis provides a theoretical framework that connects observable behaviors to underlying cognitive strategies, enhancing the understanding of motor learning across various contexts. Our study underscores the necessity of a holistic approach to motor learning research, recognizing the complex interaction between cognitive and motor processes in skill acquisition.

Using mechanistic knowledge to appraise contemporary approaches to the rehabilitation of upper limb function following stroke

It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning 'the structure or way of working of the parts in a natural system') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to 'cross-road' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, 'disconnectome' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.

Dynamic changes in somatosensory and cerebellar activity mediate temporal recalibration of self-touch

An organism's ability to accurately anticipate the sensations caused by its own actions is crucial for a wide range of behavioral, perceptual, and cognitive functions. Notably, the sensorimotor expectations produced when touching one's own body attenuate such sensations, making them feel weaker and less ticklish and rendering them easily distinguishable from potentially harmful touches of external origin. How the brain learns and keeps these action-related sensory expectations updated is unclear. Here we employ psychophysics and functional magnetic resonance imaging to pinpoint the behavioral and neural substrates of dynamic recalibration of expected temporal delays in self-touch. Our psychophysical results reveal that self-touches are less attenuated after systematic exposure to delayed self-generated touches, while responses in the contralateral somatosensory cortex that normally distinguish between delayed and nondelayed self-generated touches become indistinguishable. During the exposure, the ipsilateral anterior cerebellum shows increased activity, supporting its proposed role in recalibrating sensorimotor predictions. Moreover, responses in the cingulate areas gradually increase, suggesting that as delay adaptation progresses, the nondelayed self-touches trigger activity related to cognitive conflict. Together, our results show that sensorimotor predictions in the simplest act of touching one's own body are upheld by a sophisticated and flexible neural mechanism that maintains them accurate in time.

Distinct learning, retention, and generalization patterns in de novo learning versus motor adaptation

People correct for movement errors when acquiring new motor skills (de novo learning) or adapting well-known movements (motor adaptation). While de novo learning establishes new control policies, adaptation modifies existing ones, and previous work have distinguished behavioral and underlying brain mechanisms for each motor learning type. However, it is still unclear whether learning in each type interferes with the other. In study 1, we use a within-subjects design where participants train with both 30° visuomotor rotation and mirror reversal perturbations, to compare adaptation and de novo learning respectively. We find no perturbation order effects, and find no evidence for differences in learning rates and asymptotes for both perturbations. Explicit instructions also provide an advantage during early learning in both perturbations. However, mirror reversal learning shows larger inter-participant variability and slower movement initiation. Furthermore, we only observe reach aftereffects following rotation training. In study 2, we incorporate the mirror reversal in a browser-based task, to investigate under-studied de novo learning mechanisms like retention and generalization. Learning persists across three or more days, substantially transfers to the untrained hand, and to targets on both sides of the mirror axis. Our results extend insights for distinguishing motor skill acquisition from adapting well-known movements.

Effect of psychostimulant medications on physical function in children with cerebral palsy: scoping review

The aim of this scoping review is to examine the extent and depth of the literature on effects of central nervous system (CNS) stimulant medications on physical function in children with cerebral palsy (CP). A systematic search for relevant peer-reviewed studies was conducted of PubMed, CINAHL, Cochrane, SPORTDiscus, Embase, & Scopus (January 2002 & August 2022). We included studies that examined the effects of CNS stimulants on physical function in children with CP. Four studies met our selection criteria. All studies explored the effect of Modafinil on physical function outcomes. Three studies of the four included studies reported positive effects of Modafinil on spasticity, motor performance, and gait, whereas one study reported no significant effects of Modafinil. Our findings suggest that there is very low-quality evidence that suggests that Modafinil may enhance physical improvements in body structure and function, including reduction in spasticity and improvements in gait parameters. IMPACT: Central nervous system stimulants were examined for efficacy on physical function and spasticity in children with cerebral palsy. The evidence on the effects of central nervous system stimulants on physical function in children with CP is limited and inconsistent.

Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial

BACKGROUND

Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations.

OBJECTIVE

The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP.

METHODS

This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure-66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test.

RESULTS

The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024.

CONCLUSIONS

The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/53728.

Enhancing Motor Sequence Learning via Transcutaneous Auricular Vagus Nerve Stimulation (taVNS): An EEG Study

Motor learning plays a crucial role in human life, and various neuromodulation methods have been utilized to strengthen or improve it. Transcutaneous auricular vagus nerve stimulation (taVNS) has gained increasing attention due to its non-invasive nature, affordability and ease of implementation. Although the potential of taVNS on regulating motor learning has been suggested, its actual regulatory effect has yet been fully explored. Electroencephalogram (EEG) analysis provides an in-depth understanding of cognitive processes involved in motor learning so as to offer methodological support for regulation of motor learning. To investigate the effect of taVNS on motor learning, this study recruited 22 healthy subjects to participate a single-blind, sham-controlled, and within-subject serial reaction time task (SRTT) experiment. Every subject involved in two sessions at least one week apart and received a 20-minute active/sham taVNS in each session. Behavioral indicators as well as EEG characteristics during the task state, were extracted and analyzed. The results revealed that compared to the sham group, the active group showed higher learning performance. Additionally, the EEG results indicated that after taVNS, the motor-related cortical potential amplitudes and alpha-gamma modulation index decreased significantly and functional connectivity based on partial directed coherence towards frontal lobe was enhanced. These findings suggest that taVNS can improve motor learning, mainly through enhancing cognitive and memory functions rather than simple movement learning. This study confirms the positive regulatory effect of taVNS on motor learning, which is particularly promising as it offers a potential avenue for enhancing motor skills and facilitating rehabilitation.

The human somatosensory cortex contributes to the encoding of newly learned movements

Recent studies have indicated somatosensory cortex involvement in motor learning and retention. However, the nature of its contribution is unknown. One possibility is that the somatosensory cortex is transiently engaged during movement. Alternatively, there may be durable learning-related changes which would indicate sensory participation in the encoding of learned movements. These possibilities are dissociated by disrupting the somatosensory cortex following learning, thus targeting learning-related changes which may have occurred. If changes to the somatosensory cortex contribute to retention, which, in effect, means aspects of newly learned movements are encoded there, disruption of this area once learning is complete should lead to an impairment. Participants were trained to make movements while receiving rotated visual feedback. The primary motor cortex (M1) and the primary somatosensory cortex (S1) were targeted for continuous theta-burst stimulation, while stimulation over the occipital cortex served as a control. Retention was assessed using active movement reproduction, or recognition testing, which involved passive movements produced by a robot. Disruption of the somatosensory cortex resulted in impaired motor memory in both tests. Suppression of the motor cortex had no impact on retention as indicated by comparable retention levels in control and motor cortex conditions. The effects were learning specific. When stimulation was applied to S1 following training with unrotated feedback, movement direction, the main dependent variable, was unaltered. Thus, the somatosensory cortex is part of a circuit that contributes to retention, consistent with the idea that aspects of newly learned movements, possibly learning-updated sensory states (new sensory targets) which serve to guide movement, may be encoded there.

Comparing Taste Perception Across Modalities in Healthy Adults: Liquids Versus Dissolvable Taste Strips

Taste stimulation has rehabilitative value in dysphagia management, as it activates salient underlying afferent pathways to swallowing which may evoke feedforward effects on swallow biomechanics. Despite its potential beneficial effects on swallow physiology, taste stimulation's clinical application is limited for persons unsafe to orally consume food/liquid. This study aimed to create edible, dissolvable taste strips matched to flavor profiles previously used in research assessing taste's effects on swallowing physiology and brain activity, and to evaluate how similar their perceived intensity and hedonic, or palatability, ratings were between their liquid counterparts. Plain, sour, sweet-sour, lemon, and orange flavor profiles were custom-made in taste strips and liquid modalities. The generalized Labeled Magnitude Scale and hedonic generalized Labeled Magnitude Scale were used to assess intensity and palatability ratings for flavor profiles in each modality. Healthy participants were recruited and stratified across age and sex. Liquids were rated as more intense than taste strips; however, there was no difference in palatability ratings between the modalities. There were significant differences across flavor profiles in intensity and palatability ratings. Collapsed across liquid and taste strip modalities, pairwise comparisons revealed all flavored stimuli were rated as more intense than the plain profile, sour was perceived as more intense and less palatable than all other profiles, and orange was rated as more palatable than sour, lemon, and plain tastants. Taste strips have useful implications for dysphagia management, as they could offer safe and patient-preferred flavor profiles to potentially provide advantageous swallowing and neural hemodynamic responses.

Memory consolidation of sequence learning and dynamic adaptation during wakefulness

Motor learning involves acquiring new movement sequences and adapting motor commands to novel conditions. Labile motor memories, acquired through sequence learning and dynamic adaptation, undergo a consolidation process during wakefulness after initial training. This process stabilizes the new memories, leading to long-term memory formation. However, it remains unclear if the consolidation processes underlying sequence learning and dynamic adaptation are independent and if distinct neural regions underpin memory consolidation associated with sequence learning and dynamic adaptation. Here, we first demonstrated that the initially labile memories formed during sequence learning and dynamic adaptation were stabilized against interference through time-dependent consolidation processes occurring during wakefulness. Furthermore, we found that sequence learning memory was not disrupted when immediately followed by dynamic adaptation and vice versa, indicating distinct mechanisms for sequence learning and dynamic adaptation consolidation. Finally, by applying patterned transcranial magnetic stimulation to selectively disrupt the activity in the primary motor (M1) or sensory (S1) cortices immediately after sequence learning or dynamic adaptation, we found that sequence learning consolidation depended on M1 but not S1, while dynamic adaptation consolidation relied on S1 but not M1. For the first time in a single experimental framework, this study revealed distinct neural underpinnings for sequence learning and dynamic adaptation consolidation during wakefulness, with significant implications for motor skill enhancement and rehabilitation.

Deep Learning for Neuromuscular Control of Vocal Source for Voice Production

A computational neuromuscular control system that generates lung pressure and three intrinsic laryngeal muscle activations (cricothyroid, thyroarytenoid, and lateral cricoarytenoid) to control the vocal source was developed. In the current study, LeTalker, a biophysical computational model of the vocal system was used as the physical plant. In the LeTalker, a three-mass vocal fold model was used to simulate self-sustained vocal fold oscillation. A constant/ǝ/vowel was used for the vocal tract shape. The trachea was modeled after MRI measurements. The neuromuscular control system generates control parameters to achieve four acoustic targets (fundamental frequency, sound pressure level, normalized spectral centroid, and signal-to-noise ratio) and four somatosensory targets (vocal fold length, and longitudinal fiber stress in the three vocal fold layers). The deep-learning-based control system comprises one acoustic feedforward controller and two feedback (acoustic and somatosensory) controllers. Fifty thousand steady speech signals were generated using the LeTalker for training the control system. The results demonstrated that the control system was able to generate the lung pressure and the three muscle activations such that the four acoustic and four somatosensory targets were reached with high accuracy. After training, the motor command corrections from the feedback controllers were minimal compared to the feedforward controller except for thyroarytenoid muscle activation.

Disruption of somatosensory cortex impairs motor learning and retention

This study tests for a function of the somatosensory cortex, that, in addition to its role in processing somatic afferent information, somatosensory cortex contributes both to motor learning and the stabilization of motor memory. Continuous theta-burst magnetic stimulation (cTBS) was applied, before force-field training to disrupt activity in either the primary somatosensory cortex, primary motor cortex, or a control zone over the occipital lobe. Tests for retention and relearning were conducted after a 24 h delay. Analysis of movement kinematic measures and force-channel trials found that cTBS to somatosensory cortex disrupted both learning and subsequent retention, whereas cTBS to motor cortex had little effect on learning but possibly impaired retention. Basic movement variables are unaffected by cTBS suggesting that the stimulation does not interfere with movement but instead disrupts changes in the cortex that are necessary for learning. In all experimental conditions, relearning in an abruptly introduced force field, which followed retention testing, showed extensive savings, which is consistent with previous work suggesting that more cognitive aspects of learning and retention are not dependent on either of the cortical zones under test. Taken together, the findings are consistent with the idea that motor learning is dependent on learning-related activity in the somatosensory cortex.NEW & NOTEWORTHY This study uses noninvasive transcranial magnetic stimulation to test the contribution of somatosensory and motor cortex to human motor learning and retention. Continuous theta-burst stimulation is applied before learning; participants return 24 h later to assess retention. Disruption of the somatosensory cortex is found to impair both learning and retention, whereas disruption of the motor cortex has no effect on learning. The findings are consistent with the idea that motor learning is dependent upon learning-related plasticity in somatosensory cortex.

