Moving objects with clumsy fingers: how predictive is grip force control in patients with impaired manual sensibility?

Fine adaptive precision grip control without maximum pinch strength changes after upper limb neurodynamic mobilization

Before and immediately after passive upper limb neurodynamic mobilizations targeting the median nerve, grip (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF) and load (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF) forces applied by the thumb, index and major fingers (three-jaw chuck pinch) were collected using a manipulandum during three different grip precision tasks: grip-lift-hold-replace (GLHR), vertical oscillations (OSC), and vertical oscillations with up and down collisions (OSC/COLL/u, OSC/COLL/d). Several parameters were collected or computed from \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF. Maximum pinch strength and fingertips pressure sensation threshold were also examined. After the mobilizations, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF max changes from 3.2 ± 0.4 to 3.4 ± 0.4 N (p = 0.014), d\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF from 89.0 ± 66.6 to 102.2 ± 59.6 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$N~\text{s}^{-1}$$\end{document}Ns-1 (p = 0.009), and d\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF from 43.6 ± 17.0 to 56.0 ± 17.9 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$N~\text{s}^{-1}$$\end{document}Ns-1 (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p<$$\end{document}p<0.001) during GLHR. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF SD changes from 0.9 ± 0.3 to 1.0 ± 0.2 N (p = 0.004) during OSC. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF peak changes from 17.4 ± 8.3 to 15.1 ± 7.5 N (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p<$$\end{document}p<0.001), \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF from 12.4 ± 6.7 to 11.3 ± 6.8 N (p = 0.033), and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF from 2.9 ± 0.4 to 3.00 ± 0.4 N (p = 0.018) during OSC/COLL/u. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF peak changes from 13.5 ± 7.4 to 12.3 ± 7.7 N (p = 0.030) and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF from 14.5 ± 6.0 to 13.6 ± 5.5 N (p = 0.018) during OSC/COLL/d. Sensation thresholds at index and thumb were reduced (p = 0.001, p = 0.008). Precision grip adaptations observed after the mobilizations could be partly explained by changes in cutaneous median-nerve pressure afferents from the thumb and index fingertips.

Anticipation and compensation for somatosensory deficits in object handling: evidence from a patient with large fiber sensory neuropathy

The purpose of this study was to determine the contributions of feedforward and feedback processes on grip force regulation and object orientation during functional manipulation tasks. One patient with massive somatosensory loss resulting from large fiber sensory neuropathy and 10 control participants were recruited. Three experiments were conducted: 1) perturbation to static holding; 2) discrete vertical movement; and 3) functional grasp and place. The availability of visual feedback was also manipulated to assess the nature of compensatory mechanisms. Results from experiment 1 indicated that both the deafferented patient and controls used anticipatory grip force adjustments before self-induced perturbation to static holding. The patient exhibited increased grip response time, but the magnitude of grip force adjustments remained correlated with perturbation forces in the self-induced and external perturbation conditions. In experiment 2, the patient applied peak grip force substantially in advance of maximum load force. Unlike controls, the patient's ability to regulate object orientation was impaired without visual feedback. In experiment 3, the duration of unloading, transport, and release phases were longer for the patient, with increased deviation of object orientation at phase transitions. These findings show that the deafferented patient uses distinct modes of anticipatory control according to task constraints and that responses to perturbations are mediated by alternative afferent information. The loss of somatosensory feedback thus appears to impair control of object orientation, whereas variation in the temporal organization of functional tasks may reflect strategies to mitigate object instability associated with changes in movement dynamics.NEW & NOTEWORTHY This study evaluates the effects of sensory neuropathy on the scaling and timing of grip force adjustments across different object handling tasks (i.e., holding, vertical movement, grasping, and placement). In particular, these results illustrate how novel anticipatory and online control processes emerge to compensate for the loss of somatosensory feedback. In addition, we provide new evidence on the role of somatosensory feedback for regulating object orientation during functional prehensile movement.

