A higher-order mechanism overrules the automatic grip-load force constraint during bimanual asymmetrical movements

Exploring hand coordination as a measure of surgical skill

BACKGROUND

The study aim was to identify residents' coordination between dominant and nondominant hands while grasping for sutures in a laparoscopic ventral hernia repair procedure simulation. We hypothesize residents will rely on their dominant and nondominant hands unequally while grasping for suture.

METHODS

Surgical residents had 15 min to complete the mesh securing and mesh tacking steps of a laparoscopic ventral hernia repair procedure. Procedure videos were coded for manual coordination events during the active suture grasping phase. Manual coordination events were defined as: active motion of dominant, nondominant, or both hands; and bimanual or unimanual manipulation of hands. A chi-square test was used to discriminate between coordination choices.

RESULTS

Thirty-six residents (postgraduate year, 1-5) participated in the study. Residents changed manual coordination types during active suture grasping 500 times, ranging between 5 and 24 events (M = 13.9 events, standard deviation [SD] = 4.4). Bimanual coordination was used most (40%) and required the most time on average (M = 20.6 s, SD = 27.2), while unimanual nondominant coordination was used least (2.2%; M = 7.9 s, SD = 6.9). Residents relied on their dominant and nondominant hands unequally (P < 0.001). During 24% of events, residents depended on their nondominant hand (n = 120), which was predominantly used to operate the suture passer device.

CONCLUSIONS

Residents appeared to actively coordinate both dominant and nondominant hands almost half of the time to complete suture grasping. Bimanual task durations took longer than other tasks on average suggesting these tasks were characteristically longer or switching hands required a greater degree of coordination. Future work is necessary to understand how task completion time and overall performance are affected by residents' hand utilization and switching between dominant and nondominant hands in surgical tasks.

Effects of task complexity on grip-to-load coordination in bimanual actions

We investigated within- and between-hand grip and load force coordination in healthy young subjects during bimanual tasks involving realistic manual actions. Actions involving disparate actions of the two hands (bimanual asymmetry) were expected to result in lower overall measures of within- and between-hand measures of grip and load force coordination. As dissociation between two hands performing disparate actions may be expected, it was also hypothesized that increased task asymmetry would result in a shift toward higher within-hand force coordination. Features such as object rotation were found to reduce some, but not all indices of both within- and between-hand force coordination. The action of connecting two independent objects was associated with declines in all indices of within- and between-hand force coordination. Evidence of task-specific differences in force application timing and a trend toward within-hand grip-load coordination differences in the current data set suggest that individual hand specification emerges naturally in everyday bimanual prehension tasks, independent of the action role of the assigned to the dominant and non-dominant hands.

Subliminal priming and effects of hand dominance

In the masked priming paradigm, motor responses to targets are influenced by previously presented subliminal primes, and are guided by facilitatory and inhibitory mechanisms that depend on prime-target compatibility/duration. In this study, we evaluate subliminal-driven priming in right- and left-handers during unimanual as well as bimanual tasks. The data from the unimanual tasks confirmed that prime-target compatibility affects performance as a function of prime-target duration. In a bimanual setting, the preferred hand benefitted from facilitation in both handedness groups whereas the non-preferred hand showed a positive priming effect only in left-handers. This denotes that left-handers are more susceptible to response activation of either hand. In addition, inhibitory priming had a stronger effect on the non-preferred than preferred hand, independent of handedness group. Overall, the findings suggest that subliminal-driven mechanisms that assist adaptive motor behavior are sensitive not only to extrinsic (task-related) factors such as prime-target compatibility but also to intrinsic (performer-related) factors such as hand dominance. The data further provide support for handedness-specific effects in motor functions and underline a significant role of hand dominance in the control of bimanual actions.

Bimanual grasp planning reflects changing rather than fixed constraint dominance

We studied whether motor-control constraints for grasping objects that are moved to new positions reflect a rigid constraint hierarchy or a flexible constraint hierarchy. In two experiments, we asked participants to move two plungers from the same start locations to different target locations (both high, both low, or one high and one low). We found that participants grasped the plungers symmetrically and at heights that ensured comfortable or easy-to-control end postures when the plungers had the same target heights, but these grasp tendencies were reduced when the plungers had different target heights. In addition, when the plungers had different mass distributions, participants behaved in ways that suggested still-different emphases of the relevant grasp constraints. When the plungers had different mass distributions, participants sacrificed bimanual symmetry for end-state comfort. The results suggest that bimanual grasp planning relies on a flexible rather than static hierarchy. Different constraints take on different degrees of importance depending on the nature of the task and on the level of task experience. The results have implications for the understanding of perceptual-motor skill learning. It may be that one mechanism underlying such learning is changing the priorities of task constraints.

