Sensory integration in the perception of movements at the human metacarpophalangeal joint

Proprioception: A New Era Set in Motion by Emerging Genetic and Bionic Strategies?

The generation of an internal body model and its continuous update is essential in sensorimotor control. Although known to rely on proprioceptive sensory feedback, the underlying mechanism that transforms this sensory feedback into a dynamic body percept remains poorly understood. However, advances in the development of genetic tools for proprioceptive circuit elements, including the sensory receptors, are beginning to offer new and unprecedented leverage to dissect the central pathways responsible for proprioceptive encoding. Simultaneously, new data derived through emerging bionic neural machine-interface technologies reveal clues regarding the relative importance of kinesthetic sensory feedback and insights into the functional proprioceptive substrates that underlie natural motor behaviors.

Taping-induced cutaneous stimulation to the ankle tendons reduces minimum toe clearance variability

Large variability of minimum toe clearance (MTC) leads to a higher risk of tripping. Visual feedback-based gait training systems have been used to regulate MTC distribution, but these systems are expensive and bulky. Furthermore, the effect of such training lasts only for a short period of time. Considering the efficacy of elastic adhesive tape-induced cutaneous stimulation to the ankle tendons in improving proprioception and movement detection, we hypothesize that application of tapes to the ankle tendons as a practical method for modifying MTC distribution. To test this hypothesis, we recruited 13 young and healthy adults and instructed them to walk on a treadmill under four conditions: no taping, taping the tibialis anterior tendon, taping the Achilles tendon, and taping both tendons. We measured MTC distribution, lower limb joint angles and muscle activations of the tibialis anterior and gastrocnemius medialis, and compared these outcomes under the four conditions. The application of elastic adhesive tape to the ankle tendons had no significant effect on the average MTC height, but tapes applied to the Achilles tendon and both tendons significantly reduced MTC variability. Taping decreased the variability of some lower limb joint angles, but taping did not induce significant changes in the activation levels of the shank muscles. These results demonstrate that elastic adhesive tape applied to the shank can reduce MTC variability with minimal resistance, inertia and cumbersomeness.

Involvement of visual signals in kinaesthesia: A virtual reality study

Body movements are invariably accompanied by various proprioceptive, visual, tactile and/or motor signals. It is therefore difficult to completely dissociate these various signals from each other in order to study their specific involvement in the perception of movement (kinaesthesia). Here, we manipulated visual motion signals in a virtual reality display by using a humanoid avatar. The visual signals of movement could therefore be manipulated freely, relative to the participant's actual movement or lack of movement. After an embodiment phase in which the avatar's movements were coupled to the participant's voluntary movements, kinaesthetic illusions were evoked by moving the avatar's right forearm (flexion or extension) while the participant's right arm remained static. The avatar's left forearm was hidden from view. In parallel, somaesthetic signals could be masked by agonist-antagonist co-vibration or be amplified (by agonist vibration only or antagonist vibration only) so that the real impact of visual cues of movement in kinaesthesia could be studied. In a study of 24 participants, masking the somaesthetic signals (which otherwise provide signals indicating that the arm is static) was associated with a greater intensity and shorter latency of the visually evoked illusions. These results confirm the importance of carefully considering somaesthetic signals when assessing the contribution of vision to kinaesthesia. The use of a combination of virtual reality and somaesthetic signal manipulation might be of clinical value.

The interaction between motion and texture in the sense of touch

Besides providing information on elementary properties of objects, like texture, roughness, and softness, the sense of touch is also important in building a representation of object movement and the movement of our hands. Neural and behavioral studies shed light on the mechanisms and limits of our sense of touch in the perception of texture and motion, and of its role in the control of movement of our hands. The interplay between the geometrical and mechanical properties of the touched objects, such as shape and texture, the movement of the hand exploring the object, and the motion felt by touch, will be discussed in this article. Interestingly, the interaction between motion and textures can generate perceptual illusions in touch. For example, the orientation and the spacing of the texture elements on a static surface induces the illusion of surface motion when we move our hand on it or can elicit the perception of a curved trajectory during sliding, straight hand movements. In this work we present a multiperspective view that encompasses both the perceptual and the motor aspects, as well as the response of peripheral and central nerve structures, to analyze and better understand the complex mechanisms underpinning the tactile representation of texture and motion. Such a better understanding of the spatiotemporal features of the tactile stimulus can reveal novel transdisciplinary applications in neuroscience and haptics.

Evolution of touch and proprioception of the limbs: Insights from fish and humans

The function of the hands is inextricably linked to cutaneous mechanosensation, both in touch and in how hand movement and posture (proprioception) are controlled. The structure and behavior of hands and distal forelimbs of other vertebrates have been evolutionarily shaped by these mechanosensory functions. The distal forelimb of tetrapod vertebrates is homologous to the pectoral fin rays and membrane of fishes. Fish fins demonstrate similar mechanosensory abilities to hands and other distal tetrapod forelimbs in touch and proprioception. These results indicate that vertebrates were using the core mechanosensory inputs, such as fast adapting and slow adapting nerve responses, to inform fin and limb function and behavior before their diversification in fish and tetrapod lineages.

Visual and somatosensory feedback mechanisms of precision manual motor control in autism spectrum disorder

BACKGROUND

Individuals with autism spectrum disorder (ASD) show deficits processing sensory feedback to reactively adjust ongoing motor behaviors. Atypical reliance on visual and somatosensory feedback each have been reported during motor behaviors in ASD suggesting that impairments are not specific to one sensory domain but may instead reflect a deficit in multisensory processing, resulting in reliance on unimodal feedback. The present study tested this hypothesis by examining motor behavior across different visual and somatosensory feedback conditions during a visually guided precision grip force test.

METHODS

Participants with ASD (N = 43) and age-matched typically developing (TD) controls (N = 23), ages 10-20 years, completed a test of precision gripping. They pressed on force transducers with their index finger and thumb while receiving visual feedback on a computer screen in the form of a horizontal bar that moved upwards with increased force. They were instructed to press so that the bar reached the level of a static target bar and then to hold their grip force as steadily as possible. Visual feedback was manipulated by changing the gain of the force bar. Somatosensory feedback was manipulated by applying 80 Hz tendon vibration at the wrist to disrupt the somatosensory percept. Force variability (standard deviation) and irregularity (sample entropy) were examined using multilevel linear models.

RESULTS

While TD controls showed increased force variability with the tendon vibration on compared to off, individuals with ASD showed similar levels of force variability across tendon vibration conditions. Individuals with ASD showed stronger age-associated reductions in force variability relative to controls across conditions. The ASD group also showed greater age-associated increases in force irregularity relative to controls, especially at higher gain levels and when the tendon vibrator was turned on.

CONCLUSIONS

Our findings that disrupting somatosensory feedback did not contribute to changes in force variability or regularity among individuals with ASD suggests a reduced ability to integrate somatosensory feedback information to guide ongoing precision manual motor behavior. We also document stronger age-associated gains in force control in ASD relative to TD suggesting delayed development of multisensory feedback control of motor behavior.

Gating Patterns to Proprioceptive Stimulation in Various Cortical Areas: An MEG Study in Children and Adults using Spatial ICA

Proprioceptive paired-stimulus paradigm was used for 30 children (10-17 years) and 21 adult (25-45 years) volunteers in magnetoencephalography (MEG). Their right index finger was moved twice with 500-ms interval every 4 ± 25 s (repeated 100 times) using a pneumatic-movement actuator. Spatial-independent component analysis (ICA) was applied to identify stimulus-related components from MEG cortical responses. Clustering was used to identify spatiotemporally consistent components across subjects. We found a consistent primary response in the primary somatosensory (SI) cortex with similar gating ratios of 0.72 and 0.69 for the children and adults, respectively. Secondary responses with similar transient gating behavior were centered bilaterally in proximity of the lateral sulcus. Delayed and prolonged responses with strong gating were found in the frontal and parietal cortices possibly corresponding to larger processing network of somatosensory afference. No significant correlation between age and gating ratio was found. We confirmed that cortical gating to proprioceptive stimuli is comparable to other somatosensory and auditory domains, and between children and adults. Gating occurred broadly beyond SI cortex. Spatial ICA revealed several consistent response patterns in various cortical regions which would have been challenging to detect with more commonly applied equivalent current dipole or distributed source estimates.