A review of the neurobiomechanical processes underlying secure gripping in object manipulation

O'SHEA, H. and S. J. Redmond. A review of the neurobiomechanical processes underlying secure gripping in object manipulation. NEUROSCI BIOBEHAV REV 286-300, 2021. Humans display skilful control over the objects they manipulate, so much so that biomimetic systems have yet to emulate this remarkable behaviour. Two key control processes are assumed to facilitate such dexterity: predictive cognitive-motor processes that guide manipulation procedures by anticipating action outcomes; and reactive sensorimotor processes that provide important error-based information for movement adaptation. Notwithstanding increased interdisciplinary research interest in object manipulation behaviour, the complexity of the perceptual-sensorimotor-cognitive processes involved and the theoretical divide regarding the fundamentality of control mean that the essential mechanisms underlying manipulative action remain undetermined. In this paper, following a detailed discussion of the theoretical and empirical bases for understanding human dexterous movement, we emphasise the role of tactile-related sensory events in secure object handling, and consider the contribution of certain biophysical and biomechanical phenomena. We aim to provide an integrated account of the current state-of-art in skilled human-object interaction that bridges the literature in neuroscience, cognitive psychology, and biophysics. We also propose novel directions for future research exploration in this area.

Stretching the skin immediately enhances perceived stiffness and gradually enhances the predictive control of grip force

When manipulating objects, we use kinesthetic and tactile information to form an internal representation of their mechanical properties for cognitive perception and for preventing their slippage using predictive control of grip force. A major challenge in understanding the dissociable contributions of tactile and kinesthetic information to perception and action is the natural coupling between them. Unlike previous studies that addressed this question either by focusing on impaired sensory processing in patients or using local anesthesia, we used a behavioral study with a programmable mechatronic device that stretches the skin of the fingertips to address this issue in the intact sensorimotor system. We found that artificial skin-stretch increases the predictive grip force modulation in anticipation of the load force. Moreover, the stretch causes an immediate illusion of touching a harder object that does not depend on the gradual development of the predictive modulation of grip force.

Grip force control and hand dexterity are impaired in individuals with diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) affects the sensory function of the hands and, consequently, may negatively impact hand dexterity, maximum grip strength (GS_Max), and hand grip force (GF) control during object manipulation. The aims of this study were to examine and compare the GF control during a simple holding task as well as GS_Max and hand dexterity of individuals with DPN and healthy controls. Ten type 2 diabetic individuals diagnosed with DPN and ten age- and gender-matched healthy controls performed two traditional timed hand dexterity tests (i.e., nine-hole peg test and Jebsen-Taylor hand function test), a GS_Max test, and a GF control test (i.e., hold a instrumented handle). The results indicated that individuals with DPN and controls produced similar GS_Max. However, individuals with DPN took longer to perform the hand dexterity tests and set lower safety margin (exerted lower GF) than controls when holding the handle. The findings showed that mild to moderate DPN did not significantly affect maximum hand force generation, but does impair hand dexterity and hand GF control, which could impair the performance of daily living manipulation tasks and put them in risk of easily dropping handheld objects.

Multisensory components of rapid motor responses to fingertip loading

Tactile and muscle afferents provide critical sensory information for grasp control, yet the contribution of each sensory system during online control has not been clearly identified. More precisely, it is unknown how these two sensory systems participate in online control of digit forces following perturbations to held objects. To address this issue, we investigated motor responses in the context of fingertip loading, which parallels the impact of perturbations to held objects on finger motion and fingerpad deformation, and characterized surface recordings of intrinsic (first dorsal interosseous, FDI) and extrinsic (flexor digitorum superficialis, FDS) hand muscles based on statistical modeling. We designed a series of experiments probing the effects of peripheral stimulation with or without anesthesia of the finger, and of task instructions. Loading of the fingertip generated a motor response in FDI at ~60 ms following the perturbation onset, which was only driven by muscle stretch, as the ring-block anesthesia reduced the gain of the response occurring later than 90 ms, leaving responses occurring before this time unaffected. In contrast, the motor response in FDS was independent of the lateral motion of the finger. This response started at ~90 ms on average and was immediately adjusted to task demands. Altogether these results highlight how a rapid integration of partially distinct sensorimotor circuits supports rapid motor responses to fingertip loading.NEW & NOTEWORTHY To grasp and manipulate objects, the brain uses touch signals related to skin deformation as well as sensory information about motion of the fingers encoded in muscle spindles. Here we investigated how these two sensory systems contribute to feedback responses to perturbation applied to the fingertip. We found distinct response components, suggesting that each sensory system engages separate sensorimotor circuits with distinct functions and latencies.