Force coordination in static manipulation: discerning the contribution of muscle synergies and cutaneous afferents

Both an elaborate coordination of the hand grip force (G; normal component of force acting at the digits-object contact area) and load force (L; tangential component), and the role of cutaneous afferents in G-L coordination have been well documented in a variety of manipulation tasks. However, our recent studies revealed that G-L coordination deteriorates when L consecutively changes direction (bidirectional tasks; e.g., when vigorously shaking objects or using tools). The aim of the study was to distinguish between the possible role of the synergy of hand grip and arm muscles (exerting G and L, respectively) and the role of cutaneous afferent input in the observed phenomenon. Subjects (N=14) exerted sinusoidal L pattern in vertical direction against an externally fixed device in trials that gradually changed from uni- to fully bidirectional. In addition, a manipulation of an external arm support decoupled L measured by the device (and, therefore, recorded by the cutaneous receptors) from the action of arm muscles exerting L. The results revealed that switching from uni- to bidirectional tasks, no matter how low and brief L exertion was in the opposite direction, was associated with an abrupt decrease in G-L coordination. This coordination remained unaffected by the manipulation of external support. The first result corroborates our previous conclusion that the force coordination in uni- and bidirectional manipulation tasks could be based on partly different neural control mechanisms. However, the second finding suggests that the studied control mechanisms could depend more on the cutaneous afferent input, rather than on the synergy of the muscles exerting G and L.

Elaborate force coordination of precision grip could be generalized to bimanual grasping techniques

Exceptional coordination of grip (G; the normal force that prevents slippage of the grasped object) and load force (L; the tangential force originating from the object's weight and inertia) has been interpreted as a part of evidence that both the anatomy and neural control of human hands have been predominantly designed for manipulation tasks. In the present study, we tested the hypothesis that the precision grasp (uses only the tips of fingers and the thumb of one hand) provides better indices of G and L coordination in static manipulation tasks than two bimanual grasps (palm-palm and fingers-thumb; both using opposing segments of two hands). However, in addition to a subtle difference in relative timing of G and L between the precision and two bimanual grasps, we only found that the fingers-thumb grasp is characterized with higher G/L ratio and somewhat higher modulation of G than not only the precision, but also the bimanual palm-palm grasp. However, all remaining data including the correlation coefficients between G and L demonstrated no difference among three evaluated grasping techniques. Therefore, we concluded that the elaborate G and L coordination associated with uni-manual grasps could be partly generalized to a variety of manipulation tasks including those based on bimanual grasping techniques. Taking into account the importance of manipulation tasks in both everyday life and clinical evaluation, future studies should extend the present research to both other grasping techniques and dynamic manipulation conditions.

Predictive control of grip force when moving object with an elastic load applied on the arm

Skilled object manipulation relies on the capability to adjust the grip force according to the consequences of our movements in terms of the resulting load force of the object. Such predictive grip force control requires (at least) two neural processes: (1) predicting the kinematic characteristics of the unfolding arm trajectory and (2) predicting the load force on the object resulting, among other factors, from the arm movement. The goal of this study was to examine whether subjects can still anticipate the resulting load force on the object when the moving arm is submitted to a type of load that does not contribute to the object load. To this end, 12 subjects were asked to rhythmically move a 0.4 kg object under three different conditions. In the first condition (ARM), an elastic cord was attached to the upper arm. In the second condition, the elastic cord was attached to the object (OBJECT). In the third condition, the elastic cord was absent (NO ELAST). At the kinematic level, results showed no influence of the elastic cord on the pattern of movement of the object. At the kinetic level, cross-correlation analyses between grip force and load force acting on the object revealed significant correlations with minimal delays. In addition, grip force profiles were similar under the ARM and NO ELAST conditions, both differing from the OBJECT condition. Overall, we interpret these results as evidence that the neural processes involved in the prediction of the arm trajectory and those involved in the prediction of the load on the object held can take into account different external force fields, thereby preserving the functionality of the behaviour.

Interlimb and within limb force coordination in static bimanual manipulation task

The aim of the study was to compare the coordination of hand grip (G) and load force (a force that tends to cause slippage of a grasped object; L) in static bimanual manipulation tasks with the same data obtained from the similar dynamic tasks. Based on the previous findings obtained from dynamic tasks, it was hypothesized that an increase in the rate of L change would be predominantly associated with a decrease in the coordination of the within limb forces (coordination of G and L of each hand as assessed through the correlation coefficients), while a decrease in coordination of interlimb forces (between two G and two L) will be less pronounced. Regarding the pattern of modulation of G, the same increase in L frequency was also expected to be associated with a decrease in G gain and an increase in G offset (as assessed by slope and intercept of the regression lines obtained from G to L diagrams, respectively), as well as with an increase in average G/L ratio. Subjects exerted oscillatory isometric L profiles by simultaneous pulling out two handles of an externally fixed device under an exceptionally wide range of L frequencies (0.67-3.33 Hz). The results demonstrated relatively high correlation coefficients between both the interlimb and within limb forces that were only moderately affected under sub-maximal L frequencies. Furthermore, the hypothesized changes in G gain and offset appeared only under the highest L frequency, while the G/L ratio remained unaffected. We conclude that, when compared with the dynamic tasks based on the unconstrained movements of hand-held objects that produce similar pattern of L change, the static manipulation tasks demonstrate a consistent and highly coordinated pattern of bilateral G and L under a wide range of frequencies. However, the neural mechanisms that play a role in the revealed differences need further elucidation.

Coordination of hand grip and load forces in uni- and bidirectional static force production tasks

The purpose of the study was to explore the differences in coordination of grip (G) and load forces (L) in a unidirectional and bidirectional bimanual static force production task. Subjects (N=10) exerted oscillatory isometric L profiles against an externally fixed hand-held device, modulated either in pure tension (unidirectional) or in alternating tension and compression (bidirectional) at a rate of either 1.33 or 2.67 Hz. The unidirectional task revealed a high level of coordination of both the ipsilateral (i.e., G and L of each hand) and contralateral pairs of forces (two Gs and two Ls) as assessed by correlation and stability of force ratios. The bidirectional task demonstrated a low level of inconsistently modulated Gs with respect to the change of L, which resulted in a deteriorated coordination, particularly between the ipsilateral forces. The overall effect of task on the force coordination was higher than the effect of frequency suggesting that the higher frequency of G modulation required in the bidirectional task is not likely to be the main cause of the observed phenomenon. We interpret these differences by a relative simplicity of the control mechanisms of the unidirectional task based on a single synergy of G and L muscles that allows simultaneous coordination of both the ipsilateral and contralateral forces. Due to the switching between two distinctive synergies involving G muscles, the bidirectional task could possess a higher control complexity causing a decoupled coordination of the ipsilateral forces, while retaining the coordination of contralateral forces at a relatively high level.

The quest to understand bimanual coordination

Many skillful manipulations engage both hands for goal achievement. Whereas the goal is planned consciously and achieved quasi-invariantly, the articulators are mobilized automatically, but in a flexible manner (Lashley's principle of motor equivalence). In brain disorders affecting hand functions, adaptive mechanisms are mobilized to improve goal achievement. Thus, chronic cerebellar patients were found to initiate a bimanual drawer task with marked intermanual desynchronization as compared to control subjects. This was partly compensated for, however, by adjusting the kinematics as the individual limbs move toward the goal, thereby improving the initial desynchronization. Adaptive strategies rarely correct deficits completely, however. Bimanual movement patterns, either in-phase or anti-phase are relatively stable in healthy human subjects, whereas brain pathology may preferentially impair the anti-phase pattern. This is the case in patients with acquired pathology of the corpus callosum, thereby suggesting that this structure is important for maintaining temporally independent limb and hand movements.

Predictive and reactive co-ordination of grip and load forces in bimanual lifting in man

We investigated the intra- and inter-manual coordination of grip force (GF) and load force (LF) during bimanual lifting and holding of a single object. In a voluntary task involving lifting a predictable load (Experiment 1), we showed scaling of GF to LF generated by either hand, similar to effects seen in previous unimanual studies. Moreover, the GF rates generated by the two hands were correlated. In part this correlation was due to the correlation between the LF rates. However, the GF rates remained correlated when the effects of the correlation in LF rates were partialled out. This novel finding suggests an additional co-ordinative constraint at the level of specification of GFs. As a contrast to the predictable loading in the first experiment, in the second experiment loading was temporally unpredictable and elicited reactive increases in GF. In Experiment 2, the intermanual correlation of GF rates was stronger than in Experiment 1. We speculate that this result reflects greater degrees of co-ordinative constraint at lower levels in the motor control hierarchy.

Bimanual organization of manipulative forces: evidence from erroneous feedforward programming of precision grip

The objective of the present study was to investigate grip-load force regulation during a bimanual lifting task with two hand-held objects. Various conditions were included during which the weight of one or both objects was changed in an unpredictable order every fourth trial. Results showed that force control of heavy weight movements preceded by light weight movements was not strongly influenced across trials. Conversely, force responses of light weight movements preceded by heavy weight movements were overestimated due to an augmented degree of grip force. However, successful updating of force output occurred after one trial. Furthermore, bimanual interactions between the grasping forces were observed, suggestive of a coordinative command that assimilated the individual response specifications. The latter also became apparent from a similar grip-load force ratio for both hands when the objects' physical properties had become predictable, independent of the forces that were produced according to the individual weight requirements. These data indicate that the grip-load force ratio is the controlled variable for bimanual manipulative behaviour.