Effects of enhanced cutaneous sensory input on interlimb strength transfer of the wrist extensors

The relative contribution of cutaneous sensory feedback to interlimb strength transfer remains unexplored. Therefore, this study aimed to determine the relative contribution of cutaneous afferent pathways as a substrate for cross-education by directly assessing how "enhanced" cutaneous stimulation alters ipsilateral and contralateral strength gains in the forearm. Twenty-seven right-handed participants were randomly assigned to 1-of-3 training groups and completed 6 sets of 8 repetitions 3x/week for 5 weeks. Voluntary training (TRAIN) included unilateral maximal voluntary contractions (MVCs) of the wrist extensors. Cutaneous stimulation (STIM), a sham training condition, included cutaneous stimulation (2x radiating threshold; 3sec; 50Hz) of the superficial radial (SR) nerve at the wrist. TRAIN + STIM training included MVCs of the wrist extensors with simultaneous SR stimulation. Two pre- and one posttraining session assessed the relative increase in force output during MVCs of isometric wrist extension, wrist flexion, and handgrip. Maximal voluntary muscle activation was simultaneously recorded from the flexor and extensor carpi radialis. Cutaneous reflex pathways were evaluated through stimulation of the SR nerve during graded ipsilateral contractions. Results indicate TRAIN increased force output compared with STIM in both trained (85.0 ± 6.2 Nm vs. 59.8 ± 6.1 Nm) and untrained wrist extensors (73.9 ± 3.5 Nm vs. 58.8 Nm). Providing 'enhanced' sensory input during training (TRAIN + STIM) also led to increases in strength in the trained limb compared with STIM (79.3 ± 6.3 Nm vs. 59.8 ± 6.1 Nm). However, in the untrained limb no difference occurred between TRAIN + STIM and STIM (63.0 ± 3.7 Nm vs. 58.8 Nm). This suggests when 'enhanced' input was provided independent of timing with active muscle contraction, interlimb strength transfer to the untrained wrist extensors was blocked. This indicates that the sensory volley may have interfered with the integration of appropriate sensorimotor cues required to facilitate an interlimb transfer, highlighting the importance of appropriately timed cutaneous feedback.

Effect of Cutaneous Feedback on the Perception of Virtual Object Weight during Manipulation

Haptic interface technologies for virtual reality applica have been developed to increase the reality and manipulability of a virtual object by creating a diverse tactile sensation. Most evaluation of the haptic technologies, however, have been limited to the haptic perception of the tactile stimuli via static virtual objects. Noting this, we investigated the effect of lateral cutaneous feedback, along with kinesthetic feedback on the perception of virtual object weight during manipulation. We modeled the physical interaction between a participant’s finger avatars and virtual objects. The haptic stimuli were rendered with custom-built haptic feedback systems that can provide kinesthetic and lateral cutaneous feedback to the participant. We conducted two virtual object manipulation experiments, 1. a virtual object manipulation with one finger, and 2. the pull-out and lift-up of a virtual object grasped with a precision grip. The results of Experiment 1 indicate that the participants felt the virtual object rendered with lateral cutaneous feedback significantly heavier than with only kinesthetic feedback (p < 0.05 for m_ref = 100 and 200 g). Similarly, the participants of Experiment 2 felt the virtual objects significantly heavier when lateral cutaneous feedback was available (p < 0.05 for m_ref = 100, 200, and 300 g). Therefore, the additional lateral cutaneous feedback to the force feedback led the participants to feel the virtual object heavier than without the cutaneous feedback. The results also indicate that the contact force applied to a virtual object during manipulation can be a function of the perceived object weight p = 0.005 for Experiment 1 and p = 0.2 for Experiment 2.

A new method to elicit and measure movement illusions in stroke by means of muscle tendon vibration: the Standardized Kinesthetic Illusion Procedure (SKIP)

Purpose: Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in stroke, MTV is scarcely used in clinical practice, likely because of the absence of standardised procedures to elicit and characterise movement illusions. This work developed and validated a Standardised Kinaesthetic Illusion Procedure (SKIP) to favour the use of MTV-induced illusions in clinical settings.Materials and methods: SKIP scores were obtained in 15 individuals with chronic stroke and 18 age- and gender-matched healthy counterparts. A further 13 healthy subjects were tested to provide more data with the general population. MTV was applied over the Achilles tendon and SKIP scoring system characterised the clearness and direction of the illusions of ankle dorsiflexion movements.Results: All healthy and stroke participants perceived movement illusions. SKIP scores on the paretic side were significantly lower compared to the non paretic and healthy. Illusions were less clear and sometimes in unexpected directions with the impaired ankle, but still possible to elicit in the presence of sensorimotor deficits.Conclusions: SKIP represents an ancillary and potentially useful clinical method to elicit and characterise illusions of movements induced by MTV. SKIP could be relevant to further assess the processing of proprioceptive afferents in stroke and their potential impact on motor control and recovery. It may be used to guide therapy and improve sensorimotor recovery. Future work is needed to investigate the metrological properties of our method (reliability, responsiveness, etc.), and also the neurophysiological underpinnings of MTV-induced illusions.

Finger Posture and Finger Load are Perceived Independently

The ability to track the time-varying postures of our hands and the forces they exert plays a key role in our ability to dexterously interact with objects. However, how precisely and accurately we sense hand kinematics and kinetics has not been completely characterized. Furthermore, the dominant source of information about hand postures stems from muscle spindles, whose responses can also signal isometric force and are modulated by fusimotor input. As such, one might expect that changing the state of the muscles – for example, by applying a load – would influence perceived finger posture. To address these questions, we measure the acuity of human hand proprioception, investigate the interplay between kinematic and kinetic signals, and determine the extent to which actively and passively achieved postures are perceived differently. We find that angle and torque perception are highly precise; that loads imposed on the finger do not affect perceived joint angle; that joint angle does not affect perceived load; and that hand postures are perceived similarly whether they are achieved actively or passively. The independence of finger posture and load perception contrasts with their interdependence in the upper arm, likely reflecting the special functional importance of the hand.

A Python Code for Simulating Single Tactile Receptors and the Spiking Responses of Their Afferents

This work presents a pieces of Python code to rapidly simulate the spiking responses of large numbers of single cutaneous tactile afferents with millisecond precision. To simulate the spike responses of all the major types of cutaneous tactile afferents, we proposed an electromechanical circuit model, in which a two-channel filter was developed to characterize the mechanical selectivity of tactile receptors, and a spike synthesizer was designed to recreate the action potentials evoked in afferents. The parameters of this model were fitted using previous neurophysiological datasets. Several simulation examples were presented in this paper to reproduce action potentials, sensory adaptation, frequency characteristics and spiking timing for each afferent type. The results indicated that the simulated responses matched previous neurophysiological recordings well. The model allows for a real-time reproduction of the spiking responses of about 4,000 tactile units with a timing precision of <6 ms. The current work provides a valuable guidance to designing highly realistic tactile interfaces such as neuroprosthesis and haptic devices.