The effects of acute cortical somatosensory deafferentation on grip force control

Grip force control involves mechanisms to adjust to unpredictable and predictable changes in loads during manual manipulation. Somatosensory feedback is critical not just to reactive, feedback control but also to updating the internal representations needed for proactive, feedforward control. The role of primary somatosensory cortex (S1) in these control strategies is not well established. Here we investigated grip force control in a rare case of acute central deafferentation following resection of S1. The subject had complete loss of somatosensation in the right arm without any deficit in muscle strength or reflexes. In the first task, the subject was asked to maintain a constant grip force with and without visual feedback. The subject was able to attain the target force with visual feedback but not maintain that force for more than a few seconds after visual feedback was removed. In the second task, the subject was asked to grip and move an instrumented object. The induced acceleration-dependent loads were countered by adjustments in grip force. Both amplitude and timing of the grip force modulation were not affected by deafferentation. The dissociation of these effects demonstrates the differential contribution of S1 to the mechanisms of grip force control.

Changes in sensory function and force production in adults with type II diabetes

INTRODUCTION

The purpose of this study was to evaluate the relationship among sensory function, disease severity, and upper extremity force production in adults with type II diabetes (T2D) as compared with healthy age- and gender-matched controls.

METHODS

Ten adults with T2D and 10 healthy age- and gender-matched control subjects underwent a battery of sensory and motor function evaluations. Data on disease severity and duration were also collected.

RESULTS

The T2D group exhibited sensory deficits and altered force production as compared with healthy controls. Sensory function correlated with disease severity, as did signal predictability of kinetic output during submaximal force production tasks. Maximal force production tasks were associated with altered output in T2D, but these data did not correlate with disease severity or sensory dysfunction.

CONCLUSIONS

Some, not all, motor performance deficits in T2D are associated with sensory dysfunction. Mechanisms responsible for these changes in adult-onset T2D are described.

Grasp-Dependent Slip Prevention for a Dexterous Artificial Hand via Wrist Velocity Feedback

A proportional controller is compared to a nonlinear backstepping controller with four different grasps for a dexterous anthropomorphic hand. A bioinspired grasp-dependent control scheme which autonomously modulates the grip force using wrist velocity feedback to prevent grasped object slip is also introduced. Four different grasp types are evaluated to illustrate how the wrist velocity feedback architecture must differ depending upon the manner in which objects are grasped. The backstepping controller can successfully increase grip force with wrist velocity in a robustly stable bioinspired fashion. Experimental results show that the developed backstepping controller improves the position tracking abilities for multiple periodic inputs, as well as reduces step input overshoot. The slip prevention capabilities of the backstepping controller are also demonstrated and compared to the proportional control scheme. Results of the slip prevention experiments show that both the grasp type and manipulator orientation with respect to gravity are significant factors in the performance of the controllers. The backstepping control scheme significantly improves slip prevention of grasped objects for multiple grasps and in two different orientations with respect to gravity.

Pathokinematics of precision pinch movement associated with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) can adversely affect fine motor control of the hand. Precision pinch between the thumb and index finger requires coordinated movements of these digits for reliable task performance. We examined the impairment upon precision pinch function affected by CTS during digit movement and digit contact. Eleven CTS subjects and 11 able-bodied (ABL) controls donned markers for motion capture of the thumb and index finger during precision pinch movement (PPM). Subjects were instructed to repetitively execute the PPM task, and performance was assessed by range of movement, variability of the movement trajectory, and precision of digit contact. The CTS group demonstrated shorter path-length of digit endpoints and greater variability in inter-pad distance and most joint angles across the PPM movement. Subjects with CTS also showed lack of precision in contact points on the digit-pads and relative orientation of the digits at contact. Carpal tunnel syndrome impairs the ability to perform precision pinch across the movement and at digit-contact. The findings may serve to identify deficits in manual dexterity for functional evaluation of CTS.

Carpal tunnel syndrome impairs sustained precision pinch performance

OBJECTIVE

The purpose of this study was to investigate effects of carpal tunnel syndrome (CTS) on digit force control during a sustained precision pinch.

METHODS

Eleven CTS individuals and 11 age- and gender-matched healthy volunteers participated in the study. The subjects were instructed to isometrically pinch an instrumented apparatus for 60s with a stable force output. Visual feedback of force output was provided for the first 30s but removed for the remaining 30s. Pinch forces were examined for accuracy, variability, and inter-digit correlation.

RESULTS

CTS led to a decrease in force accuracy and an increase in amount of force variability, particularly without visual feedback (p<0.001). However, CTS did not affect the structure of force variability or force correlation between digits (p>0.05). The force of the thumb was less accurate and more variable than that of the index finger for both the CTS and healthy groups (p<0.001).

CONCLUSIONS

Sensorimotor deficits associated with CTS lead to inaccurate and unstable digit forces during sustained precision pinch.

SIGNIFICANCE

This study shed light on basic and pathophysiological mechanisms of fine motor control and aids in development of new strategies for diagnosis and evaluation of CTS.

Hand functioning in children with cerebral palsy

Brain lesions may disturb hand functioning in children with cerebral palsy (CP), making it difficult or even impossible for them to perform several manual activities. Most conventional treatments for hand dysfunction in CP assume that reducing the hand dysfunctions will improve the capacity to manage activities (i.e., manual ability, MA). The aim of this study was to investigate the directional relationships (direct and indirect pathways) through which hand skills influence MA in children with CP. A total of 136 children with CP (mean age: 10 years; range: 6–16 years; 35 quadriplegics, 24 diplegics, 77 hemiplegics) were assessed. Six hand skills were measured on both hands: touch-pressure detection (Semmes–Weinstein esthesiometer), stereognosis (Manual Form Perception Test), proprioception (passive mobilization of the metacarpophalangeal joints), grip strength (GS) (Jamar dynamometer), gross manual dexterity (GMD) (Box and Block Test), and fine finger dexterity (Purdue Pegboard Test). MA was measured with the ABILHAND-Kids questionnaire. Correlation coefficients were used to determine the linear associations between observed variables. A path analysis of structural equation modeling was applied to test different models of causal relationships among the observed variables. Purely sensory impairments did seem not to play a significant role in the capacity to perform manual activities. According to path analysis, GMD in both hands and stereognosis in the dominant hand were directly related to MA, whereas GS was indirectly related to MA through its relationship with GMD. However, one-third of the variance in MA measures could not be explained by hand skills. It can be concluded that MA is not simply the integration of hand skills in daily activities and should be treated per se, supporting activity-based interventions.

Cross recurrence quantification analysis of precision grip following peripheral median nerve block

Background

Precision grip by the thumb and index finger is vulnerable to sensorimotor deficits. Traditional biomechanical parameters offer limited insight into the dynamical coordination between digits during precision grip. In this study, the thumb and index finger were viewed as “coupled systems”, and a cross recurrence quantification analysis (CRQA) was used to examine the changes of interdigit dynamics and synchronization caused by peripheral median nerve block.

Methods

Seven subjects performed a precision grip by holding an instrumented handle before and after median nerve block at the wrist. The forces and the torques at each digit-handle interface were recorded with two six-component transducers. For CRQA, the percentage of recurrence rate (%RR), percentage of determinism (%DET), longest diagonal line (Lmax) and percentage of laminarity (%LAM) were computed for the force, torque and center of pressure (COP) signals. Phase synchronization of the thumb and index finger was examined based on the τ-recurrence rate. Paired t-tests and Wilcoxon signed-rank tests were used for statistical comparisons. The twin-surrogate hypothesis test was used to examine phase synchronization.

Results

Nerve block led to significant increases (p < 0.05) for %DET, Lmax and %LAM in all components of force, torque, and COP. Only the normal force met the conditions of phase synchronization for all successfully completed pre- and post-block grasping trials. The probability of synchronization with larger time lags (τ > 0.1 s) increased after nerve block. The percentage of trials that the thumb led the index finger increased from 52% (pre-block) to 86% (post-block).

Conclusions

Nerve block caused more deterministic structures in force, torque and COP when the thumb interacted with the index finger. A compensatory mechanism may be responsible for this change. Phase synchronization between the opposite normal forces exerted by the thumb and index finger would be an essential dynamical principle for a precision grip. The nerve block resulted in an increased interdigit phase delay and increased probability that the thumb leads the index finger. The CRQA provides an effective tool to examine interdigit coordination during precision grip and has the potential for clinical evaluation of hand dysfunction.

Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent

Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips) or a combination of CTS-affected and non-affected digits ('mixed' grips), we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS-affected and non-affected digits.

Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation

The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS), a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g) for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

Corticospinal influences on the distal muscles of the hand in conditions of inertial loading

Electromyographic activity and synchronous discharges in the muscles of the wrist induced by transcranial magnetic stimulation of the motor cortex as the thumb and index finger were used to hold a handle bearing a weight were studied during performance of a number of motor tasks. When the subject increased grip force, for example, in response to increases in the weight of the attached load or by voluntarily squeezing the handle, the evoked response increased proportionally to muscle activity. If the subject moved the hand holding the handle up and down with an amplitude of 10 cm and a frequency of 0.5-1 Hz, grip force changed in accordance with the predicted inertial loading. The muscle response in the adductor pollicis muscle increased to a greater extent than the activity in the muscle. The response to sudden inertial loading consisted of a reflex increase in grip force, the muscle response increasing to a lesser extent than activity in the muscle. This suggests that larger increases in evoked muscle responses on up and down movement of the hand with a load are associated with anticipatory changes in grip force. These results are assessed from the point of view of the involvement of the motor cortex in generating anticipatory changes in muscle activity in the distal muscles.

Variability of precision pinch movements caused by carpal tunnel syndrome

PURPOSE

Carpal tunnel syndrome (CTS) impairs the performance of fine motor tasks of the hand, leading to clumsiness. Precision pinch by the thumb and index finger is a frequent task that requires the fine control of each digit as well as the coordination of the 2 digits. The purpose of this study was to examine the performance of precision pinch movements impaired by CTS.

METHODS

Sixteen CTS subjects and 16 gender- and age-matched control subjects were instructed to repetitively perform the precision pinch movement with the thumb and index finger. A marker-based motion analysis method was used to obtain the kinematic data of the thumb and index finger during the precision pinch movements. Pinch performance was quantified by the variability of tip positions, joint angles, and tip distance at the pinch closures in the repeated movements.

RESULTS

The CTS subjects performed the precision pinch movements less consistently compared with performance of the control subjects. The inconsistency was demonstrated by the increased variability of the tip positions of the 2 digits and the joint angles of the index finger. However, the variability of thumb joint angles was not significantly different between the 2 groups. The tip-to-tip distance, an indicator of thumb and index finger coordination, was relatively reproducible for both groups. Still, the CTS subjects showed a 50% greater variability of the tip distance compared with that of the control subjects.

CONCLUSIONS

Carpal tunnel syndrome impairs the performance of precision pinch movement as indicated by the increased variability. The results correlate with the observed clumsiness or lack of dexterity for patients with CTS.

Does the location of the touch from the contralateral finger application affect grip force control while lifting an object?

It was recently shown that the magnitude of grip force used to lift and transport a hand-held object decreased if a light finger touch from the contralateral arm was provided to the wrist of the target arm [A.S. Aruin, Support-specific modulation of grip force in individuals with hemiparesis, Arch. Phys. Med. Rehabil. 86 (2005) 768-775]. In this study, we investigated whether the location of the finger touch along the target arm affects the way grip force is reduced. Subjects performed the same task of lifting and transporting an instrumented object with no involvement of the contralateral arm and when an index finger touch of the contralateral arm was provided to the wrist, thumb, mid-forearm, and the hand-held object. Grip force was reduced by approximately the same amount in all conditions with the finger touch compared to the no touch condition suggesting that its reduction was not associated with a particular point of contact of the finger with the target arm. The results of the study provide additional evidence to support of the use of a second arm in the performance of activities of daily living and stress the importance of future studies investigating contralateral arm sensory input on grip force control.

Lower median nerve block impairs precision grip

The purpose of this study was to investigate precision grip impairment caused by a lower median nerve block at the wrist. The median nerve block was achieved by injecting bupivacaine hydrochloride into the carpal tunnel, which acutely simulated a median neuropathy. Seven healthy male subjects were instructed to grip, lift, and hold an instrumented handle within 60s using precision grip. The same tasks were performed before and after the nerve block. Force and torque data were recorded using two miniature 6-component force/torque transducers. The precision grip was quantified by the safety margin (i.e. the difference between the actual grip force and the minimal grip force to keep the object from dropping), the variation of grip force, and the migration area of center of pressure (i.e. the area defined by the center of pressure at a digit-transducer surface while holding the handle). Two subjects were unable to complete the precision grip tasks after the nerve block, and their data were excluded from the analyses. The median nerve block caused significant increases (P<0.05) in the safety margin of the grip force (>50%), the grip force variation (>80%), and the area of center of pressure migration (>250%). Median nerve block at the wrist impairs the fine motor control during precision grip. Our results corroborate the important role played by sensory function in hand fine motor control. Clinically, the measures related to precision grip have the potential to quantify impairment of hand function caused by neuromuscular disorders, to monitor the progress of a hand disorder, and to evaluate the efficacy of a treatment or rehabilitation procedure.

Impaired Discrimination of Surface Friction Contributes to Pinch Grip Deficit After Stroke

Background. Impaired sensation and force production could both contribute to handgrip limitation after stroke. Clinically, training is usually directed to motor impairment rather than sensory impairment despite the prevalence of sensory deficit and the importance of sensory input for grip control. Objective. The aim of this study was to investigate if sensory deficits contribute to pinch grip dysfunction beyond that attributable to motor deficits poststroke. Methods. The study enlisted 45 stroke participants and 45 healthy controls matched for age, gender, and hand dominance. Ability to differentiate surface friction (Friction Discrimination Test [FDT]), match object weight (Weight Matching Test [WMT]), produce grip force to track a visual target (Visually Guided Pinch Test [VGPT]), and perform a Pinch-Grip Lift-and-Hold Test (PGLHT) was quantified relative to normative performance, as defined by matched controls. The relationship between sensory ability (FDT, WMT) and altered PGLHT performance adjusted for motor ability (VGPT) after stroke was then examined using multivariate regression. Results. Deficits in FDT, WMT, and VGPT ability were present in at least half of the stroke sample and were largely independent across the variables. Poorer friction discrimination was significantly associated with longer latencies of grip-lift ( r = .34; P = .03) and grip force dysregulation ( r= .34; P= .03) after the impact of VGPT was statistically removed from PGLHT ability. However, performance on WMT did not relate to either PGLHT deficit. Conclusion. The findings indicate that impaired friction discrimination ability contributes to altered timing and force adjustment during PGLHT poststroke.

Objective evaluation of manual performance deficits in neurological movement disorders

Impaired hand function is a frequent finding in movement disorders. The skilled control of prehensile finger forces is an essential feature of tool use in daily life. In healthy subjects, grip force is precisely adjusted to the mechanical object properties, such as weight and surface friction. Grip force is accurately scaled to be only a small amount higher than the minimum necessary to prevent a hand-held object from slipping. When an object is lifted and moved around in space, grip force is modulated in parallel with the movement-induced fluctuations in load. The absence of a temporal delay between grip and load force profiles implies that the central nervous system is able to predict the load variations before the intended manipulation. Sensory information is used to adjust the level of applied finger forces efficiently to the requirements of the mechanical object properties and the task at hand. The characteristics of impaired finger force control include inefficient grip force scaling and imprecision of the temporal coupling between grip and load force profiles. Here, we review the characteristics of deficient grip force behavior in movement disorders, e.g. Parkinson's disease, task-specific dystonia, Gille de la Tourette's syndrome and cerebellar disease. Grip force analysis is a highly sensitive method to document even subtle impairments of finger force control and may be used both as a diagnostic tool and for the objective evaluation of treatment in neurological movement disorders.

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.

Grip forces when passing an object to a partner

The goal of the present study was to investigate how grip forces are applied when transferring stable control of an object from one person to another. We asked how grip forces would be modified by the passer to (1) control for inertial forces as the object was transported toward the receiver and (2) control for the impending perturbation when the receiver made contact with the object. Twelve volunteers worked in pairs during this experiment. One partner, playing the role of passer, transported an object with embedded load cells forward or held the object at an interception location. The second partner, playing the role of receiver, waited at an interception location or reached toward the passed object. Kinematic results indicated that while passers performed a stereotypical movement, receivers were sensitive to the motion of the object as they reached to make contact. Grip force results indicated that passers' grip forces and grip/load force ratios were variable on a trial-to-trial basis, suggesting that a refined internal model of the passing task was not achieved within the timeframe of the experiment. Furthermore, a decoupling of the temporal and magnitude characteristics of the grip and inertial forces was noted in conditions where passers transported the object toward the receiver. During object transfer, it was noted that passers used visual feedback-based anticipatory control to precisely time initial grip force release, while somatosensory control was used by both the passer and receiver to precisely coordinate transfer rate.

Deficits of anticipatory grip force control after damage to peripheral and central sensorimotor systems

Healthy subjects adjust their grip force economically to the weight of a hand-held object. In addition, inertial loads, which arise from arm movements with the grasped object, are anticipated by parallel grip force modulations. Internal forward models have been proposed to predict the consequences of voluntary movements. Anesthesia of the fingers impairs grip force economy but the feedforward character of the grip force/load coupling is preserved. To further analyze the role of sensory input for internal forward models and to characterize the consequences of central nervous system damage for anticipatory grip force control, we measured grip force behavior in neurological patients. We tested a group of stroke patients with varying degrees of impaired fine motor control and sensory loss, a single patient with complete and permanent differentation from all tactile and proprioceptive input, and a group of patients with amyotrophic lateral sclerosis (ALS) that exclusively impairs the motor system without affecting sensory modalities. Increased grip forces were a common finding in all patients. Sensory deficits were a strong but not the only predictor of impaired grip force economy. The feedforward mode of grip force control was typically preserved in the stroke patients despite their central sensory deficits, but was severely disturbed in the patient with peripheral sensory deafferentation and in a minority of stroke patients. Moderate deficits of feedforward control were also obvious in ALS patients. Thus, the function of the internal forward model and the precision of grip force production may depend on a complex anatomical and functional network of sensory and motor structures and their interaction in time and space.

The cutaneous contribution to adaptive precision grip

Only after injury, or perhaps prolonged exposure to cold that is sufficient to numb the fingers, do we suddenly appreciate the complex neural mechanisms that underlie our effortless dexterity in manipulating objects. The nervous system is capable of adapting grip forces to a wide range of object shapes, weights and frictional properties, to provide optimal and secure handling in a variety of potentially perturbing environments. The dynamic interplay between sensory information and motor commands provides the basis for this flexibility, and recent studies supply somewhat unexpected evidence of the essential role played by cutaneous feedback in maintaining and acquiring predictive grip force control. These examples also offer new insights into the adaptive control of other voluntary movements.

Grip force behavior during object manipulation in neurological disorders: Toward an objective evaluation of manual performance deficits

The control of prehensile finger forces is an essential feature of skilled manual performance. The basic aspects of healthy grip force behavior have been well documented. In healthy subjects, grip force is precisely adjusted to the mechanical object properties. Grip force is always slightly higher than the minimum necessary to prevent the object from slipping. When we move a hand-held object, grip force is modulated in parallel with movements-induced load fluctuations without an obvious delay. The absence of a temporal delay between grip and load force profiles suggests that the central nervous system is able to predict the load variations before the intended manipulation and consequently regulates grip force in anticipation. Feedback from the grasping fingertips is used to adjust the level of applied fingertip force efficiently to the actual loading requirements. Pathologic grip force control affects the efficiency of produced force and the precision of the temporal coupling between grip and load force profiles. Here, we review the characteristics of pathologic grip force behavior in various neurological disorders. Detailed examination of grip force control is simple and well suited for the objective evaluation of impaired motor function of the hand and its rehabilitation.

Selective deficits of grip force control during object manipulation in patients with reduced sensibility of the grasping digits

Persons with impaired manual sensibility frequently report problems to use the hand in manipulative tasks, such as using tools or buttoning a shirt. At least two control processes determine grip forces during voluntary object manipulation. Anticipatory force control specifies the motor commands on the basis of predictions about physical object properties and the consequences of our own actions. Feedback sensory information from the grasping digits, representing mechanical events at the skin-object interface, automatically modifies grip force according to the actual loading requirements and updates sensorimotor memories to support anticipatory grip force control. We investigated grip force control in nine patients with moderately impaired tactile sensibility of the grasping digits and in nine sex- and age-matched healthy controls lifting and holding an instrumented object. In healthy controls grip force was adequately scaled to the weight of the object to be lifted. The grip force was programmed to smoothly change in parallel with load force over the entire lifting movement. In particular, the grip force level was regulated in an economical way to be always slightly higher than the minimum required to prevent the object slipping. The temporal coupling between the grip and load force profiles achieved a high precision with the maximum grip and load forces coinciding closely in time. For the temporal regulation of the grip force profile patients with impaired tactile sensibility maintained the close co-ordination between proximal arm muscles, responsible for the lifting movement and the fingers stabilising the grasp. Maximum grip force coincided with maximum acceleration of the lifting movement. However, patients employed greater maximum grip forces and greater grip forces to hold the object unsupported when compared with controls. Our results give further evidence to the suggestion that during manipulation of objects with known physical properties the anticipatory temporal regulation of the grip force profile is centrally processed and less under sensory feedback control. In contrast, sensory afferent information from the grasping fingers plays a dominant role for the efficient scaling of the grip force level according to actual loading requirements.

When motor execution is selectively impaired: control of manipulative finger forces in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a degenerative motor neuron disorder with progressive and exclusive loss of motor neurons in the spinal cord, brainstem, and motor cortex. Five patients with amyotrophic lateral sclerosis, and 5 age-matched, healthy control subjects performed vertical point-to-point arm movements with an instrumented hand-held object. In between the movements, the object was held stationary. Compared with healthy controls, all patients generated greater grip forces during the phase of stationary holding of the object and greater ratios between grip and load force maximums during the arm movements. We conclude that in amyotrophic lateral sclerosis, the ability to scale the grip force magnitude efficiently according to the actual loading requirements is impaired. When performing upward movements, controls increased grip force in parallel with load force right from the movement onset; during downward movements, controls anticipated an early decrease of load force by constant or decreasing grip forces. In contrast, 3 of 5 patients showed an early increase of grip force during both upward and downward movements, indicating that in amyotrophic lateral sclerosis, the differential regulation of the grip force output according to the direction-dependent load force profile may be impaired. In motor neuron disease, the inaccurate grip force scaling and the impaired temporal coupling between grip and load force profiles may either directly result from deficient motor execution or be secondary to accompanying symptoms, such as dyscoordination of hand and finger muscles due to spasticity.

Grip force control during object manipulation in cerebral stroke

OBJECTIVE

To analyze impairments of manipulative grip force control in patients with chronic cerebral stroke and relate deficits to more elementary aspects of force and grip control.

METHODS

Nineteen chronic stroke patients with fine motor deficits after unilateral cerebral lesions were examined when performing 3 manipulative tasks consisting of stationary holding, transport, and vertical cyclic movements of an instrumented object. Technical sensors measured the grip force used to stabilize the object in the hand and the object accelerations, from which the dynamic loads were calculated.

RESULTS

Many patients produced exaggerated grip forces with their affected hand in all types of manipulations. The amount of finger displacement in a grip perturbation task emerged as a highly sensitive measure for predicting the force increases. Measures of grip strength and maximum speed of force changes could not account for the impairments with comparable accuracy. In addition to force economy, the precision of the coupling between grip and load forces was impaired. However, no temporal delays were typically observed between the grip and load force profiles during cyclic movements.

CONCLUSIONS

Impaired sensibility and sensorimotor processing, evident by delayed reactions in the perturbation task, lead to an excessive increase of the safety margin between the actual grip force and the minimum force necessary to prevent object slipping. In addition to grip force scaling, cortical sensorimotor areas are responsible for smoothly and precisely adjusting grip forces to loads according to predictions about movement-induced loads and sensory experiences. However, the basic feedforward mechanism of grip force control by internal models appears to be preserved, and thus may not be a cortical but rather a subcortical or cerebellar function, as has been suggested previously.