Proprioceptive short-term memory in passive motor learning

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

Reoptimization of single-joint motor patterns to non-Earth gravity torques induced by a robotic exoskeleton

Gravity is a ubiquitous component of our environment that we have learned to optimally integrate in movement control. Yet, altered gravity conditions arise in numerous applications from space exploration to rehabilitation, thereby pressing the sensorimotor system to adapt. Here, we used a robotic exoskeleton to reproduce the elbow joint-level effects of arbitrary gravity fields ranging from 1g to -1g, passing through Mars- and Moon-like gravities, and tested whether humans can reoptimize their motor patterns accordingly. By comparing the motor patterns of actual arm movements with those predicted by an optimal control model, we show that our participants (N = 61 ) adapted optimally to each gravity-like torque. These findings suggest that the joint-level effects of a large range of gravities can be efficiently apprehended by humans, thus opening new perspectives in arm weight support training in manipulation tasks, whether it be for patients or astronauts.

Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke

BACKGROUND

Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV).

METHODS

In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation.

RESULTS

(1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions.

CONCLUSIONS

These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.

Benefits of Enacting and Observing Gestures on Foreign Language Vocabulary Learning: A Systematic Review and Meta-Analysis

The integration of physical movements, such as gestures, into learning holds potential for enhancing foreign language (L2) education. Uncovering whether actively performing gestures during L2 learning is more, or equally, effective compared to simply observing such movements is central to deepening our understanding of the efficacy of movement-based learning strategies. Here, we present a meta-analysis of seven studies containing 309 participants that compares the effects of gesture self-enactment and observation on L2 vocabulary learning. The results showed that gesture observation was just as effective for L2 learning as gesture enactment, based on free recall, cued L2 recognition, and cued native language recognition performance, with a large dispersion of true effect across studies. Gesture observation may be sufficient for inducing embodied L2 learning benefits, in support of theories positing shared mechanisms underlying enactment and observation. Future studies should examine the effects of gesture-based learning over longer time periods with larger sample sizes and more diverse word classes.

Neurophysiological, muscular, and perceptual adaptations of exoskeleton use over days during overhead work with competing cognitive demands

This study captured neurophysiological, muscular, and perceptual adaptations to shoulder exoskeleton use during overhead work with competing physical-cognitive demands. Twenty-four males and females, randomly divided into control and exoskeleton groups, performed an overhead reaching and pointing task over three days without (single task) and with (dual task) a working memory task. Task performance, electromyography (EMG), neural activity, heart rate, and subjective responses were collected. While task completion time reduced for both groups at the same rate over days, EMG activity of shoulder muscles was lower for the exoskeleton group for both tasks, specifically for females during the dual task. Dual task reduced the physiological benefits of exoskeletons and neuromotor strategies to adapt to the dual task demands differed between the groups. Neuromuscular benefits of exoskeleton use were immediately realized irrespective of cognitive demand, however the perceptual, physiological, and neural adaptations with exoskeleton use were task- and sex-specific.

A robot-aided visuomotor wrist training induces motor and proprioceptive learning that transfers to the untrained ipsilateral elbow

BACKGROUND

Learning of a visuomotor task not only leads to changes in motor performance but also improves proprioceptive function of the trained joint/limb system. Such sensorimotor learning may show intra-joint transfer that is observable at a previously untrained degrees of freedom of the trained joint.

OBJECTIVE

Here, we examined if and to what extent such learning transfers to neighboring joints of the same limb and whether such transfer is observable in the motor as well as in the proprioceptive domain. Documenting such intra-limb transfer of sensorimotor learning holds promise for the neurorehabilitation of an impaired joint by training the neighboring joints.

METHODS

Using a robotic exoskeleton, 15 healthy young adults (18-35 years) underwent a visuomotor training that required them to make continuous, increasingly precise, small amplitude wrist movements. Wrist and elbow position sense just-noticeable-difference (JND) thresholds and spatial movement accuracy error (MAE) at wrist and elbow in an untrained pointing task were assessed before and immediately after, as well as 24 h after training.

RESULTS

First, all participants showed evidence of proprioceptive and motor learning in both trained and untrained joints. The mean JND threshold decreased significantly by 30% in trained wrist (M: 1.26° to 0.88°) and by 35% in untrained elbow (M: 1.96° to 1.28°). Second, mean MAE in untrained pointing task reduced by 20% in trained wrist and the untrained elbow. Third, after 24 h the gains in proprioceptive learning persisted at both joints, while transferred motor learning gains had decayed to such extent that they were no longer significant at the group level.

CONCLUSION

Our findings document that a one-time sensorimotor training induces rapid learning gains in proprioceptive acuity and untrained sensorimotor performance at the practiced joint. Importantly, these gains transfer almost fully to the neighboring, proximal joint/limb system.

Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions

Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.

Does visual experience influence arm proprioception and its lateralization? Evidence from passive matching performance in congenitally-blind and sighted adults

In humans, body segments' position and movement can be estimated from multiple senses such as vision and proprioception. It has been suggested that vision and proprioception can influence each other and that upper-limb proprioception is asymmetrical, with proprioception of the non-dominant arm being more accurate and/or precise than proprioception of the dominant arm. However, the mechanisms underlying the lateralization of proprioceptive perception are not yet understood. Here we tested the hypothesis that early visual experience influences the lateralization of arm proprioceptive perception by comparing 8 congenitally-blind and 8 matched, sighted right-handed adults. Their proprioceptive perception was assessed at the elbow and wrist joints of both arms using an ipsilateral passive matching task. Results support and extend the view that proprioceptive precision is better at the non-dominant arm for blindfolded sighted individuals. While this finding was rather systematic across sighted individuals, proprioceptive precision of congenitally-blind individuals was not lateralized as systematically, suggesting that lack of visual experience during ontogenesis influences the lateralization of arm proprioception.

What does receiving autism diagnosis in adulthood look like? Stakeholders' experiences and inputs

INTRODUCTION

The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood.

METHOD

We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces.

RESULTS

Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey.

CONCLUSION

This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible.

Table Tennis, as a Method of Sensorimotor Training, Induces Haptic and Motor Gains in Children With a Probable Developmental Coordination Disorder

This study examined whether table tennis as a method of sensorimotor training improves haptic and motor function and to what extent haptic function gain correlates with changes in motor ability in children with probable developmental coordination disorder (pDCD). Children with pDCD were randomly assigned to the table tennis and nontraining control groups. The children in the table tennis group received 36 sessions of table tennis training, including ball balancing, hitting the ball against the wall, strokes, and serving. Haptic sensitivity, acuity, and motor function domains were measured. The results showed a 41.5% improvement in haptic sensitivity in children exposed to table tennis training compared with 2.8% in those without training. This improved haptic sensitivity significantly correlated with motor function gain, suggesting that somatosensory gains occur simultaneously with changes in motor function in children with pDCD. This novel upper limb motor training approach may be an interesting method of sensorimotor training in neurological rehabilitation in children with pDCD.

Passive somatosensory training enhances piano skill in adolescent and adult pianists: A preliminary study

Sensory afferent information, such as auditory and somatosensory feedback while moving, plays a crucial role in both control and learning of motor performance across the lifespan. Music performance requires skillful integration of multimodal sensory information for the production of dexterous movements. However, it has not been understood what roles somatosensory afferent information plays in the acquisition and sophistication of specialized motor skills of musicians across different stages of development. In the present preliminary study, we addressed this issue by using a novel technique with a hand exoskeleton robot that can externally move the fingers of pianists. Short-term exposure to fast and complex finger movements generated by the exoskeleton (i.e., passive movements) increased the maximum rate of repetitive piano keystrokes by the pianists. This indicates that somatosensory inputs derived from the externally generated motions enhanced the quickness of the sequential finger movements in piano performance, even though the pianists did not voluntarily move the fingers. The enhancement of motor skill through passive somatosensory training using the exoskeleton was more pronounced in adolescent pianists than adult pianists. These preliminary results implicate a sensitive period of neuroplasticity of the somatosensory-motor system of trained pianists, which emphasizes the importance of somatosensory-motor training in professional music education during adolescence.

Neural recovery after cortical injury: Effects of MSC derived extracellular vesicles on motor circuit remodeling in rhesus monkeys

Reorganization of motor circuits in the cortex and corticospinal tract are thought to underlie functional recovery after cortical injury, but the mechanisms of neural plasticity that could be therapeutic targets remain unclear. Recent work from our group have shown that systemic treatment with mesenchymal stem cell derived (MSCd) extracellular vesicles (EVs) administered after cortical damage to the primary motor cortex (M1) of rhesus monkeys resulted in a robust recovery of fine motor function and reduced chronic inflammation. Here, we used immunohistochemistry for cfos, an activity-dependent intermediate early gene, to label task-related neurons in the surviving primary motor and premotor cortices, and markers of axonal and synaptic plasticity in the spinal cord. Compared to vehicle, EV treatment was associated with a greater density of cfos+ pyramidal neurons in the deep layers of M1, greater density of cfos+ inhibitory interneurons in premotor areas, and lower density of synapses on MAP2+ lower motor neurons in the cervical spinal cord. These data suggest that the anti-inflammatory effects of EVs may reduce injury-related upper motor neuron damage and hyperexcitability, as well as aberrant compensatory re-organization in the cervical spinal cord to improve motor function.

Multisensory interactions on auditory and somatosensory information in expert pianists

Fine-tuned sensory functions typically characterize skilled individuals. Although numerous studies demonstrated enhanced unimodal sensory functions at both neural and behavioral levels in skilled individuals, little is known about their multisensory interaction function, especially multisensory integration and selective attention that involve volitional control of information derived from multiple sensory organs. In the current study, expert pianists and musically untrained individuals performed five sets of intensity discrimination tasks at the auditory and somatosensory modalities with different conditions: (1) auditory stimulus, (2) somatosensory stimulus, (3) congruent auditory and somatosensory stimuli (i.e., multisensory integration), (4) auditory and task-irrelevant somatosensory stimuli, and (5) somatosensory and task-irrelevant auditory stimuli. In the fourth and fifth conditions, participants were instructed to ignore a task-irrelevant stimulus and to pay attention to a task-relevant stimulus (i.e., selective attention), respectively. While the discrimination perception was superior in the condition (3) compared to the better one of the individual unimodal conditions only in the pianists, the task-irrelevant somatosensory stimulus worsened the auditory discrimination more in the pianists than the nonmusicians. These findings indicate unique multisensory interactions in expert pianists, which enables pianists to efficiently integrate the auditory and somatosensory information, but exacerbates top-down selective inhibition of somatosensory information during auditory processing.

Changes in excitability and GABAergic neuronal activity of the primary somatosensory cortex after motor learning

Introduction

It is widely known that motor learning changes the excitability of the primary motor cortex. More recently, it has been shown that the primary somatosensory cortex (S1) also plays an important role in motor learning, but the details have not been fully examined. Therefore, we investigated how motor skill training affects somatosensory evoked potential (SEP) in 30 neurologically healthy subjects.

Methods

SEP N20/P25_component and N20/P25 SEP paired-pulse depression (SEP-PPD) were assessed before and immediately after complex or simple visuomotor tasks.

Results

Motor learning was induced more efficiently by the complex visuomotor task than by the simple visuomotor task. Both the N20/P25 SEP amplitude and N20/P25 SEP-PPD increased significantly immediately after the complex visuomotor task, but not after the simple visuomotor task. Furthermore, the altered N20/P25 SEP amplitude was associated with an increase in motor learning efficiency.

Conclusion

These results suggest that motor learning modulated primary somatosensory cortex excitability.

I Can Step Clearly Now, the TENS Is On: Transcutaneous Electric Nerve Stimulation Decreases Sensorimotor Uncertainty during Stepping Movements

Transcutaneous electric nerve stimulation (TENS) is a method of electrical stimulation that elicits activity in sensory nerves and leads to improvements in the clinical metrics of mobility. However, the underlying perceptual mechanisms leading to this improvement are unknown. The aim of this study was to apply a Bayesian inference model to understand how TENS impacts sensorimotor uncertainty during full body stepping movements. Thirty healthy adults visited the lab on two occasions and completed a motor learning protocol in virtual reality (VR) on both visits. Participants were randomly assigned to one of three groups: TENS on first visit only (TN), TENS on second visit only (NT), or a control group where TENS was not applied on either visit (NN). Using methods of Bayesian inference, we calculated the amount of uncertainty in the participants' center of mass (CoM) position estimates on each visit. We found that groups TN and NT decreased the amount of uncertainty in the CoM position estimates in their second visit while group NN showed no difference. The least amount of uncertainty was seen in the TN group. These results suggest that TENS reduces the amount of uncertainty in sensory information, which may be a cause for the observed benefits with TENS.

Critical review of multisensory integration programs and proposal of a theoretical framework for its combination with neurocognitive training

INTRODUCTION

The main purpose of this manuscript is to critically review the Multisensory Integration (MI) training programs applied to older adults, their characteristics, target sensory systems, efficacy, assessment methods, and results. We also intend to propose an integrated framework to support combined interventions of neurocognitive and sensory training.

AREAS COVERED

A critical review was conducted covering the most relevant literature on the MI training programs applied to older adults. Two MI training programs applied to cognitively healthy older adults were found: (a) audio-visual temporal discrimination training and (b) simultaneity judgment training. Both led to the improvement of the MI between pre- and post-training. However, only the audio-visual temporal discrimination training led to the generalization of the improvements to another MI task.

EXPERT OPINION

Considering the relationship between sensory and cognitive functioning, this review supports the potential advantages of combining MI with neurocognitive training in the rehabilitation of older adults. We suggested that this can be achieved within the framework of Branched Programmed Neurocognitive Training (BPNT). Criteria for deciding the most suitable multisensory intervention, that is, MI or Multisensory Stimulation, and general guidelines for the development of MI intervention protocols with older adults with or without cognitive impairment are provided.

Tactile Sensation Improves Following Motor Rehabilitation for Chronic Stroke: The VIGoROUS Randomized Controlled Trial

Background. Up to 85% of people with chronic stroke experience somatosensory impairment, which contributes to poor sensorimotor control and non-use of the affected limb. Neurophysiological mechanisms suggest motor rehabilitation may improve tactile sense post-stroke, however, somatosensory recovery has rarely been reported in controlled trials. Objective. To compare the effect of four upper limb motor rehabilitation programs on the recovery of tactile sensation in adults with chronic stroke. Methods. Adults with chronic stroke and mild or moderate upper extremity hemiparesis (n = 167) were enrolled in a multi-site randomized controlled trial. Participants completed three weeks of gaming therapy, gaming therapy with additional telerehabilition, Constraint-Induced Movement therapy, or traditional rehabilitation. Here, we report the results of a secondary outcome, tactile sensation, measured with monofilaments, before and after treatment, and 6 months later. Results. A mixed-effects general linear model revealed similar positive change in tactile sensitivity regardless of the type of training. On average, participants were able to detect a stimulus that was 32% and 33% less after training and at 6-month follow-up, respectively. One-third of participants experienced recategorization of their level of somatosensory impairment (e.g., regained protective sensation) following training. Poorer tactile sensation at baseline was associated with greater change. Conclusions. About one-third of individuals with mild/moderate chronic hemiparesis experience sustained improvements in tactile sensation following motor rehabilitation, regardless of the extent of tactile input in the rehabilitation program. Potential for sensory improvement is an additional motivator for those post-stroke. Characteristics of those who improve and mechanisms of improvement are important future questions. Clinicaltrials.gov NCT02631850.

Identifying Oscillations under Multi-site Sensory Stimulation for High-level Peripheral Nerve Injured Patients：A Pilot Study

OBJECTIVE

For high-level peripheral nerve injured (PNI) patients with severe sensory dysfunction of upper extremities, identifying the multi-site tactile stimulation is of great importance to provide neurorehabilitation with sensory feedback. In this pilot study, we showed the feasibility of identifying multi-site and multi-intensity tactile stimulation in terms of electroencephalography (EEG).

APPROACH

Three high-level PNI patients and eight non-PNI participants were recruited in this study. Four different sites over the upper arm, forearm, thumb finger and little finger were randomly stimulated at two intensities (both sensory-level) based on the transcutaneous electrical nerve stimulation (TENS). Meanwhile, 64-channel EEG signals were recorded during the passive tactile sense stimulation on each side.

MAIN RESULTS

The spatial-spectral distribution of brain oscillations underlying multi-site sensory stimulation showed dominant power attenuation over the somatosensory and prefrontal cortices in both alpha-band (8-12 Hz) and beta-band (13-30 Hz). But there was no significant difference among different stimulation sites in terms of the averaged power spectral density over the region of interest (ROI). By further identifying different stimulation sites using temporal-spectral features, we found the classification accuracies were all above 89% for the affected arm of PNI patients, comparable to that from their intact side and that from the non-PNI group. When the stimulation site-intensity combinations were treated as eight separate classes, the classification accuracies were ranging from 88.89% to 99.30% for the affected side of PNI subjects, similar to that from their non-affected side and that from the non-PNI group. Other performance metrics, including Specificity, Precision, and F1-Score, also showed a sound identification performance for both PNI patients and non-PNI subjects.

SIGNIFICANCE

These results suggest that reliable brain oscillations could be evoked and identified well, even though induced tactile sense could not be discerned by the PNI patients. This study have implication for facilitating bidirectional neurorehabilitation systems with sensory feedback.

Interrelationships of Touch and Proprioception with Motor Impairments in Individuals with Cerebral Palsy: A Systematic Review

Considering that somatosensory impairments may impact motor performance in individuals with cerebral palsy (CP), a better understanding of these relations is relevant to planning interventions. To synthesize research evidence to date on the interrelationships between the somatosensory functions of touch and proprioception with motor functions in persons with CP, we systematically searched Embase, CINAHL, PsycINFO, and Medline databases for studies relating these variables that were published in English from the inception of these databases to November 2020. We targeted the following content categories in our literature search: (a) cerebral palsy; (b) sensory functions; (c) tactile functions; (d) proprioception functions; and (e) motor functions. The selection, data extraction, and methodological quality assessment of these studies were performed in duplicate. We retrieved and analyzed information regarding the studies' methodological approaches and synthesized results. The 11 studies that met our inclusion criteria showed that, in individuals with CP, impairments in tactile discrimination, proprioception, and stereognosis are related to motor functions in terms of overall manual ability, grip strength, postural control and locomotion. Thus, clinical practitioners should attend to somatosensory aspects of motor impairment in individuals with CP. More research is needed to clarify the direction of these associations.

Are tools truly incorporated as an extension of the body representation?: Assessing the evidence for tool embodiment

The predominant view on human tool-use suggests that an action-oriented body representation, the body schema, is altered to fit the tool being wielded, a phenomenon termed tool embodiment. While observations of perceptual change after tool-use purport to support this hypothesis, several issues undermine their validity in this context, discussed at length in this critical review. The primary measures used as indicators of tool embodiment each face unique challenges to their construct validity. Further, the perceptual changes taken as indicating extension of the body representation only appear to account for a fraction of the tool's size in any given experiment, and do not demonstrate the covariance with tool length that the embodiment hypothesis would predict. The expression of tool embodiment also appears limited to a narrow range of tool-use tasks, as deviations from a simple reaching paradigm can mollify or eliminate embodiment effects altogether. The shortcomings identified here generate important avenues for future research. Until the source of the kinematic and perceptual effects that have substantiated tool embodiment is disambiguated, the hypothesis that the body representation changes to fit tools during tool-use should not be favored over other possibilities such as the formation of separable internal tool models, which seem to offer a more complete account of human tool-use behaviors. Indeed, studies of motor learning have observed analogous perceptual changes as aftereffects to adaptation despite the absence of handheld tool-use, offering a compelling alternative explanation, though more work is needed to confirm this possibility.

Twelve- and Fourteen-Year-Old School Children Differentially Benefit from Sensorimotor- and Multisensory-Enriched Vocabulary Training

Both children and adults have been shown to benefit from the integration of multisensory and sensorimotor enrichment into pedagogy. For example, integrating pictures or gestures into foreign language (L2) vocabulary learning can improve learning outcomes relative to unisensory learning. However, whereas adults seem to benefit to a greater extent from sensorimotor enrichment such as the performance of gestures in contrast to multisensory enrichment with pictures, this is not the case in elementary school children. Here, we compared multisensory- and sensorimotor-enriched learning in an intermediate age group that falls between the age groups tested in previous studies (elementary school children and young adults), in an attempt to determine the developmental time point at which children’s responses to enrichment mature from a child-like pattern into an adult-like pattern. Twelve-year-old and fourteen-year-old German children were trained over 5 consecutive days on auditorily presented, concrete and abstract, Spanish vocabulary. The vocabulary was learned under picture-enriched, gesture-enriched, and non-enriched (auditory-only) conditions. The children performed vocabulary recall and translation tests at 3 days, 2 months, and 6 months post-learning. Both picture and gesture enrichment interventions were found to benefit children’s L2 learning relative to non-enriched learning up to 6 months post-training. Interestingly, gesture-enriched learning was even more beneficial than picture-enriched learning for the 14-year-olds, while the 12-year-olds benefitted equivalently from learning enriched with pictures and gestures. These findings provide evidence for opting to integrate gestures rather than pictures into L2 pedagogy starting at 14 years of age.

Central vs. Peripheral Vision during a Singe-Leg Drop Jump: Implications of Dynamics and Patellofemoral Joint Stress

Landing on a single-leg without receiving direct visual information (e.g., not looking at the ground) may increase the risk of injury. We examined whether visual focus contributed to the changing lower-extremity dynamics and patellofemoral joint stress during a single-leg drop jump task. Twenty healthy volunteers visited the laboratory for three separate sessions. During each session, participants randomly performed either of two types of a single-leg drop jump task from a 30 cm high wooden box. Subsequently, participants looked at the landing spot (central vision condition) or kept their heads up (peripheral vision condition) when performing the task. Sagittal and frontal plane lower-extremity joint angles and joint moments (in the ankle, knee, and hip), including the vertical ground reaction force, and patellofemoral joint stress during the first landing phase (from initial contact to peak knee flexion) were compared. Greater ankle inversion and hip adduction were observed when landing with the peripheral vision condition. However, the magnitudes were negligeable (Cohen’s d effect size <0.35). No statistical difference was observed in other comparisons. Landing on a single-leg from a 30 cm height without receiving full visual attention (peripheral vision condition) does not increase the risk of lower-extremity traumatic and overuse injuries.

Intrinsic somatosensory feedback supports motor control and learning to operate artificial body parts

Objective.Considerable resources are being invested to enhance the control and usability of artificial limbs through the delivery of unnatural forms of somatosensory feedback. Here, we investigated whether intrinsic somatosensory information from the body part(s) remotely controlling an artificial limb can be leveraged by the motor system to support control and skill learning.Approach.We used local anaesthetic to attenuate somatosensory inputs to the big toes while participants learned to operate through pressure sensors a toe-controlled and hand-worn robotic extra finger. Motor learning outcomes were compared against a control group who received sham anaesthetic and quantified in three different task scenarios: while operating in isolation from, in synchronous coordination, and collaboration with, the biological fingers.Main results.Both groups were able to learn to operate the robotic extra finger, presumably due to abundance of visual feedback and other relevant sensory cues. Importantly, the availability of displaced somatosensory cues from the distal bodily controllers facilitated the acquisition of isolated robotic finger movements, the retention and transfer of synchronous hand-robot coordination skills, and performance under cognitive load. Motor performance was not impaired by toes anaesthesia when tasks involved close collaboration with the biological fingers, indicating that the motor system can close the sensory feedback gap by dynamically integrating task-intrinsic somatosensory signals from multiple, and even distal, body-parts.Significance.Together, our findings demonstrate that there are multiple natural avenues to provide intrinsic surrogate somatosensory information to support motor control of an artificial body part, beyond artificial stimulation.

Mechanisms of Human Motor Learning Do Not Function Independently

Human motor learning is governed by a suite of interacting mechanisms each one of which modifies behavior in distinct ways and rely on different neural circuits. In recent years, much attention has been given to one type of motor learning, called motor adaptation. Here, the field has generally focused on the interactions of three mechanisms: sensory prediction error SPE-driven, explicit (strategy-based), and reinforcement learning. Studies of these mechanisms have largely treated them as modular, aiming to model how the outputs of each are combined in the production of overt behavior. However, when examined closely the results of some studies also suggest the existence of additional interactions between the sub-components of each learning mechanism. In this perspective, we propose that these sub-component interactions represent a critical means through which different motor learning mechanisms are combined to produce movement; understanding such interactions is critical to advancing our knowledge of how humans learn new behaviors. We review current literature studying interactions between SPE-driven, explicit, and reinforcement mechanisms of motor learning. We then present evidence of sub-component interactions between SPE-driven and reinforcement learning as well as between SPE-driven and explicit learning from studies of people with cerebellar degeneration. Finally, we discuss the implications of interactions between learning mechanism sub-components for future research in human motor learning.

Passive Proprioceptive Training Alters the Sensitivity of Muscle Spindles to Imposed Movements

Humans rely on precise proprioceptive feedback from our muscles, which is important in both the acquisition and execution of movements, to perform daily activities. Somatosensory input from the body shapes motor learning through central processes, as demonstrated for tasks using the arm, under active (self-generated) and passive conditions. Presently, we investigated whether passive movement training of the ankle increased proprioceptive acuity (psychophysical experiment) and whether it changed the peripheral proprioceptive afferent signal (microneurography experiment). In the psychophysical experiment, the ankle of 32 healthy human participants was moved passively using pairs of ramp-and-hold movements in different directions. In a pretraining test, participants made judgements about the movement direction in a two-alternative forced choice paradigm. Participants then underwent passive movement training, but only half were cued for learning, where a reference position was signaled by a sound and the participant had to learn to recognize this position; they then completed a post-training test. In a paradigm using the same setup, nine healthy participants underwent microneurography recordings of Ia muscle afferents from the peroneal nerve, where all were cued during training. In the psychophysical experiment, proprioceptive acuity improved with training only in the cued group. In the microneurography experiment, we found that muscle afferent firing was modulated, via an increase in the dynamic index, after training. We suggest that changes in muscle afferent input from the periphery can contribute to and support central perceptual and motor learning, as shown under passive conditions using ankle movements, which may be exploited for movement rehabilitation.

Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors

OBJECTIVE

Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity.

APPROACH

In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30-minute treatment of continuous passive motion (CPM) using a robotic glove.

MAIN RESULTS

On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network.

SIGNIFICANCE

This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.

Identifying knowledge important to teach about the nervous system in the context of secondary biology and science education-A Delphi study

Teaching about the nervous system has become a challenging task in secondary biology and science education because of the fast development in the field of neuroscience. A major challenge is to determine what content to teach. Curricula goals are often too general to guide instruction, and information about the nervous system has become overwhelming and diverse with ubiquitous relevance in society. In addition, several misconceptions and myths are circulating in educational communities causing world-wide confusion as to what content is correct. To help teachers, textbook authors, and curricula developers in this challenging landscape of knowledge, the aim of the present study is to identify the expert view on what knowledge is important for understanding the nervous system in the context of secondary biology and science education. To accomplish this, we have conducted a thematic content analysis of textbooks followed by a Delphi study of 15 experts in diverse but relevant fields. The results demonstrate six curriculum themes including gross anatomy and function, cell types and functional units, the nerve signal, connections between neurons, when nerve signals travel through networks of neurons, and plasticity in the nervous system, as well as 26 content principles organized in a coherent curriculum progression from general content to more specific content. Whereas some of the principles clarify and elaborate on traditional school biology knowledge, others add new knowledge to the curriculum. Importantly, the new framework for teaching about the nervous system presented here, meets the needs of society, as expressed by recent international policy frameworks of OECD and WHO, and it addresses common misconceptions about the brain. The study suggests an update of the biology and science curriculum.

Precision control for a flexible body representation

Adaptive body representation requires the continuous integration of multisensory inputs within a flexible 'body model' in the brain. The present review evaluates the idea that this flexibility is augmented by the contextual modulation of sensory processing 'top-down'; which can be described as precision control within predictive coding formulations of Bayesian inference. Specifically, I focus on the proposal that an attenuation of proprioception may facilitate the integration of conflicting visual and proprioceptive bodily cues. Firstly, I review empirical work suggesting that the processing of visual vs proprioceptive body position information can be contextualised 'top-down'; for instance, by adopting specific attentional task sets. Building up on this, I review research showing a similar contextualisation of visual vs proprioceptive information processing in the rubber hand illusion and in visuomotor adaptation. Together, the reviewed literature suggests that proprioception, despite its indisputable importance for body perception and action control, can be attenuated top-down (through precision control) to facilitate the contextual adaptation of the brain's body model to novel visual feedback.

The various forms of sensorimotor plasticity following limb amputation and their link with rehabilitation strategies

Limb amputation is characterized by complex and intermingled brain reorganization processes combining sensorimotor deprivation induced by the loss of the limb per se, and compensatory behaviors, such as the over-use of the intact or remaining limb. While a large body of evidence documents sensorimotor representation plasticity following arm amputation, less investigations have been performed to fully understand the use-dependent plasticity phenomenon and the role of behavioral compensation in brain reorganization. In this article, I will review the findings on sensorimotor plasticity after limb amputation, focusing on these two aspects: sensorimotor deprivation and adaptive patterns of limb usage, and describe the models that attempt to link these reorganizational processes with phantom limb pain. Two main models have been proposed: the maladaptive plasticity model which states that the reorganization of the adjacent cortical territories into the representation of the missing limb is proportional to phantom pain intensity, and the persistent representation model, which rather suggests that the intensity of residual brain activity associated with phantom hand movements scales with phantom limb pain intensity. I will finally illustrate how this fundamental research helps designing new therapeutic strategies for phantom plain relief.

Motor Cortex Causally Contributes to Vocabulary Translation following Sensorimotor-Enriched Training

The role of the motor cortex in perceptual and cognitive functions is highly controversial. Here, we investigated the hypothesis that the motor cortex can be instrumental for translating foreign language vocabulary. Human participants of both sexes were trained on foreign language (L2) words and their native language translations over 4 consecutive days. L2 words were accompanied by complementary gestures (sensorimotor enrichment) or pictures (sensory enrichment). Following training, participants translated the auditorily presented L2 words that they had learned. During translation, repetitive transcranial magnetic stimulation was applied bilaterally to a site within the primary motor cortex (Brodmann area 4) located in the vicinity of the arm functional compartment. Responses within the stimulated motor region have previously been found to correlate with behavioral benefits of sensorimotor-enriched L2 vocabulary learning. Compared to sham stimulation, effective perturbation by repetitive transcranial magnetic stimulation slowed down the translation of sensorimotor-enriched L2 words, but not sensory-enriched L2 words. This finding suggests that sensorimotor-enriched training induced changes in L2 representations within the motor cortex, which in turn facilitated the translation of L2 words. The motor cortex may play a causal role in precipitating sensorimotor-based learning benefits, and may directly aid in remembering the native language translations of foreign language words following sensorimotor-enriched training. These findings support multisensory theories of learning while challenging reactivation-based theories.SIGNIFICANCE STATEMENT Despite the potential for sensorimotor enrichment to serve as a powerful tool for learning in many domains, its underlying brain mechanisms remain largely unexplored. Using transcranial magnetic stimulation and a foreign language (L2) learning paradigm, we found that sensorimotor-enriched training can induce changes in L2 representations within the motor cortex, which in turn causally facilitate the translation of L2 words. The translation of recently acquired L2 words may therefore rely not only on auditory information stored in memory or on modality-independent L2 representations, but also on the sensorimotor context in which the words have been experienced.

Replicability and reliability of the background and target velocity effects in smooth pursuit eye movements

When we follow a slowly moving target with our eyes, we perform smooth pursuit eye movements (SPEM). Previous investigations point to significantly and robustly reduced SPEM performance in the presence of a stationary background and at higher compared to lower target velocities. However, the reliability of these background and target velocity effects has not yet been investigated systematically. To address this issue, 45 healthy participants (17 m, 28 f) took part in two experimental sessions 7 days apart. In each session, participants were instructed to follow a horizontal SPEM target moving sinusoidally between ±7.89° at three different target velocities, corresponding to frequencies of 0.2, 0.4 and 0.6 Hz. Each target velocity was presented once with and once without a stationary background, resulting in six blocks. The blocks were presented twice per session in order to additionally explore potential task length effects. To assess SPEM performance, velocity gain was calculated as the ratio of eye to target velocity. In line with previous research, detrimental background and target velocity effects were replicated robustly in both sessions with large effect sizes. Good to excellent test-retest reliabilities were obtained at higher target velocities and in the presence of a stationary background, whereas lower reliabilities occurred with slower targets and in the absence of background stimuli. Target velocity and background effects resulted in largely good to excellent reliabilities. These findings not only replicated robust experimental effects of background and target velocity at group level, but also revealed that these effects can be translated into reliable individual difference measures.

An end-to-end CNN with attentional mechanism applied to raw EEG in a BCI classification task

Objective.Motor-imagery (MI) classification base on electroencephalography (EEG) has been long studied in neuroscience and more recently widely used in healthcare applications such as mobile assistive robots and neurorehabilitation. In particular, EEG-based MI classification methods that rely on convolutional neural networks (CNNs) have achieved relatively high classification accuracy. However, naively training CNNs to classify raw EEG data from all channels, especially for high-density EEG, is computationally demanding and requires huge training sets. It often also introduces many irrelevant input features, making it difficult for the CNN to extract the informative ones. This problem is compounded by a dearth of training data, which is particularly acute for MI tasks, because these are cognitively demanding and thus fatigue inducing.Approach.To address these issues, we proposed an end-to-end CNN-based neural network with attentional mechanism together with different data augmentation (DA) techniques. We tested it on two benchmark MI datasets, brain-computer interface (BCI) competition IV 2a and 2b. In addition, we collected a new dataset, recorded using high-density EEG, and containing both MI and motor execution (ME) tasks, which we share with the community.Main results.Our proposed neural-network architecture outperformed all state-of-the-art methods that we found in the literature, with and without DA, reaching an average classification accuracy of 93.6% and 87.83% on BCI 2a and 2b, respectively. We also directly compare decoding of MI and ME tasks. Focusing on MI classification, we find optimal channel configurations and the best DA techniques as well as investigate combining data across participants and the role of transfer learning.Significance.Our proposed approach improves the classification accuracy for MI in the benchmark datasets. In addition, collecting our own dataset enables us to compare MI and ME and investigate various aspects of EEG decoding critical for neuroscience and BCI.

Somatotopic Specificity of Perceptual and Neurophysiological Changes Associated with Visuo-proprioceptive Realignment

When visual and proprioceptive estimates of hand position disagree (e.g., viewing the hand underwater), the brain realigns them to reduce mismatch. This perceptual change is reflected in primary motor cortex (M1) excitability, suggesting potential relevance for hand movement. Here, we asked whether fingertip visuo-proprioceptive misalignment affects only the brain's representation of that finger (somatotopically focal), or extends to other parts of the limb that would be needed to move the misaligned finger (somatotopically broad). In Experiments 1 and 2, before and after misaligned or veridical visuo-proprioceptive training at the index finger, we used transcranial magnetic stimulation to assess M1 representation of five hand and arm muscles. The index finger representation showed an association between M1 excitability and visuo-proprioceptive realignment, as did the pinkie finger representation to a lesser extent. Forearm flexors, forearm extensors, and biceps did not show any such relationship. In Experiment 3, participants indicated their proprioceptive estimate of the fingertip, knuckle, wrist, and elbow, before and after misalignment at the fingertip. Proprioceptive realignment at the knuckle, but not the wrist or elbow, was correlated with realignment at the fingertip. These results suggest the effects of visuo-proprioceptive mismatch are somatotopically focal in both sensory and motor domains.

Two types of sensorimotor strategies for whole-body movement in individuals with stroke: a pilot study

PURPOSE

This study compared the sensory-motor interactions and strategies for whole-body movement in individuals with stroke who had damaged motor system area or sensory system area in the brain.

METHODS

Participants with hemiparesis were asked to perform sit-to-stand movements while their vision was restricted, which can affect completion of the task. The participants were divided into two groups. The first group had no history of lesions in the sensory system area but did have a history of lesions in the motor system area (no damaged sensory-system: NDS). The second group had a history of lesions in the sensory system area of the brain (damaged sensory-system: DS). Center-of-pressure (COP) trajectories were measured to evaluate balance control in participants with and without vision, and numbers of sub-movements (i.e. numbers of segmented movements which reflect the degree of use of the feedback loops) were measured to evaluate feedforward and feedback control. Movement times were also measured.

RESULTS

When vision was restricted, NDS participants showed increased variability in mediolateral COP trajectories during movement and utilized mainly feedforward control. In contrast, DS participants showed reduced variability in mediolateral COP trajectories during movement and utilized additional feedback control.

CONCLUSIONS

These results demonstrate two types of strategies for whole-body movements in individuals with stroke. These differences may be attributed to whether the individual can compensate for vision with somatic senses and whether appropriate processing of somatosensory information has been lost. Individuals with hemiparesis created dexterous and flexible strategies to execute tasks successfully, depending on the characteristics of their sensorimotor disorders.

Sonification of combined action observation and motor imagery: Effects on corticospinal excitability

Action observation and motor imagery are valuable strategies for motor learning. Their simultaneous use (AOMI) increases neural activity, with related benefits for motor learning, compared to the two strategies alone. In this study, we explored how sonification influences AOMI. Twenty-five participants completed a practice block based on AOMI, motor imagery and physical execution of the same action. Participants were divided into two groups: An experimental group that practiced with sonification during AOMI (sAOMI), and a control group, which did not receive any extrinsic feedback. Corticospinal excitability at rest and during action observation and AOMI was assessed before and after practice, with and without sonification sound, to test the development of an audiomotor association. The practice block increased corticospinal excitability in all testing conditions, but sonification did not affect this. In addition, we found no differences in action observation and AOMI, irrespective of sonification. These results suggest that, at least for simple tasks, sonification of AOMI does not influence corticospinal excitability; In these conditions, sonification may have acted as a distractor. Future studies should further explore the relationship between task complexity, value of auditory information and action, to establish whether sAOMI is a valuable for motor learning.