Recording single- and multi-unit neuronal action potentials from the surface of the dorsal root ganglion

The dorsal root ganglia (DRG) contain cell bodies of primary afferent neurons, which are frequently studied by recording extracellularly with penetrating microelectrodes inserted into the DRG. We aimed to isolate single- and multi-unit activity from primary afferents in the lumbar DRG using non-penetrating electrode arrays and to characterize the relationship of that activity with limb position and movement. The left sixth and seventh lumbar DRG (L6-L7) were instrumented with penetrating and non-penetrating electrode arrays to record neural activity during passive hindlimb movement in 7 anesthetized cats. We found that the non-penetrating arrays could record both multi-unit and well-isolated single-unit activity from the surface of the DRG, although with smaller signal to noise ratios (SNRs) compared to penetrating electrodes. Across all recorded units, the median SNR was 1.1 for non-penetrating electrodes and 1.6 for penetrating electrodes. Although the non-penetrating arrays were not anchored to the DRG or surrounding tissues, the spike amplitudes did not change (<1% change from baseline spike amplitude) when the limb was moved passively over a limited range of motion (~20 degrees at the hip). Units of various sensory fiber types were recorded, with 20% of units identified as primary muscle spindles, 37% as secondary muscle spindles, and 24% as cutaneous afferents. Our study suggests that non-penetrating electrode arrays can record modulated single- and multi-unit neural activity of various sensory fiber types from the DRG surface.

The preload force affects the perception threshold of muscle vibration-induced movement illusions

The control and the execution of motor tasks are largely influenced by proprioceptive feedback, i.e. the information about the position and movement of the body. In 1972, it was discovered that a vibratory stimulation applied non-invasively to a muscle or a tendon induces a movement illusion consistent with the elongation of the vibrated muscle/tendon. Although this phenomenon was reported by several studies, it is still unclear how to reliably reproduce it because of the many different features of the stimulation altering the sensation (e.g. frequency, duration, location). By performing a psychophysical test, we analysed the effects of the stimulation point and the preload force on the minimum stimulation amplitude needed to elicit an illusion of movement. In particular, we stimulated two groups of healthy subjects on three target regions of the biceps brachii muscle (the distal tendon, the muscle belly and one of the proximal tendons) applying three preload force ranges (0.5–0.75N, 1–2N and 3–4N). Our results showed that the minimum stimulation amplitude eliciting a sensation is affected by the preload force. On the contrary, it did not change significantly among the three stimulated regions. Nevertheless, the reported vividness of the illusion of movement changed across the stimulated points decreasing while moving from the distal to the proximal tendons. Overall, these outcomes contribute to the scientific debate on the features that modulate the vibration-induced movement illusion proposing ways to increase the reliability of the procedure in basic and applied research studies.

Effects of a compression garment on sensory feedback transmission in the human upper limb

Compression apparel is popular in both medical and sport performance settings. Perceived benefits are suggested to include changes in sensory feedback transmission caused by activation of mechanoreceptors. However, little is known about effects of compression apparel on sensorimotor control. Our purpose was to mechanistically examine whether compression apparel modulates sensory feedback transmission and reaching accuracy in the upper limb. Two experiments were completed under CONTROL and COMPRESSION (sleeve applied across the elbow joint) conditions. M-waves and H-reflexes were elicited by stimulating the median nerve and were recorded via surface electromyography (EMG). In experiment 1, H-reflexes and M-H recruitment curves were assessed at REST, during wrist flexion (10% EMG_max), and during a cutaneous conditioning of the superficial radial (SR) or distal median (MED) nerve. Cutaneous reflexes were elicited during 10% wrist flexion via stimulation of SR or MED. In experiment 2, unconditioned H-reflex measures were assessed at rest, during arm cycling, and during a discrete reaching task. Results indicate that compression apparel modulates spinal cord excitability across multiple sensory pathways and movement tasks. Interestingly, there was a significant improvement in reaching accuracy while wearing the compression sleeve. Taken together, the compression sleeve appears to increase precision and sensitivity around the joint where the sleeve is applied. Compression apparel may function as a "filter" of irrelevant mechanoreceptor information allowing for optimal task-related sensory information to enhance proprioception. NEW & NOTEWORTHY Wearing a customized compression sleeve was shown to alter the excitability of multiple pathways within the central nervous system regardless of conditioning input or movement task and was accompanied by improved accuracy of reaching movements and determination of movement end point. Compression apparel may assist as a type of "filter function" of tonic and nonspecific mechanoreceptor information leading to increased precision and movement sensitivity around the joint where compression is applied.

Two Visual Pathways in Primates Based on Sampling of Space: Exploitation and Exploration of Visual Information

Evidence is strong that the visual pathway is segregated into two distinct streams—ventral and dorsal. Two proposals theorize that the pathways are segregated in function: The ventral stream processes information about object identity, whereas the dorsal stream, according to one model, processes information about either object location, and according to another, is responsible in executing movements under visual control. The models are influential; however recent experimental evidence challenges them, e.g., the ventral stream is not solely responsible for object recognition; conversely, its function is not strictly limited to object vision; the dorsal stream is not responsible by itself for spatial vision or visuomotor control; conversely, its function extends beyond vision or visuomotor control. In their place, we suggest a robust dichotomy consisting of a ventral stream selectively sampling high-resolution/focal spaces, and a dorsal stream sampling nearly all of space with reduced foveal bias. The proposal hews closely to the theme of embodied cognition: Function arises as a consequence of an extant sensory underpinning. A continuous, not sharp, segregation based on function emerges, and carries with it an undercurrent of an exploitation-exploration dichotomy. Under this interpretation, cells of the ventral stream, which individually have more punctate receptive fields that generally include the fovea or parafovea, provide detailed information about object shapes and features and lead to the systematic exploitation of said information; cells of the dorsal stream, which individually have large receptive fields, contribute to visuospatial perception, provide information about the presence/absence of salient objects and their locations for novel exploration and subsequent exploitation by the ventral stream or, under certain conditions, the dorsal stream. We leverage the dichotomy to unify neuropsychological cases under a common umbrella, account for the increased prevalence of multisensory integration in the dorsal stream under a Bayesian framework, predict conditions under which object recognition utilizes the ventral or dorsal stream, and explain why cells of the dorsal stream drive sensorimotor control and motion processing and have poorer feature selectivity. Finally, the model speculates on a dynamic interaction between the two streams that underscores a unified, seamless perception. Existing theories are subsumed under our proposal.

Proprioceptive Localization of the Hand Changes When Skin Stretch around the Elbow Is Manipulated

Cutaneous information has been shown to influence proprioceptive position sense when subjects had to judge or match the posture of their limbs. In the present study, we tested whether cutaneous information also affects proprioceptive localization of the hand when moving it to a target. In an explorative study, we manipulated the skin stretch around the elbow by attaching elastic sports tape to one side of the arm. Subjects were asked to move the unseen manipulated arm to visually presented targets. We found that the tape induced a significant shift of the end-points of these hand movements. Surprisingly, this shift corresponded with an increase in elbow extension, irrespective of the side of the arm that was taped. A control experiment showed that this cannot be explained by how the skin stretches, because the skin near the elbow stretches to a similar extent on the inside and outside of the arm when the elbow angle increases and decreases, respectively. A second control experiment reproduced and extended the results of the main experiment for tape on the inside of the arm, and showed that the asymmetry was not just a consequence of the tape originally being applied slightly differently to the outside of the arm. However, the way in which the tape was applied does appear to matter, because applying the tape in the same way to the outside of the arm as to the inside of the arm influenced different subjects quite differently, suggesting that the relationship between skin stretch and sensed limb posture is quite complex. We conclude that the way the skin is stretched during a goal-directed movement provides information that helps guide the hand toward the target.

