Impairment of human proprioception by high-frequency cutaneous vibration

BackWards - Unveiling the brain's topographic organization of paraspinal sensory input

Cortical reorganization and its potential pathological significance are being increasingly studied in musculoskeletal disorders such as chronic low back pain (CLBP) patients. However, detailed sensory-topographic maps of the human back are lacking, and a baseline characterization of such representations, reflecting the somatosensory organization of the healthy back, is needed before exploring potential sensory map reorganization. To this end, a novel pneumatic vibrotactile stimulation method was used to stimulate paraspinal sensory afferents, while studying their cortical representations in unprecedented detail. In 41 young healthy participants, vibrotactile stimulations at 20 Hz and 80 Hz were applied bilaterally at nine locations along the thoracolumbar axis while functional magnetic resonance imaging (fMRI) was performed. Model-based whole-brain searchlight representational similarity analysis (RSA) was used to investigate the organizational structure of brain activity patterns evoked by thoracolumbar sensory inputs. A model based on segmental distances best explained the similarity structure of brain activity patterns that were located in different areas of sensorimotor cortices, including the primary somatosensory and motor cortices and parts of the superior parietal cortex, suggesting that these brain areas process sensory input from the back in a "dermatomal" manner. The current findings provide a sound basis for testing the "cortical map reorganization theory" and its pathological relevance in CLBP.

An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research

Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.

Human Exteroception during Object Handling with an Upper Limb Exoskeleton

Upper limb exoskeletons may confer significant mechanical advantages across a range of tasks. The potential consequences of the exoskeleton upon the user's sensorimotor capacities however, remain poorly understood. The purpose of this study was to examine how the physical coupling of the user's arm to an upper limb exoskeleton influenced the perception of handheld objects. In the experimental protocol, participants were required to estimate the length of a series of bars held in their dominant right hand, in the absence of visual feedback. Their performance in conditions with an exoskeleton fixed to the forearm and upper arm was compared to conditions without the upper limb exoskeleton. Experiment 1 was designed to verify the effects of attaching an exoskeleton to the upper limb, with object handling limited to rotations of the wrist only. Experiment 2 was designed to verify the effects of the structure, and its mass, with combined movements of the wrist, elbow, and shoulder. Statistical analysis indicated that movements performed with the exoskeleton did not significantly affect perception of the handheld object in experiment 1 (BF₀₁ = 2.3) or experiment 2 (BF₀₁ = 4.3). These findings suggest that while the integration of an exoskeleton complexifies the architecture of the upper limb effector, this does not necessarily impede transmission of the mechanical information required for human exteroception.

Positional transversal release is effective as stretching on range of movement, performance and balance: a cross-over study

Background

The aim of this study was to compare the positional transversal release (PTR) technique to stretching and evaluate the acute effects on range of movement (ROM), performance and balance.

Methods

Thirty-two healthy individuals (25.3 ± 5.6 years; 68.8 ± 12.5 kg; 172.0 ± 8.8 cm) were tested on four occasions 1 week apart. ROM through a passive straight leg raise, jumping performance through a standing long jump (SLJ) and balance through the Y-balance test were measured. Each measure was assessed before (T0), immediately after (T1) and after 15 min (T2) of the provided intervention. On the first occasion, no intervention was administered (CG). The intervention order was randomized across participants and comprised static stretching (SS), proprioceptive neuromuscular facilitation (PNF) and the PTR technique. A repeated measure analysis of variance was used for comparisons.

Results

No differences across the T0 of the four testing sessions were observed. No differences between T0, T1 and T2 were present for the CG session. A significant time × group interaction for ROM in both legs from T0 to T1 (mean increase of 5.4° and 4.9° for right and left leg, respectively) was observed for SS, PNF and the PTR. No differences for all groups were present between T1 and T2. No differences in the SLJ and in measures of balance were observed across interventions.

Conclusions

The PTR is equally effective as SS and PNF in acutely increasing ROM of the lower limbs. However, the PTR results less time-consuming than SS and PNF. Performance and balance were unaffected by all the proposed interventions.

In the back of your mind: Cortical mapping of paraspinal afferent inputs

Topographic organisation is a hallmark of vertebrate cortex architecture, characterised by ordered projections of the body's sensory surfaces onto brain systems. High-resolution functional magnetic resonance imaging (fMRI) has proven itself as a valuable tool to investigate the cortical landscape and its (mal-)adaptive plasticity with respect to various body part representations, in particular extremities such as the hand and fingers. Less is known, however, about the cortical representation of the human back. We therefore validated a novel, MRI-compatible method of mapping cortical representations of sensory afferents of the back, using vibrotactile stimulation at varying frequencies and paraspinal locations, in conjunction with fMRI. We expected high-frequency stimulation to be associated with differential neuronal activity in the primary somatosensory cortex (S1) compared with low-frequency stimulation and that somatosensory representations would differ across the thoracolumbar axis. We found significant differences between neural representations of high-frequency and low-frequency stimulation and between representations of thoracic and lumbar paraspinal locations, in several bilateral S1 sub-regions, and in regions of the primary motor cortex (M1). High-frequency stimulation preferentially activated Brodmann Area (BA) regions BA3a and BA4p, whereas low-frequency stimulation was more encoded in BA3b and BA4a. Moreover, we found clear topographic differences in S1 for representations of the upper and lower back during high-frequency stimulation. We present the first neurobiological validation of a method for establishing detailed cortical maps of the human back, which might serve as a novel tool to evaluate the pathological significance of neuroplastic changes in clinical conditions such as chronic low back pain.

Acute physiological and functional effects of repetitive shocks on the hand-arm system - a pilot study on healthy subjects

PURPOSE

Exposure to hand-transmitted shocks is a widespread phenomenon at the workplace. Separate risk assessments for shocks do not exist in current international hand-arm vibration regulations, leading to a potential underestimation of associated health risks.

METHODS

In a pilot study approach, N = 8 healthy males were exposed to sets of 3×5 minutes of repetitive shocks and 1×5 minutes of random vibration, controlled at a weighted vibration total value of 10 m/s² respectively. Baseline and post-exposure measurements of vibration perception thresholds, finger skin temperature, maximal grip / pinch force and the Purdue Pegboard test were conducted. Muscle activity was monitored continuously by surface electromyography.

RESULTS

Shock exposures evoked a temporary increase of vibration perception thresholds with high examination frequencies. A decrease of skin temperature was hinted for 1 s^-1 and 20 s^-1 shocks. Electromyographical findings indicated an additional load on two forearm muscles during shock transmission. Maximum grip force and manual dexterity were not affected, pinch force only partially reduced after the exposures.

CONCLUSION

Physiological effects from shock exposure conform to those described for hand-arm vibration exposure in principle, although some divergence can be hypothesized. Randomized designs are required to conclusively assess the need of occupational health concepts specifically for hand-transmitted shocks.

Preliminary study on acute effects of an intervention to increase dorsiflexion range of motion in reducing medial knee displacement

BACKGROUND

Dynamic knee valgus, visually represented as medial knee displacement, is associated with anterior cruciate ligament injury. Recently, restrictions in ankle dorsiflexion range of motion have been associated with medial knee displacement. Therefore, interventions potentially increasing ankle dorsiflexion range of motion could alleviate medial knee displacement. The purpose of this pilot study was to explore the acute effects of an intervention to increase ankle dorsiflexion range of motion and reduce medial knee displacement in individuals who display medial knee displacement that is corrected with a heel lift.

METHODS

Eight young participants who displayed medial knee displacement corrected with a heel lift completed a single-session intervention aimed at increasing dorsiflexion range of motion. Immediately before and after the intervention session, dorsiflexion range of motion in three static conditions (passive straight-knee, passive bent-knee, and weight-bearing lunge) and medial knee displacement during an overhead squat were assessed.

FINDINGS

The single-session training program increased participants' dorsiflexion range of motion in all three static conditions (p = 0.0005 for straight-knee, 0.02 for bent-knee, and 0.01 for lunge) with moderate to large effect sizes (0.55-1.18). Additionally, the training resulted in a significant reduction in medial knee displacement during the overhead squat (p = 0.02).

INTERPRETATION

The finding indicate that our interventional protocol appears beneficial in increasing dorsiflexion range of motion among individuals with medial knee displacement. Additionally, improving dorsiflexion range of motion may be a promising direction for reducing medial knee displacement, which is a risk factor for anterior cruciate ligament injury.

Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics

Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.

Proprioceptive sensitivity to imposed finger deflections

Hand proprioception, the sense of the posture and movements of the wrist and digits, is critical to dexterous manual behavior and to stereognosis, the ability to sense the three-dimensional structure of objects held in the hand. To better understand this sensory modality and its role in hand function, we sought to characterize the acuity with which the postures and movements of finger joints are sensed. To this end, we measured the ability of human subjects to discriminate changes in posture and speed around the three joints of the index finger. In these experiments, we isolated the sensory component by imposing the postures on an otherwise still hand, to complement other studies in which subjects made judgments on actively achieved postures. We found that subjects could reliably sense 12-16% changes in joint angle and 18-32% changes in joint speed. Furthermore, the acuity for posture and speed was comparable across the three joints of the finger. Finally, task performance was unaffected by the presence of a vibratory stimulus, calling into question the role of cutaneous cues in hand proprioception.NEW & NOTEWORTHY Manual dexterity and stereognosis are supported by two exquisite sensory systems, namely touch and proprioception. Here, we measure the sensitivity of hand proprioception and show that humans can sense the posture and movements of the fingers with great accuracy. We also show that application of a skin vibration does not impair sensitivity, suggesting that proprioceptive acuity relies primarily on receptors in the muscles (and possibly tendons) rather than the skin.

Accuracy and precision of a wrist movement when vibrotactile prompts inform movement speed

Purpose: This study investigated the effect of movement speed on task accuracy and precision when participants were provided temporally oriented vibrotactile prompts. Materials and methods: Participants recreated a simple wrist flexion/extension movement at fast and slow speeds based on target patterns conveyed via vibrating motors affixed to the forearm. Each participant was given five performance-blinded trials to complete the task at each speed. Movement accuracy (root mean square error) and precision (standard deviation) were calculated for each trial in both the spatial and temporal domains. Results: 28 participants completed the study. Results showed temporal accuracy and precision improved with movement speed (both: fast > slow, p < 0.01), while all measures improved across trials (temporal accuracy and precision: trial 1 < all other trials, p < 0.05; spatial accuracy: trial 1 and 2 < all other trials, p < 0.05; spatial precision: trial 1 < all other trials, p < 0.05). Conclusions: Overall, temporal and spatial results indicate participants quickly recreated and maintained the desired pattern regardless of speed. Additionally, movement speed seems to influence movement accuracy and precision, particularly within the temporal domain. These results highlight the potential of vibrotactile prompts in rehabilitation paradigms aimed at motor re-education.

Spatial and temporal influences on discrimination of vibrotactile stimuli on the arm

Body-machine interfaces (BMIs) provide a non-invasive way to control devices. Vibrotactile stimulation has been used by BMIs to provide performance feedback to the user, thereby reducing visual demands. To advance the goal of developing a compact, multivariate vibrotactile display for BMIs, we performed two psychophysical experiments to determine the acuity of vibrotactile perception across the arm. The first experiment assessed vibration intensity discrimination of sequentially presented stimuli within four dermatomes of the arm (C5, C7, C8, and T1) and on the ulnar head. The second experiment compared vibration intensity discrimination when pairs of vibrotactile stimuli were presented simultaneously vs. sequentially within and across dermatomes. The first experiment found a small but statistically significant difference between dermatomes C7 and T1, but discrimination thresholds at the other three locations did not differ. Thus, while all tested dermatomes of the arm and hand could serve as viable sites of vibrotactile stimulation for a practical BMI, ideal implementations should account for small differences in perceptual acuity across dermatomes. The second experiment found that sequential delivery of vibrotactile stimuli resulted in better intensity discrimination than simultaneous delivery, independent of whether the pairs were located within the same dermatome or across dermatomes. Taken together, our results suggest that the arm may be a viable site to transfer multivariate information via vibrotactile feedback for body-machine interfaces. However, user training may be needed to overcome the perceptual disadvantage of simultaneous vs. sequentially presented stimuli.

Independent Early and Late Sensory Processes for Proprioceptive Integration When Planning a Step

Somatosensory inputs to the cortex undergo an early and a later stage of processing which are characterized by an early and a late somatosensory evoked potentials (SEP). The early response is highly representative of the stimulus characteristics whereas the late response reflects a more integrative, task specific, stage of sensory processing. We hypothesized that the later processing stage is independent of the early processing stage. We tested the prediction that a reduction of the first volley of input to the cortex should not prevent the increase of the late SEP. Using the sensory interference phenomenon, we halved the amplitude of the early response to somatosensory input of the ankle joints (evoked by vibration) when participants either planned a step forward or remained still. Despite the initial cortical response to the vibration being massively decreased in both tasks, the late response was still enhanced during step planning. Source localization indicated the posterior parietal cortex (PPC) as the likely origin of the late response modulation. Overall these results support the dissociation between the processes underlying the early and late SEP. The later processing stage could involve both direct and indirect thalamic connections to PPC which bypass the postcentral somatosensory cortex.

Kinaesthetic illusion shapes the cortical plasticity evoked by action observation

KEY POINTS

The combination of action observation (AO) and a peripheral nerve stimulation has been shown to induce plasticity in the primary motor cortex (M1). However, using peripheral nerve stimulation little is known about the specificity of the sensory inputs. The current study, using muscle tendon vibration to stimulate muscle spindles and transcranial magnetic stimulation to assess M1 excitability, investigated whether a proprioceptive stimulation leading to a kinaesthetic illusion of movement (KI) was able to evoke M1 plasticity when combined with AO. M1 excitability increased immediately and up to 60 min after AO-KI stimulation as a function of the vividness of the perceived illusion, and only when the movement directions of AO and KI were congruent. Tactile stimulation coupled with AO and KI alone were not sufficient to induce M1 plasticity. This methodology might be proposed to subjects during a period of immobilization to promote M1 activity without requiring any voluntary movement.

ABSTRACT

Physical practice is crucial to evoke cortical plasticity, but motor cognition techniques, such as action observation (AO), have shown their potentiality in promoting it when associated with peripheral afferent inputs, without the need of performing a movement. Here we investigated whether the combination of AO and a proprioceptive stimulation, able to evoke a kinaesthetic illusion of movement (KI), induced plasticity in the primary motor cortex (M1). In the main experiment, the role of congruency between the observed action and the illusory movement was explored together with the importance of the specificity of the sensory input modality (proprioceptive vs. tactile stimulation) to induce plasticity in M1. Further, a control experiment was carried out to assess the role of the mere kinaesthetic illusion on M1 excitability. Results showed that the combination of AO and KI evoked plasticity in M1, with an increase of the excitability immediately and up to 60 min after the conditioning protocol (P always <0.05). Notably, a significant increase in M1 excitability occurred only when the directions of the observed and illusory movements were congruent. Further, a significant positive linear relationship was found between the amount of M1 excitability increase and the vividness of the perceived illusion (P = 0.03). Finally, the tactile stimulation coupled with AO was not sufficient to induce changes in M1 excitability as well as the KI alone. All these findings indicate the importance of combining different sensory input signals to induce plasticity in M1, and that proprioception is the most suitable sensory modality to allow it.

Vibrotactile information improves proprioceptive reaching target localization

When pointing to parts of our own body (e.g., the opposite index finger), the position of the target is derived from proprioceptive signals. Consistent with the principles of multisensory integration, it has been found that participants better matched the position of their index finger when they also had visual cues about its location. Unlike vision, touch may not provide additional information about finger position in space, since fingertip tactile information theoretically remains the same irrespective of the postural configuration of the upper limb. However, since tactile and proprioceptive information are ultimately coded within the same population of posterior parietal neurons within high-level spatial representations, we nevertheless hypothesized that additional tactile information could benefit the processing of proprioceptive signals. To investigate the influence of tactile information on proprioceptive localization, we asked 19 participants to reach with the right hand towards the opposite unseen index finger (proprioceptive target). Vibrotactile stimuli were applied to the target index finger prior to movement execution. We found that participants made smaller errors and more consistent reaches following tactile stimulation. These results demonstrate that transient touch provided at the proprioceptive target improves subsequent reaching precision and accuracy. Such improvement was not observed when tactile stimulation was delivered to a distinct body part (the shoulder). This suggests a specific spatial integration of touch and proprioception at the level of high-level cortical body representations, resulting in touch improving position sense.

Mechanisms of tactile sensory deterioration amongst the elderly

It is known that roughness-smoothness, hardness-softness, stickiness-slipperiness and warm-cold are predominant perceptual dimensions in macro-, micro- and nano- texture perception. However, it is not clear to what extent active tactile texture discrimination remains intact with age. The general decrease in tactile ability induces physical and emotional dysfunction in elderly, and has increasing significance for an aging population. We report a method to quantify tactile acuity based on blinded active exploration of systematically varying micro-textured surfaces and a same-different paradigm. It reveals that elderly participants show significantly reduced fine texture discrimination ability. The elderly group also displays statistically lower finger friction coefficient, moisture and elasticity, suggesting a link. However, a subpopulation of the elderly retains discrimination ability irrespective of cutaneous condition and this can be related to a higher density of somatosensory receptors on the finger pads. Skin tribology is thus not the primary reason for decline of tactile discrimination with age. The remediation of cutaneous properties through rehydration, however leads to a significantly improved tactile acuity. This indicates unambiguously that neurological tactile loss can be temporarily compensated by restoring the cutaneous contact mechanics. Such mechanical restoration of tactile ability has the potential to increase the quality of life in elderly.

A Simple Non-invasive Method for Temporary Knockdown of Upper Limb Proprioception

Proprioception may be the least well measured of all contributors to the neural control of movement. New precise, reliable measures of proprioception are needed for clinical diagnosis of impairment, and to measure outcomes of proprioceptive training. The purpose of this simple, non-invasive method is to temporarily knockdown upper limb proprioception in healthy adults, to an extent that would be useful in the development and testing of upper limb proprioception measures. Knockdown models have two main advantages over studying humans with impaired proprioception: participant availability and the ability to control the extent of impairment across participants. Current published methods of temporary proprioception knockdown of the upper limb, such as ischemic nerve blocks and cryotherapy, are invasive, impractical, or uncomfortable for the participant. Here, vibration over the ulnar groove was used to reduce upper limb proprioception. High frequency vibration may reduce proprioceptive acuity by inhibiting pacinian corpuscle-induced input. The effect of vibration used in this protocol was confirmed using two quantitative measures. This method was simple to administer, comfortable for participants, and practical.

Plantar Sole Unweighting Alters the Sensory Transmission to the Cortical Areas

It is well established that somatosensory inputs to the cortex undergo an early and a later stage of processing. The later has been shown to be enhanced when the earlier transmission decreased. In this framework, mechanical factors such as the mechanical stress to which sensors are subjected when wearing a loaded vest are associated with a decrease in sensory transmission. This decrease is in turn associated with an increase in the late sensory processes originating from cortical areas. We hypothesized that unweighting the plantar sole should lead to a facilitation of the sensory transmission. To test this hypothesis, we recorded cortical somatosensory evoked potentials (SEPs) of individuals following cutaneous stimulation (by mean of an electrical stimulation of the foot sole) in different conditions of unweighting when standing still with eyes closed. To this end, the effective bodyweight (BW) was reduced from 100% BW to 40% BW. Contrary to what was expected, we found an attenuation of sensory information when the BW was unweighted to 41% which was not compensated by an increase of the late SEP component. Overall these results suggested that the attenuation of sensory transmission observed in 40 BW condition was not solely due to the absence of forces acting on the sole of the feet but rather to the current relevance of the afferent signals related to the balance constraints of the task.

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.

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.

Inter- and Intradigit Somatotopic Map of High-Frequency Vibration Stimulations in Human Primary Somatosensory Cortex

Although more about the somatotopic mapping of fingers continues to be uncovered, there is lack of mapping attempts regarding the integration of within-finger and across-finger somatotopic coordinates in Broadmann area (BA) 3. This study aimed to address the issue by finding an inter-/intradigit somatotopic map with high-frequency (250 Hz) vibrotactile stimulation. Functional magnetic resonance imaging (fMRI) data were acquired while stimulation was applied to 3 phalanxes (distal [p1], intermediate [p2], and proximal [p3] phalanx) of 4 fingers (index, middle, ring, and little finger) for a total of 12 finger-phalanx combinations for a human. