Kinematics of a coordinated goal-directed bimanual task

Goal conceptualization has distinct effects on spatial and temporal bimanual coordination after left- and right- hemisphere stroke

Perception of task goal influences motor performance and coordination. In bimanual actions, it is unclear how one's perception of task goals influences bimanual coordination and performance in individuals with unilateral stroke. We characterized inter-limb coordination differences in individuals with chronic right- and left-hemisphere damaged (RCVA: n = 24, LCVA: n = 24) stroke and age-matched neurotypical controls (n = 24) as they completed bimanual reaching tasks under distinct goal conditions. In the dual-goal condition, participants reached to move two virtual bricks (cursors) assigned to each hand toward independent targets. In the common-goal condition, they moved a central common virtual brick representing both hands to a single, central target. Spatial and temporal coordination (cross-correlation coefficients of hand velocity and their time-lag), the redundant axis deviations (the hand deviations in the axis orthogonal to the axis along the cursor-target direction), and the contribution ratio of the paretic hand were measured. Compared to the dual-goal condition, reaching actions to the common-goal demonstrated better spatial bimanual coordination in all three participant groups. Temporal coordination was better during common-goal than dual-goal actions only for the LCVA group. Additionally, and novel to this field, sex, as a biological variable, differently influenced movement time and redundant axis deviation in participants with stroke under the common-goal condition. Specifically, female stroke survivors showed larger movements in the redundant axes and, consequently, longer movement times, which was more prominent in the LCVA group. Our results indicate that perception of task goals influences bimanual coordination, with common goal improving spatial coordination in neurotypical individuals and individuals with unilateral stroke and providing additional advantage for temporal coordination in those with LCVA. Sex influences bimanual performance in stroke survivors and needs to be considered in future investigations.

Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases

Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.

Neural motor control differs between bimanual common-goal vs. bimanual dual-goal tasks

Coordinating bimanual movements is essential for everyday activities. Two common types of bimanual tasks are common goal, where two arms share a united goal, and dual goal, which involves independent goals for each arm. Here, we examine how the neural control mechanisms differ between these two types of bimanual tasks. Ten non-disabled individuals performed isometric force tasks of the elbow at 10% of their maximal voluntary force in both bimanual common and dual goals as well as unimanual conditions. Using transcranial magnetic stimulation, we concurrently examined the intracortical inhibitory modulation (short-interval intracortical inhibition, SICI) as well as the interlimb coordination strategies utilized between common- vs. dual-goal tasks. Results showed a reduction of SICI in both hemispheres during dual-goal compared to common-goal tasks (dominant hemisphere: P = 0.04, non-dominant hemisphere: P = 0.03) and unimanual tasks (dominant hemisphere: P = 0.001, non-dominant hemisphere: P = 0.001). For the common-goal task, a reduction of SICI was only seen in the dominant hemisphere compared to unimanual tasks (P = 0.03). Behaviorally, two interlimb coordination patterns were identified. For the common-goal task, both arms were organized into a cooperative "give and take" movement pattern. Control of the non-dominant arm affected stabilization of bimanual force (R² = 0.74, P = 0.001). In contrast, for the dual-goal task, both arms were coupled together in a positive fashion and neither arm affected stabilization of bimanual force (R² = 0.31, P = 0.1). The finding that intracortical inhibition and interlimb coordination patterns were different based on the goal conceptualization of bimanual tasks has implications for future research.

Developmental Characteristics of Disparate Bimanual Movement Skills in Typically Developing Children

Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5-6 years old), older children (7-9 years old), and adolescents (10-16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

Structured skill practice during intensive bimanual training leads to better trunk and arm control than unstructured practice in children with unilateral spastic cerebral palsy

BACKGROUND

Recently, intensive practice showed good efficacy in improving upper extremity function for children with unilateral spastic cerebral palsy (USCP). However, little is known about the significance of skill progression frequently used during intensive practice.

AIMS

We evaluate the importance of skill progression during intensive bimanual practice on movement coordination.

METHODS AND PROCEDURES

Twenty children with USCP (average age: 8.5; MACS levels: I-III) participated in the study. Ten children were randomly allocated to a structured practice group (SPG) with skill progression, and the other 10 children randomized to an unstructured practice group (UPG) without skill progression. Both groups practiced bimanual activities 6h a day for 15days. Children were asked to perform a bimanual drawer-opening task before and after intensive practice using 3-D kinematic analyses.

OUTCOMES AND RESULTS

Both groups showed improved temporal bimanual coordination with increased normalized movement overlap of the two hands (p=0.005) and decreased goal synchronization time (p=0.002). However, only the SPG showed decreased trunk involvement (p=0.01) and increased elbow joint excursion (p=0.017) with decreased variability (p=0.015 and 0.048 respectively).

CONCLUSIONS AND IMPLICATIONS

The results highlighted the importance of skill progression for intensive practice to improve upper extremity and trunk movement control and consistency for children with USCP.

The co-ordination of bimanual rapid aiming movements following stroke

Objective: To determine the role of anticipatory and movement control processes for the coordination of bimanual target aiming in individuals post stroke.

Subjects: Thirty adults with chronic stroke and 30 individuals without stroke history.

Design: A two-group (stroke, control) by two-aiming type (unimanual, bimanual) by two-limb (paretic, nonparetic; left, right for controls) design with repeated measures on the last two factors.

Outcome measures: Kinematic analyses of performance and psychometric measures of reaction time, movement time, peak resultant velocity, time to and after peak resultant velocity and interlimb timing for movement initiation and target impact.

Results: Compared with unimanual aiming, the nonparetic limb exhibited a prolonged movement time in the bimanual condition; the locus for prolongation was primarily in the deceleration phase. This adaptive response allowed for a nearly simultaneous (both limbs) target impact in 81% of trials. Compared with the unimanual condition, the nonparetic limb exhibited a lower peak velocity (10%) in the bimanual condition. Conversely, compared with the unimanual condition, the paretic limb exhibited a higher peak velocity (4%) in the bimanual condition. This disociation between limb and condition was observed for the stroke group but not the control group.

Conclusions: The interlimb coordination that emerged for the stroke group revealed a complex and asymmetric contribution from each limb mediated through anticipatory and motor control processes. We suggest that this coordination may be harnessed for future bimanual intervention approaches to rehabilitation of upper limb function after stroke.

Task-Dependent Bimanual Coordination After Stroke: Relationship With Sensorimotor Impairments

OBJECTIVES

To determine (1) bimanual coordination deficits in patients with stroke using 3-dimensional kinematic analyses as they perform naturalistic tasks requiring collaborative interaction of the 2 arms; and (2) whether bimanual coordination deficits are related to clinical measures of sensorimotor impairments and unimanual performance of the paretic arm.

DESIGN

Case-control study.

SETTING

Rehabilitation hospital research institute.

PARTICIPANTS

Participants (N=24) were patients with unilateral chronic stroke (n=14) and age-matched controls (n=10).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Temporal coordination between the 2 hands as participants performed (1) a symmetric task: reach to pick up a box using both hands; and (2) an asymmetric task: open a drawer with 1 hand to press a button inside with the other hand.

RESULTS

During the symmetric task, patients and controls showed preserved temporal coupling while transporting the hands to the box. However, on reaching the box, patients demonstrated an impaired ability to cooperatively interact their 2 arms for an efficient pickup. This led to significantly longer pickup times compared with controls. Pickup time positively correlated with proprioceptive deficits of the paretic arm. During the asymmetric task, patients had a longer time delay between drawer opening and button pressing movements than controls. The deficits in asymmetric coordination did not significantly correlate with sensorimotor impairments or unimanual paretic arm performance.

CONCLUSIONS

Bimanual coordination was impaired in patients poststroke during symmetric and asymmetric bimanual tasks that required cooperative interaction between the 2 arms. While the proprioceptive system contributes to symmetric cooperative coordination, commonly tested measures of paretic arm impairment or performance, or both, do not strongly predict deficits in bimanual coordination.

Temporal coupling is more robust than spatial coupling: an investigation of interlimb coordination after stroke

Interlimb coordination obtained through temporal and spatial coupling is a significant feature of human motor control. To understand the robustness of this capability the authors introduced a method to quantify interlimb coordination strength and compare individuals with asymmetric effector ability poststroke to nondisabled controls. Quantitative analyses determined the relative strength of interlimb coupling with an asymmetric obstacle avoidance task. Participants performed bimanual discrete, multijoint aiming movements in the frontal plane with a vertical barrier positioned midway to the target for one limb. To quantify coupling strength between limbs and groups, we regressed individual participant nonbarrier limb movement time or maximum vertical displacement separately, on barrier limb performance. Temporal and spatial interlimb coupling strength varied across participants in both groups. Barrier limb performance predicted nonbarrier limb behavior; however, interlimb coupling was significantly stronger for the nondisabled compared to the stroke group. In the stroke group, deficits in interlimb coordination affected spatial coupling more than temporal coupling. The decreased coupling strength detected, even in the presence of mild hemiparesis, demonstrates the measure's sensitivity. The authors propose this metric as a powerful assessment of the effectiveness of rehabilitation interventions and to monitor the recovery of bimanual coordination poststroke.

Interlimb coordination during a cooperative bimanual object manipulation task

This experiment examined asymmetries in the execution of an object manipulation task that requires the coordinated use of both hands. To this end, twenty right-hand-dominant participants performed a bimanual object manipulation task, which required that they reach for and grasp two objects located on a tabletop, fit the two objects through a hole in a horizontally or vertically oriented fitting board, and then rotate the objects 180° to produce a "beep" tone. Overall, the two hands were highly synchronized at the start, but not at end, of each movement phase. The decrease in interlimb coupling at later stages of the movement phase was primarily driven by the shorter movement time values for the dominant right hand. In addition, degree of left object rotation was greater than the right object, irrespective of board orientation. In sum, the results suggest that manual asymmetries and role assignment are not hardwired constraints, but depend on the overall task constraints and the manner in which the task is conceptualized.

Hand use for grasping in a bimanual task: evidence for different roles?

It has been proposed that the two hands play different roles during bimanual object interaction. The right hand takes on an explorative, highly precise, manipulative role while the left hand supports and stabilizes the object. Does this division of labour influence hand use during visually guided grasping? Three experiments were designed to address this question: right-handed individuals put together 3D models using big or small building blocks scattered across a tabletop. Participants were free to build the models; however, it felt comfortable (Experiment 1) or they were required to build on a large (Experiment 2) or small (Experiment 3) base plate. In Experiment 1, the right hand was preferred for grasping while the left hand stabilized the building model. When participants used the large base plate (Experiment 2), right hand use for grasping decreased and left hand use increased. The plate provided freedom to the left hand from having to stabilize the building model, but it also interfered with right/left hand movements directed towards the opposite side of the grasping hand (contralateral movements). To investigate which of these two factors would explain the change in hand use for grasping, a very small base plate was used in the last experiment. Results showed similar right hand use values to those seen in the first experiment (without the use of a plate), even though the left hand was 'released from its stabilizing duties.' The results predict a left-hemisphere right hand advantage in the control of grasping.

The effect of intensive bimanual training on coordination of the hands in children with congenital hemiplegia

Recent studies have suggested efficacy of intensive bimanual training in improving the quality and quantity of affected hand use in children with hemiplegia. However, it is not known whether such training affects the coordination of the two hands. In the present study, 20 children with congenital hemiplegia (age 4-10 years; MACS levels I-II) were randomly assigned to either an intensive bimanual training (Hand-Arm Bimanual Intensive Therapy: HABIT) group, or a control group consisting of equally intensive unimanual treatment (Constraint-Induced Movement Therapy, CIMT) for 6h per day for 15 days (90h). To assess their bimanual coordination, children were asked to open a drawer with one hand and manipulate its contents with the other hand. 3-D movement kinematics were recorded and subsequently analyzed by a blind evaluator. The role of the two hands was varied. Following treatment, superior improvement in bimanual coordination was found for the bimanual training group as indicated by greater movement overlap (the percentage of time with both hands engaged in the task p = 0.047) and better goal synchronization (reduced time differences between the two hands completing the task goals, p = 0.005). The results suggest that bimanual training improves the spatial-temporal control of the two hands, and are in agreement with the principle of practice specificity.

Bilateral assessment of functional tasks for robot-assisted therapy applications

This article presents a novel evaluation system along with methods to evaluate bilateral coordination of arm function on activities of daily living tasks before and after robot-assisted therapy. An affordable bilateral assessment system (BiAS) consisting of two mini-passive measuring units modeled as three degree of freedom robots is described. The process for evaluating functional tasks using the BiAS is presented and we demonstrate its ability to measure wrist kinematic trajectories. Three metrics, phase difference, movement overlap, and task completion time, are used to evaluate the BiAS system on a bilateral symmetric (bi-drink) and a bilateral asymmetric (bi-pour) functional task. Wrist position and velocity trajectories are evaluated using these metrics to provide insight into temporal and spatial bilateral deficits after stroke. The BiAS system quantified movements of the wrists during functional tasks and detected differences in impaired and unimpaired arm movements. Case studies showed that stroke patients compared to healthy subjects move slower and are less likely to use their arm simultaneously even when the functional task requires simultaneous movement. After robot-assisted therapy, interlimb coordination spatial deficits moved toward normal coordination on functional tasks.

The organization of intralimb and interlimb synergies in response to different joint dynamics

We sought to understand differences in joint coordination between the dominant and nondominant arms when performing repetitive tasks. The uncontrolled manifold approach was used to decompose the variability of joint motions into components that reflect the use of motor redundancy or movement error. First, we hypothesized that coordination of the dominant arm would demonstrate greater use of motor redundancy to compensate for interaction forces than would coordination of the nondominant arm. Secondly, we hypothesized that when interjoint dynamics were more complex, control of the interlimb relationship would remain stable despite differences in control of individual hand paths. Healthy adults performed bimanual tracing of two orientations of ellipses that resulted in different magnitudes of elbow interaction forces. For the dominant arm, joint variance leading to hand path error was the same for both ellipsis orientations, whereas joint variance reflecting the use of motor redundancy increased when interaction moment was highest. For the nondominant arm, more joint error variance was found when interaction moment was highest, whereas motor redundancy did not differ across orientations. There was no apparent difference in interjoint dynamics between the two arms. Thus, greater skill exhibited by the dominant arm may be related to its ability to utilize motor redundancy to compensate for the effect of interaction forces. However, despite the greater error associated with control of the nondominant hand, control of the interlimb relationship remained stable when the interaction moment increased. This suggests separate levels of control for inter- versus intra-limb coordination in this bimanual task.

Disruption of bilateral temporal coordination during arm swinging in patients with hemiparesis

Persistent motor deficits in the paretic arm present a major barrier to the recovery of the ability to perform bimanual tasks even in individuals who have recovered well after a stroke. Impaired performance may be related to deficits in bimanual temporal coordination due to stroke-related damage of specific brain motor structures as well as changed biomechanics of the paretic arm. To determine the extent of the deficit in bilateral temporal coordination after the stroke, we investigated how bilateral reciprocal coordination was regained after external perturbations of the arm in individuals with hemiparesis due to stroke. We used a bilateral task that would be minimally affected by the unilateral arm motor deficit. Nine non-disabled control subjects and 12 individuals with chronic hemiparesis performed reciprocal (anti-phase) arm swinging in the standing position for 15 s per trial. In each trial, movement of one arm was unexpectedly and transiently (approximately 150-350 ms) arrested at the level of the wrist once in the forward and once in the backward phase of swinging. Perturbation was applied to the left and right arms in control subjects and to the paretic and non-paretic arms of individuals with hemiparesis. Kinematic data from endpoint markers on both hands and electromyographic activity of anterior and posterior deltoid muscles from both arms were recorded. The oscillatory period, the phase differences between arms and the mean EMG activity before, during and after perturbation were analyzed. In both groups the perturbation altered the period of the perturbed cycle in both the arrested and non-arrested arms and resulted in a change from anti-phase to in-phase coordination, following which anti-phase coordination was regained. Recovery of anti-phase swinging took significantly longer in patients with hemiparesis compared to control subjects. Stable pre-perturbed (anti-phase) reciprocal coordination was regained within one cycle following perturbation for the control subjects and within two cycles following perturbation for the patients with hemiparesis. Analysis of EMG activation levels showed that, compared to control subjects, there was significantly less activation of the shoulder muscles in response to perturbation in the patient group and the pattern of muscle activation in the paretic arm was opposite to that in the non-paretic and control arms. The finding that patients had a reduced capacity for maintaining and restoring the required reciprocal coordination when perturbation occurred suggests that stroke-related brain damage in our patients led to instability of bilateral temporal coordination for this rhythmical task.

Goal synchronization of bimanual skills depends on proprioception

The present experiments in Human subjects were designed to test whether proprioceptive feedback plays a role in optimising bimanual synchronization in a goal-oriented familiar task. Goal-synchronization is a typical feature of bimanual everyday skills. The purpose of the study was to disturb proprioceptive signalling by means of vibrating the leading left limb while subjects performed a bimanual task on a drawer manipulandum. Blindfolded subjects reached for and opened the drawer with the left hand while the right hand was reaching for grasping an object as the drawer was fully opened. Discrete events of the task were used to measure movement onset times of pulling and grasping hands and of goal arrival times. A spatial--temporal goal invariance was still present despite asymmetrical limb assignments and subjects were blindfolded. In contrast, when vibration (80 Hz) was applied to the forearm flexors of the leading pulling limb, we found that the interval between the hands at goal reaching was significantly prolonged. This suggests that synchronization is not predetermined entirely by feedforward commands and that proprioceptive feedback is necessary for updating an internal forward model and perhaps also for lower-level corrections in order to ensure covariant limb movements for optimal goal-synchronization.

Unilateral vs. bilateral coordination of circle-drawing tasks

The number of joint motions available in the upper extremity provides for multiple solutions to the coordination of a motor task. Making use of these abundant joint motions provides for task flexibility. Controlling bimanual movements poses another level of complexity because of possible tradeoffs between coordination within a limb and coordination between the limbs. We examined how flexible patterns of joint coordination were used to stabilize the hand's path when drawing a circle independently compared to a bimanual pattern. Across-trial variance of joint motions was partitioned into two components: goal-equivalent variance (GEV), representing variance of joint motions consistent with a stable hand path and non-goal-equivalent variance (NGEV) representing variance of joint motions that led to deviations of the hand's path. GEV was higher than NGEV in both unimanual and bimanual drawing, with one exception. Both GEV and NGEV, related to control of the individual hands' motion, decreased when engaged in the bimanual compared to unimanual drawing. Moreover, NGEV, leading to variability in the vectorial distance between the hands, was higher when the two hands drew circles in a bimanually asymmetric vs. symmetric pattern, consistent with reported differences in the relative phasing of the two hands. Our results suggest that the nervous system controls the individual hands' motions by separate intra-limb synergies during both unimanual and bimanual drawing, and superimposes an additional synergy to achieve stable relative motion of the two hands during bimanual drawing.

Coordination of bowing and fingering in violin playing

Playing string instruments implies motor skills including asymmetrical interlimb coordination. How special is musical skill as compared to other bimanually coordinated, non-musical skillful performances? We succeeded for the first time to measure quantitatively bimanual coordination in violinists playing repeatedly a simple tone sequence. A motion analysis system was used to record finger and bow trajectories for assessing the temporal structure of finger-press, finger-lift (left hand), and bow stroke reversals (right arm). The main results were: (1) fingering consisted of serial and parallel (anticipatory) mechanisms; (2) synchronization between finger and bow actions varied from -12 ms to 60 ms, but these 'errors' were not perceived. The results suggest that (1) bow-finger synchronization varied by about 50 ms from perfect simultaneity, but without impairing auditory perception; (2) the temporal structure depends on a number of combinatorial mechanisms of bowing and fingering. These basic mechanisms were observed in all players, including all amateurs. The successful biomechanical measures of fingering and bowing open a vast practical field of assessing motor skills. Thus, objective assessment of larger groups of string players with varying musical proficiency, or of professional string players developing movement disorders, may be helpful in music education.

Changes in functional coupling patterns during bimanual task performance

Functional interaction between cortical areas may involve synchronization of activities, manifest as coherence between EEG signals. However, although EEG-EEG coherence changes when motor tasks are compared to each other or rest, there is little evidence that coherence is modulated within an action. To address this issue we used a bimanual drawer-opening task necessitating asymmetrical hand actions and comprising distinct movement phases. Pronounced modulations in EEG-EEG coherence in the beta band (>12-24 Hz) occurred with movement phase. Differences in coherence due to a switch in role of the hands were mainly observed in the alpha band (8-12 Hz). These findings suggest that inter-regional synchronization changes dynamically across task execution in line with behavioral performance.

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.