Upper Extremity Proprioception After Stroke: Bridging the Gap Between Neuroscience and Rehabilitation

Proprioception is an important aspect of function that is often impaired in the upper extremity following stroke. Unfortunately, neurorehabilitation has few evidence based treatment options for those with proprioceptive deficits. The authors consider potential reasons for this disparity. In doing so, typical assessments and proprioceptive intervention studies are discussed. Relevant evidence from the field of neuroscience is examined. Such evidence may be used to guide the development of targeted interventions for upper extremity proprioceptive deficits after stroke. As researchers become more aware of the impact of proprioceptive deficits on upper extremity motor performance after stroke, it is imperative to find successful rehabilitation interventions to target these deficits and ultimately improve daily function.

Representation of Afferent Signals from Forearm Muscle and Cutaneous Nerves in the Primary Somatosensory Cortex of the Macaque Monkey

Proprioception is one's overall sense of the relative positions and movements of the various parts of one's body. The primary somatosensory cortex (SI) is involved in generating the proprioception by receiving peripheral sensory inputs from both cutaneous and muscle afferents. In particular, area 3a receives input from muscle afferents and areas 3b and 1 from cutaneous afferents. However, segregation of two sensory inputs to these cortical areas has not been evaluated quantitatively because of methodological difficulties in distinguishing the incoming signals. To overcome this, we applied electrical stimulation separately to two forearm nerves innervating muscle (deep radial nerve) and skin (superficial radial nerve), and examined the spatiotemporal distribution of sensory evoked potentials (SEPs) in SI of anaesthetized macaques. The SEPs arising from the deep radial nerve were observed exclusively at the bottom of central sulcus (CS), which was identified as area 3a using histological reconstruction. In contrast, SEPs evoked by stimulation of the superficial radial nerve were observed in the superficial part of SI, identified as areas 3b and 1. In addition to these earlier, larger potentials, we also found small and slightly delayed SEPs evoked by cutaneous nerve stimulation in area 3a. Coexistence of the SEPs from both deep and superficial radial nerves suggests that area 3a could integrate muscle and cutaneous signals to shape proprioception.

Electrical stimulation ventilatory feedback facilitates maintenance of a prolonged expiration pattern during exercise: A proof-of-concept study in healthy adults

This study aimed at verifying the safety and effects of electrical stimulation ventilatory feedback (ESVF) to provide feedback during expiration, which may assist with breathing control in patients with chronic obstructive pulmonary disease (COPD). Because this is a new therapy, we examined the feasibility of the therapy in healthy adults. The 23 healthy adult participants were randomized into two groups: a stimulation group that received ESVF and a placebo group with the ESVF device attached, but not activated. Sensory stimulation was provided at a frequency of 20 Hz and pulse duration of 200 μs. During breathing training, participants practiced a prolonged expiration pattern and were instructed to maintain the breathing pattern during exercise. A variety of parameters such as respiratory time from the gas analyzer monitor and quantitative load were measured during lower-extremity cycle ergometer exercise. The primary outcome was the expiratory to inspiratory time ratio, which was significantly higher in the stimulation group than in the placebo group, both during and after exercise. No side effects were reported during the use of electrical stimulation. Therefore, ESVF is safe and facilitates maintenance of a prolonged expiration pattern during and after exercise.

The Change in Fingertip Contact Area as a Novel Proprioceptive Cue

Humans, many animals, and certain robotic hands have deformable fingertip pads [1, 2]. Deformable pads have the advantage of conforming to the objects that are being touched, ensuring a stable grasp for a large range of forces and shapes. Pad deformations change with finger displacements during touch. Pushing a finger against an external surface typically provokes an increase of the gross contact area [3], potentially providing a relative motion cue, a situation comparable to looming in vision [4]. The rate of increase of the area of contact also depends on the compliance of the object [5]. Because objects normally do not suddenly change compliance, participants may interpret an artificially induced variation in compliance, which coincides with a change in the gross contact area, as a change in finger displacement, and consequently they may misestimate their finger's position relative to the touched object. To test this, we asked participants to compare the perceived displacements of their finger while contacting an object varying pseudo-randomly in compliance from trial to trial. Results indicate a bias in the perception of finger displacement induced by the change in compliance, hence in contact area, indicating that participants interpreted the altered cutaneous input as a cue to proprioception. This situation highlights the capacity of the brain to take advantage of knowledge of the mechanical properties of the body and of the external environment.

Cutaneous stimulation at the ankle: a differential effect on proprioceptive postural control according to the participants' preferred sensory strategy

Background

Ankle movements can be partially encoded by cutaneous afferents. However, little is known about the central integration of these cutaneous signals, and whether individual differences exist in this integration. The aim of this study was to determine whether the effect of cutaneous stimulation at the ankle would differ depending on the participants’ preferred sensory strategy appraised by relative proprioceptive weighting (RPw).

Methods

Forty-seven active young individuals free of lower-limb injury stood on a force platform either barefoot or wearing a custom-designed bootee. Vibrations (60 Hz, 0.5 mm) were applied either to the peroneal tendons or to the lumbar paraspinal muscles.

Results

The barefoot RPw was strongly negatively correlated to the absolute change in RPw measured in the bootee condition (r = −0.81, P < 0.001). Participants were then grouped depending on their barefoot RPw value. The RPw was significantly higher in the bootee condition than in the barefoot condition only for participants with low barefoot RPw.

Conclusions

The external cutaneous stimulation given by the bootee increased the weight of ankle proprioceptive signals only for participants with low barefoot RPw. This result confirmed that optimization of the ankle proprioceptive signals provided by cutaneous afferent stimulation has a differential effect depending on the participants’ preferred sensory strategy.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-016-0140-y) contains supplementary material, which is available to authorized users.

Vivid Mental Imagery of Biomechanically Impossible Movements Elicited by Cortical Electrostimulation of the Central Region in an Awake Patient

BACKGROUND

The perception we have of our own body, called 'body image,' is crucial for self-awareness. Here, we evoked reproducible mental imagery of a postural illusion by intrasurgical electrostimulation of the central cortex.

CASE REPORT

A 24-year-old patient experienced seizures involving vivid mental imagery of biomechanically impossible movements of the upper limb. A right precentral low-grade glioma was diagnosed. Awake surgery with intraoperative electrostimulation sensorimotor mapping was performed. Remarkably, the same mental representations of biomechanically impossible movements of the left upper limb were repeatedly elicited during stimulation of the central cortex. These eloquent areas were preserved, even though the precentral part of the knob of the hand was removed. After a transient monoplegia, the patient recovered and resumed a normal life which included playing the guitar.

CONCLUSION

These mental experiences of a postural illusion generated by intraoperative stimulation could be related to neuroplasticity mechanisms induced by the slow growth of low-grade glioma within the knob of the hand. Such a functional reorganization may explain why this area was removed without permanent deficits. This perception of biomechanically impossible movements during surgery might be due to a transient disruption by stimulating the frontoparietal network involved in the coding of the body image.

Cerebral, subcortical, and cerebellar activation evoked by selective stimulation of muscle and cutaneous afferents: an fMRI study

Abstract We compared the brain areas that showed significant flow changes induced by selective stimulation of muscle and cutaneous afferents using fMRI BOLD imaging. Afferents arising from the right hand were studied in eight volunteers with electrical stimulation of the digital nerve of the index finger and over the motor point of the FDI muscle. Both methods evoked areas of significant activation cortically, subcortically, and in the cerebellum. Selective muscle afferent stimulation caused significant activation in motor-related areas. It also caused significantly greater activation within the contralateral precentral gyrus, insula, and within the ipsilateral cerebellum as well as greater areas of reduced blood flow when compared to the cutaneous stimuli. We demonstrated separate precentral and postcentral foci of excitation with muscle afferent stimulation. We conclude, contrary to the findings with evoked potentials, that muscle afferents evoke more widespread cortical, subcortical, and cerebellar activation than do cutaneous afferents. This emphasizes the importance, for studies of movement, of matching the kinematic aspects in order to avoid the results being confounded by alterations in muscle afferent activation. The findings are consistent with clinical observations of the movement consequences of sensory loss and may also be the basis for the contribution of disturbed sensorimotor processing to disorders of movement.

Exercise and osteoarthritis: cause and effects

Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.

Differential contributions of vision, touch and muscle proprioception to the coding of hand movements

To further elucidate the mechanisms underlying multisensory integration, this study examines the controversial issue of whether congruent inputs from three different sensory sources can enhance the perception of hand movement. Illusory sensations of clockwise rotations of the right hand were induced by either separately or simultaneously stimulating visual, tactile and muscle proprioceptive channels at various intensity levels. For this purpose, mechanical vibrations were applied to the pollicis longus muscle group in the subjects’ wrists, and a textured disk was rotated under the palmar skin of the subjects’ right hands while a background visual scene was projected onto the rotating disk. The elicited kinaesthetic illusions were copied by the subjects in real time and the EMG activity in the adductor and abductor wrist muscles was recorded. The results show that the velocity of the perceived movements and the amplitude of the corresponding motor responses were modulated by the nature and intensity of the stimulation. Combining two sensory modalities resulted in faster movement illusions, except for the case of visuo-tactile co-stimulation. When a third sensory input was added to the bimodal combinations, the perceptual responses increased only when a muscle proprioceptive stimulation was added to a visuo-tactile combination. Otherwise, trisensory stimulation did not override bimodal conditions that already included a muscle proprioceptive stimulation. We confirmed that vision or touch alone can encode the kinematic parameters of hand movement, as is known for muscle proprioception. When these three sensory modalities are available, they contribute unequally to kinaesthesia. In addition to muscle proprioception, the complementary kinaesthetic content of visual or tactile inputs may optimize the velocity estimation of an on-going movement, whereas the redundant kinaesthetic content of the visual and tactile inputs may rather enhance the latency of the perception.

The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force

This is a review of the proprioceptive senses generated as a result of our own actions. They include the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness. Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb position and movement is not generated by individual receptors, but by populations of afferents. Afferent signals generated during a movement are processed to code for endpoint position of a limb. The afferent input is referred to a central body map to determine the location of the limbs in space. Experimental phantom limbs, produced by blocking peripheral nerves, have shown that motor areas in the brain are able to generate conscious sensations of limb displacement and movement in the absence of any sensory input. In the normal limb tendon organs and possibly also muscle spindles contribute to the senses of force and heaviness. Exercise can disturb proprioception, and this has implications for musculoskeletal injuries. Proprioceptive senses, particularly of limb position and movement, deteriorate with age and are associated with an increased risk of falls in the elderly. The more recent information available on proprioception has given a better understanding of the mechanisms underlying these senses as well as providing new insight into a range of clinical conditions.

Population coding of forelimb joint kinematics by peripheral afferents in monkeys

Various peripheral receptors provide information concerning position and movement to the central nervous system to achieve complex and dexterous movements of forelimbs in primates. The response properties of single afferent receptors to movements at a single joint have been examined in detail, but the population coding of peripheral afferents remains poorly defined. In this study, we obtained multichannel recordings from dorsal root ganglion (DRG) neurons in cervical segments of monkeys. We applied the sparse linear regression (SLiR) algorithm to the recordings, which selects useful input signals to reconstruct movement kinematics. Multichannel recordings of peripheral afferents were performed by inserting multi-electrode arrays into the DRGs of lower cervical segments in two anesthetized monkeys. A total of 112 and 92 units were responsive to the passive joint movements or the skin stimulation with a painting brush in Monkey 1 and Monkey 2, respectively. Using the SLiR algorithm, we reconstructed the temporal changes of joint angle, angular velocity, and acceleration at the elbow, wrist, and finger joints from temporal firing patterns of the DRG neurons. By automatically selecting a subset of recorded units, the SLiR achieved superior generalization performance compared with a regularized linear regression algorithm. The SLiR selected not only putative muscle units that were responsive to only the passive movements, but also a number of putative cutaneous units responsive to the skin stimulation. These results suggested that an ensemble of peripheral primary afferents that contains both putative muscle and cutaneous units encode forelimb joint kinematics of non-human primates.

Ankle joint movements are encoded by both cutaneous and muscle afferents in humans

We analyzed the cutaneous encoding of two-dimensional movements by investigating the coding of movement velocity for differently oriented straight-line movements and the coding of complex trajectories describing cursive letters. The cutaneous feedback was then compared with that of the underlying muscle afferents previously recorded during the same "writing-like" movements. The unitary activity of 43 type II cutaneous afferents was recorded in the common peroneal nerve in healthy subjects during imposed ankle movements. These movements consisted first of ramp-and-hold movements imposed at two different and close velocities in seven directions and secondly of "writing-like" movements. In both cases, the responses were analyzed using the neuronal population vector model. The results show that movement velocity encoding depended on the direction of the ongoing movement. Discriminating between two velocities therefore involved processing the activity of afferent populations located in the various skin areas surrounding the moving joint, as shown by the statistically significant difference observed in the amplitude of the sum vectors. Secondly, "writing-like" movements induced cutaneous neuronal patterns of activity, which were reproducible and specific to each trajectory. Lastly, the "cutaneous neuronal trajectories," built by adding the sum vectors tip-to-tail, nearly matched both the movement trajectories and the "muscle neuronal trajectories," built from previously recorded muscle afferents. It was concluded that type II cutaneous and the underlying muscle afferents show similar encoding properties of two-dimensional movement parameters. This similarity is discussed in relation to a central gating process that would for instance increase the gain of cutaneous inputs when muscle information is altered by the fusimotor drive.

The effects of kinesthetic illusory sensation induced by a visual stimulus on the corticomotor excitability of the leg muscles

A novel method of visual stimulus, reported by Kaneko et al. [14], induced a vivid kinesthetic illusion and increased the corticomotor excitability of the finger muscles without any overt movement. To explore the effect of this method on the lower limbs, motor evoked potentials (MEP) were recorded from the left tibialis anterior (TA) and soleus muscles using transcranial magnetic stimulation (TMS). A computer screen that showed the moving image of an ankle movement was placed over the subject's leg, and its position was modulated to induce an illusory sensation that the subject's own ankle was moving (illusion condition). TMS was delivered at rest and at two different times during the illusion condition (ankle dorsiflexion phase: illusion-DF; ankle plantarflexion phase: illusion-PF). The MEP amplitude of the TA, which is the agonist muscle for ankle dorsiflexion, was significantly increased during the illusion-DF condition. This indicated that the visual stimulus showing the moving image of an ankle movement could induce a kinesthetic illusion and selectively increase the corticomotor excitability in an agonist muscle for an illusion, as was previously reported for an upper limb. The MEP amplitude of the soleus, which is the agonist muscle for ankle plantarflexion, increased during the illusion-PF condition, but not significantly. Because of the vividness of the illusory sensation was significantly greater during the illusion-DF condition than the illusion-PF condition, we concluded that the vividness of the illusory sensation had a crucial role in increasing corticomotor excitability.

Contributions of skin and muscle afferent input to movement sense in the human hand

In the stationary hand, static joint-position sense originates from multimodal somatosensory input (e.g., joint, skin, and muscle). In the moving hand, however, it is uncertain how movement sense arises from these different submodalities of proprioceptors. In contrast to static-position sense, movement sense includes multiple parameters such as motion detection, direction, joint angle, and velocity. Because movement sense is both multimodal and multiparametric, it is not known how different movement parameters are represented by different afferent submodalities. In theory, each submodality could redundantly represent all movement parameters, or, alternatively, different afferent submodalities could be tuned to distinctly different movement parameters. The study described in this paper investigated how skin input and muscle input each contributes to movement sense of the hand, in particular, to the movement parameters dynamic position and velocity. Healthy adult subjects were instructed to indicate with the left hand when they sensed the unseen fingers of the right hand being passively flexed at the metacarpophalangeal (MCP) joint through a previously learned target angle. The experimental approach was to suppress input from skin and/or muscle: skin input by anesthetizing the hand, and muscle input by unexpectedly extending the wrist to prevent MCP flexion from stretching the finger extensor muscle. Input from joint afferents was assumed not to play a significant role because the task was carried out with the MCP joints near their neutral positions. We found that, during passive finger movement near the neutral position in healthy adult humans, both skin and muscle receptors contribute to movement sense but qualitatively differently. Whereas skin input contributes to both dynamic position and velocity sense, muscle input may contribute only to velocity sense.

Degraded postural performance after muscle fatigue can be compensated by skin stimulation

It has been shown that the ability of humans to maintain a quiet standing posture is degraded after fatigue of the muscles at the ankle. Yet, it has also been shown that skin stimulation at the ankle could improve postural performance. In the present study, we addressed the issue of the interaction of these two effects. Subjects were tested with the eyes closed in four conditions of quiet stance: with or without skin stimulation and before and after a fatigue protocol. The skin was stimulated with a piece of medical adhesive tape on the Achilles' tendon. The fatigue protocol consisted of multiple sets of ankle plantar flexion of both legs on stool. Without fatigue, we did not observe a significant effect of the tape. With fatigue, subjects decreased their postural performance significantly, but this effect was cancelled out when a piece of tape was glued on the Achilles' tendon. This indicated that the beneficial effect of the tape was unveiled by the degraded postural performance after fatigue. We conclude that, when the muscular sensory input flow normally relevant for the postural system is impaired due to fatigue, the weight of cutaneous information increases for the successful representation of movements in space to adjust postural control.

Coding and use of tactile signals from the fingertips in object manipulation tasks

During object manipulation tasks, the brain selects and implements action-phase controllers that use sensory predictions and afferent signals to tailor motor output to the physical properties of the objects involved. Analysis of signals in tactile afferent neurons and central processes in humans reveals how contact events are encoded and used to monitor and update task performance.

Local subcutaneous and muscle pain impairs detection of passive movements at the human thumb

Activity in both muscle spindle endings and cutaneous stretch receptors contributes to the sensation of joint movement. The present experiments assessed whether muscle pain and subcutaneous pain distort proprioception in humans. The ability to detect the direction of passive movements at the interphalangeal joint of the thumb was measured when pain was induced experimentally in four sites: the flexor pollicis longus (FPL), the subcutaneous tissue overlying this muscle, the flexor carpi radialis (FCR) muscle and the subcutaneous tissue distal to the metacarpophalangeal joint of thumb. Tests were conducted when pain was at a similar subjective intensity. There was no significant difference in the ability to detect flexion or extension under any painful or non-painful condition. The detection of movement was significantly impaired when pain was induced in the FPL muscle, but pain in the FCR, a nearby muscle that does not act on the thumb, had no effect. Subcutaneous pain also significantly impaired movement detection when initiated in skin overlying the thumb, but not in skin overlying the FPL muscle in the forearm. These findings suggest that while both muscle and skin pain can disturb the detection of the direction of movement, the impairment is site-specific and involves regions and tissues that have a proprioceptive role at the joint. Also, pain induced in FPL did not significantly increase the perceived size of the thumb. Proprioceptive mechanisms signalling perceived body size are less disturbed by a relevant muscle nociceptive input than those subserving movement detection. The results highlight the complex relationship between nociceptive inputs and their influence on proprioception and motor control.

Proprio-tactile integration for kinesthetic perception: an fMRI study

This study aims to identify the cerebral networks involved in the integrative processing of somesthetic inputs for kinesthetic purposes. In particular, we investigated how muscle proprioceptive and tactile messages can result in a unified percept of one's own body movements. We stimulated either separately or conjointly these two sensory channels in order to evoke kinesthetic illusions of a clockwise rotation of 10 subjects' right hand in an fMRI environment. Results first show that, whether induced by a tactile or a proprioceptive stimulation, the kinesthetic illusion was accompanied by the activation of a very similar cerebral network including cortical and subcortical sensorimotor areas, which are also classically found in passive or imagined movement tasks. In addition, the strongest kinesthetic illusions occurred under the congruent proprio-tactile co-stimulation condition. They were specifically associated to brain area activations distinct from those evidenced under the unimodal stimulations: the inferior parietal lobule, the superior temporal sulcus, the insula-claustrum region, and the cerebellum. These findings support the hypothesis that heteromodal areas may subserve multisensory integrative mechanisms at cortical and subcortical levels. They also suggest the integrative processing might consist of detection of the spatial coherence between the two kinesthetic messages involving the inferior parietal lobule activity and of a detection of their temporal coincidence via a subcortical relay, the insula structure, usually linked to the relative synchrony of different stimuli. Finally, the involvement of the superior temporal sulcus in the feeling of biological movement and that of the cerebellum in the movement timing control are also discussed.

Limb-state feedback from ensembles of simultaneously recorded dorsal root ganglion neurons

Functional electrical stimulation (FES) holds great potential for restoring motor functions after brain and spinal cord injury. Currently, most FES systems are under simple finite state control, using external sensors which tend to be bulky, uncomfortable and prone to failure. Sensory nerve signals offer an interesting alternative, with the possibility of continuous feedback control. To test feasibility, we recorded from ensembles of sensory neurons with microelectrode arrays implanted in the dorsal root ganglion (DRG) of walking cats. Limb position and velocity variables were estimated accurately (average R2 values >0.5) over a range of walking speeds (0.1-0.5 m s(-1)) using a linear combination of firing rates from 10 or more neurons. We tested the feasibility of sensory control of intraspinal FES by recording from DRG neurons during hindlimb movements evoked by intraspinal microstimulation of the lumbar spinal cord in an anesthetized cat. Although electrical stimulation generated artifacts, this problem was overcome by detecting and eliminating events that occurred synchronously across the array of microelectrodes. The sensory responses to limb movement could then be measured and decoded to generate an accurate estimate of the limb state. Multichannel afferent recordings may thus provide FES systems with the feedback needed for adaptive control and perturbation compensation, though long-term stability remains a challenge.

Impairment of human proprioception by high-frequency cutaneous vibration

These experiments assessed whether the impairment in proprioceptive acuity in the hand during 'interfering' cutaneous stimulation could be caused by inputs from Pacinian corpuscles. The ability to detect passive movements at the proximal interphalangeal joint of the index finger was measured when vibrotactile stimuli were applied to the adjacent middle finger and thenar eminence at frequencies and amplitudes that favour activation of rapidly adapting cutaneous afferents. Inputs from Pacinian corpuscles are favoured with high-frequency vibration (300 Hz), while those from Meissner corpuscles are favoured by lower frequencies (30 Hz). Detection of movement was significantly impaired when 300 Hz (20 microm peak-to-peak amplitude) complex vibration or 300 Hz (50 microm) sinusoidal vibration was applied to the middle finger and thenar eminence. In contrast, detection of movements was not altered by low-frequency sinusoidal vibration at 30 Hz with an amplitude of 50 microm or with a larger amplitude matched in subjective intensity to the 300 Hz sinusoidal stimulus. Thus it is unlikely that the impairment in detection was due to attention being diverted by vibration of an adjacent digit. In addition, an increase in amplitude of 300 Hz vibration led to a greater impairment of movement detection, so that the impairment was graded with the input. The time taken to nominate the direction of applied movement also increased during 300 Hz but not during 30 Hz sinusoidal vibration. These findings suggest that stimuli which preferentially activate Pacinian, but not Meissner corpuscles, impair proprioceptive acuity in a movement detection task.

Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome

The aim of this study was to assess the effect of patellar taping of the proprioceptive status of patients with patellofemoral pain syndrome (PFPS). A total of 32 subjects (18 males, 14 females of age 31.9 +/- 11.2, body mass index 25.8 +/- 5.3) with PFPS were tested for Joint Position Sense (JPS) using a Biodex dynamometer. Outcomes of interest were the absolute error (AE), the variable error (VE) and the relative error (RE) of the JPS values for both active (AAR) and passive (PAR) angle reproduction at an angular velocity of 2 degrees /s with a start angle at 90 degrees and target angles of 60 degrees and 20 degrees . Taping was applied in random order across the patella of each subject with each of the subjects acting as their own internal control. Results indicated initially that application of patellar tape did not enhance and in some cases worsened the JPS of the subjects (P > 0.05). However, when the subjects' proprioceptive status was graded according to their closeness to the target angles into 'good' (5 degrees , N = 10) and 'poor' ( > 5 degrees , N = 22) taping enhanced nearly all values of those with 'poor' proprioception, with AE at 20 degrees to statistical significance (P = 0.021). In conclusion, this study has shown that patellar taping did not improve the AAR and PAR JPS tests of a whole sample of 32 PFPS patients. It also has shown that a subgroup of PFPS patients with poor proprioception may exist and be helped by patellar taping.

Cutaneous afferents provide a neuronal population vector that encodes the orientation of human ankle movements

The aim of this study was to analyse the directional coding of two-dimensional limb movements by cutaneous afferents from skin areas covering a multidirectional joint, the ankle. The activity of 89 cutaneous afferents was recorded in the common peroneal nerve, and the mean discharge frequency of each unit was measured during the outward phase of ramp and hold movements imposed in 16 different directions. Forty-two afferents responded to the movements in the following decreasing order (SA2, n = 24/27; FA2, n = 13/17; FA1, n = 3/24; SA1, n = 2/21). All the units activated responded to a specific range of directions, defining their 'preferred sector', within which their response peaked in a given direction, their 'preferred direction'. Based on the distribution of the preferred directions, two populations of afferents, and hence two skin areas were defined: the anterior and the external lateral parts of the leg. As the directional tuning of each population was cosine shaped, the neuronal population vector model was applied and found to efficiently describe the movement direction encoded by cutaneous afferents, as it has been previously reported for muscle afferents. The responses of cutaneous afferents were then considered with respect to those of the afferents from the underlying muscles, which were previously investigated, and an almost perfect matching of directional sensitivity was observed. It is suggested that the common movement-encoding characteristics exhibited by cutaneous and muscle afferents, as early as the peripheral level, may facilitate the central co-processing of their feedbacks subserving kinaesthesia.

Peripheral median nerve block impairs precision pinch movement

OBJECTIVE

The objective of this study was to investigate the effects of a simulated peripheral median nerve lesion on precision pinch movement by the thumb and index finger.

METHODS

A median neuropathy was created by blocking the median nerve at the wrist using an anesthetic. The subjects (n=5) were asked to perform pulp-to-pulp precision pinch movements before and after the nerve block. Digit motion data was obtained with a marker-based motion analysis system.

RESULTS

The radial offset of the thumb tip, as defined by the minimum distance of the thumb tip to the flexion-extension plane of the index finger, showed an increase of 11.2mm after the nerve block. For the thumb, the nerve block caused a decrease in the range of motion at the metacarpophalangeal (MCP) joint, and a compensatory increase in the range of motion at the interphalangeal (IP) joint. The range of motion ratio (MCP:IP) changed from 1:4.8 (pre-block) to 1:1.0 (post-block). The maximum flexion angle at the MCP joint increased from 18.8 degrees (pre-block) to 33.7 degrees (post-block), and maximum flexion angle at the IP joint decreased from 42.6 degrees (pre-block) to 18.8 degrees (post-block). For the index finger, the nerve block caused a decrease in the range of motion at the MCP joint, and compensatory increases in the ranges of motion at the proximal and distal interphalangeal (PIP and DIP) joints. The range of motion ratio (MCP:PIP:DIP) changed from 1:1.1:0.7 (pre-block) to 1:2.4:1.8 (post-block). The maximum flexion angle at the MCP joint decreased from 56.8 degrees (pre-block) to 34.6 degrees (post-block), and the maximum flexion angle at the PIP joint increased from 51.2 degrees (pre-block) to 76.0 degrees (post-block), but the change at the DIP joint was insignificant.

CONCLUSIONS

The median nerve block caused remarkable degradation of the pinch performance as quantified by an inaccurate pulp-to-pulp contact of the thumb to the index finger and an alteration of joint motion of the digits.

SIGNIFICANCE

Many fine manual tasks require accurate pulp-to-pulp positioning of the thumb to the index finger. Within the hand, the median nerve is critical to the fine sensorimotor function due to the motor supply and the sensory endings to the thumb and index finger. People with median neuropathies (for example, carpal tunnel syndrome) experience clumsiness while performing simple manual tasks. The current approach to the examination of precision pinch movement may be utilized to quantify the apparent hand clumsiness observed in individuals with peripheral neuropathy such as carpal tunnel syndrome.

The effects of a 3-week use of lumbosacral orthoses on proprioception in the lumbar spine

STUDY DESIGN

Longitudinal, repeated-measures, factorial design. The trunk axial rotation repositioning error was the dependent variable, while the orthoses, test mode (passive versus active), and the testing session were the independent variables.

OBJECTIVES

To verify whether lumbosacral orthoses (LSOs) affect proprioception in the lumbar spine and whether these effects change over a 3-week period during which the LSO is consistently worn.

BACKGROUND

To date, there is no compelling evidence that lumbar orthoses support the spine. One hypothesis advanced by several authors is that they may enhance position sense (proprioception) in the lumbar spine.

METHODS AND MEASURES

Fourteen subjects without low back pain wore lumbosacral orthoses 3 hours a day for 3 weeks. Spine proprioception was tested in a seated posture in 3 sessions (days 0, 7, and 21).

RESULTS

A significant 3-way interaction was found between the effects of the orthoses, session, and test mode (P = .03). The ratio of passive to active average error indicated that after 3 weeks of wearing LSO, proprioception in the passive test worsened in relation to the active test with the LSO. In contrast, proprioception in the passive test improved in relation to the active test when performed without the LSO.

CONCLUSIONS

The LSO did affect proprioception in the lumbar spine. These effects most likely changed over time due to sensorimotor adaptation. However, no overall proprioceptive benefits could be ascertained from healthy subjects wearing the LSO.

Kinesthesia: The role of muscle receptors

The kinesthetic sense, the sense of position and movement of our limbs, has been the subject of speculation for more than 400 years. The present-day view is that it is signaled principally by muscle spindles, with a subsidiary role played by skin and joint receptors. The problem with muscle spindles as position sensors is that they are able to generate impulses in response to muscle length changes as well as from fusimotor activity. The central nervous system must be able to distinguish between activity from the two sources. Recent observations on position sense after fatigue and during load-bearing suggest that an additional source of kinesthetic information comes from a centrally generated sensation, the sense of effort. This has consequences for kinesthesia in the presence of the force of gravity. A contribution from central feedback mechanisms to the sense of effort is relevant to certain clinical conditions.

Electroactive polymeric sensors in hand prostheses: bending response of an ionic polymer metal composite

In stark contrast to the inspiring functionality of the natural hand, limitations of current upper limb prostheses stemming from marginal feedback control, challenges of mechanical design, and lack of sensory capacity, are well-established. This paper provides a critical review of current sensory systems and the potential of a selection of electroactive polymers for sensory applications in hand prostheses. Candidate electroactive polymers are reviewed in terms of their relevant advantages and disadvantages, together with their current implementation in related applications. Empirical analysis of one of the most novel electroactive polymers, ionic polymer metal composites (IPMC), was conducted to demonstrate its potential for prosthetic applications. With linear responses within the operating range typical of hand prostheses, bending angles, and bending rates were accurately measured with 4.4+/-2.5 and 4.8+/-3.5% error, respectively, using the IPMC sensors. With these comparable error rates to traditional resistive bend sensors and a wide range of sensitivities and responses, electroactive polymers offer a promising alternative to more traditional sensory approaches. Their potential role in prosthetics is further heightened by their flexible and formable structure, and their ability to act as both sensors and actuators.

Cutaneous Receptors Contribute to Kinesthesia at the Index Finger, Elbow, and Knee

The neural mechanisms underlying the sense of joint position and movement remain controversial. While cutaneous receptors are known to contribute to kinesthesia for the fingers, the present experiments test the hypothesis that they contribute at other major joints. Illusory movements were evoked at the interphalangeal (IP) joints of the index finger, the elbow, and the knee by stimulation of populations of cutaneous and muscle spindle receptors, both separately and together. Subjects matched perceived movements with voluntary movements of homologous joints on the contralateral side. Cutaneous receptors were activated by stretch of the skin (using 2 intensities of stretch) and vibration activated muscle spindle receptors. Stimuli were designed to activate receptors that discharge during joint flexion. For the index finger, vibration was applied over the extensor tendons on the dorsum of the hand, to evoke illusory metacarpophalangeal (MCP) joint flexion, and skin stretch was delivered around the IP joints. The strong skin stretch evoked the illusion of flexion of the proximal IP joint in 6/8 subjects (12 ± 5°, mean ± SE). For the group, strong skin stretch delivered during vibration increased the perceived flexion of the proximal IP joint by eight times with a concomitant decrease in perceived flexion of the MCP joint compared with vibration alone ( P < 0.05). For the elbow, vibration was applied over the distal tendon of triceps brachii and skin stretch over the dorsal forearm. When delivered alone, strong skin stretch evoked illusory elbow flexion in 5/10 subjects (9 ± 4°). Simultaneous strong skin stretch and vibration increased the illusory elbow flexion for the group by 1.5 times compared with vibration ( P < 0.05). For the knee, vibration was applied over the patellar tendon and skin stretch over the thigh. Skin stretch alone evoked illusory knee flexion in 3/10 subjects (8 ± 4°) and when delivered during vibration, perceived knee flexion increased for the group by 1.4 times compared with vibration ( P < 0.05). Hence inputs from cutaneous receptors, muscle receptors, and combined inputs from both receptors likely subserve kinesthesia at joints throughout the body.

Effect of slow, small movement on the vibration-evoked kinesthetic illusion

The study reported in this paper investigated how vibration-evoked illusions of joint rotation are influenced by slow (0.3 degrees /s), small (2-4 degrees ) passive rotation of the joint. Normal human adults (n=15) matched the perceived position of the left ("reference") arm with the right ("matching") arm while vibration (50 pps, 0.5 mm) was applied for 30 s to the relaxed triceps brachii of the reference arm. Both arms were constrained to rotate horizontally at the elbow. Three experimental conditions were investigated: (1) vibration of the stationary reference arm, (2) slow, small passive extension or flexion of the reference arm during vibration, and (3) slow, small passive extension or flexion of the reference arm without vibration. Triceps brachii vibration at 50 pps induced an illusion of elbow flexion. The movement illusion began after several seconds, relatively fast to begin with and gradually slowing down to a stop. On average, triceps vibration produced illusory motion at an average latency of 6.3 s, amplitude of 9.7 degrees , velocity of 0.6 degrees /s, and duration of 16.4 s. During vibration, slow, small ( approximately 0.3 degrees /s, 1.3 degrees ) passive rotations of the joint dramatically enhanced, stopped, or reversed the direction of illusory movement, depending on the direction of the passive joint rotation. However, the subjects' perceptions of these passive elbow rotations were exaggerated: 2-3 times the size of the actual movement. In the absence of vibration, the subjects accurately reproduced these passive joint rotations. We discuss whether the exaggerated perception of slow, small movement during vibration is better explained by contributions of non muscle spindle Ia afferents or by changes in the mechanical transmission of vibration to the receptor.

Cutaneous reflexes during rhythmic arm cycling are insensitive to asymmetrical changes in crank length

The neural control of a movement depends upon the motor task performed. To further understand the neural regulation of different variations of the same type of movement, we created three dissimilar bilateral rhythmic arm cycling tasks by unilaterally manipulating crank length (CL). Modulation in the amplitude and sign of cutaneous reflexes was used as an index of neural control. Neurologically intact subjects performed three bilateral cycling trials at approximately 1 Hz with the ipsilateral crank arm at one of three different lengths. Cutaneous reflexes were evoked during each trial with trains (5 x 1.0 ms pulses at 300 Hz) of electrical stimulation delivered to the superficial radial nerve at the ipsilateral wrist. EMG recordings were made bilaterally from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted after phase-averaging contingent upon the timing of stimulation in the movement cycle. CL variation created an asymmetrical cycling pattern and produced significant changes in the range of motion at the ipsilateral shoulder and elbow. Background EMG amplitude in muscles of the contralateral arm generally increased significantly as CL decreased. Therefore at a given phase in the movement cycle, the background EMG was different between the three cycling trials. In contrast, cutaneous reflex amplitudes in muscles of both arms were similar at each phase of the movement cycle between the different CLs trials at both early and middle latencies. This was particularly evident in muscles ipsilateral to nerve stimulation. We suggest that variations of arm cycling that primarily yield significant changes in the amplitude of muscle activity do not require significant task-specific change in neural control.

Temporal discrimination of two passive movements in humans: a new psychophysical approach to assessing kinaesthesia

Percutaneous electrical stimulation of the motor point of the first dorsal interosseous muscle (FDI) was used to produce a non-painful contraction of the FDI muscle that caused index finger abduction movement but no radiating cutaneous paraesthesias or sharp sensations localized to joints. Pairs of stimuli separated by different time intervals were given and subjects were asked to report whether they perceived a single or a double index finger abduction movement. The threshold value was the shortest interval for which the subjects reported two separate index finger abduction movements. Temporal discrimination movement thresholds (TDMT) were measured for both right and left hand. To assess the possible role of muscle and cutaneous afferents in temporal discrimination, we investigated the effects of high-frequency (20 Hz) electrical stimulation of the right ulnar and radial nerves on TDMT. In humans, muscle afferents from FDI are supplied by the ulnar nerve whereas the cutaneous territory overlying the muscle and joint is supplied by the radial and median nerves. Threshold values were not significantly different for right (75.1 ms) and left (75.6 ms) hands. During ulnar and to a lesser extent during radial nerve stimulation, TDMT values were significantly increased (119.2 and 93.5 ms, respectively) compared with baseline conditions (78.0 ms) whereas no changes were observed during median nerve stimulation (80.5 ms). These results suggest that muscle, and in part cutaneous, afferents contribute to temporal discrimination of a dual movement. The technique may provide a useful way of measuring temporal discrimination of kinaesthetic inputs in humans.

Amplitude of muscle stretch modulates corticomotor gain during passive movement

Previous studies have shown that the excitability of corticomotor projections to forearm muscles exhibit phasic modulation during passive movement (flexion-extension) about the wrist joint. We examined the stimulus-response properties of flexor carpi radialis (FCR) and extensor carpi radialis (ECR) to transcranial magnetic stimulation (TMS) applied over the contralateral motor cortex while the wrist was moved passively at two different sinusoidal frequency-amplitude relationships. Movement velocity (and therefore, the rate of change in muscle length) at the time of stimulation was held constant. Motor evoked potential (MEP) amplitudes were facilitated during passive muscle shortening and suppressed during passive muscle lengthening with suppression being more evident at higher stimulation intensities. For both FCR and ECR, during the shortening phase, responses were facilitated during the large amplitude movement relative to the small amplitude movement. It is suggested that the altered gain may be related to the thixotropic properties of muscle.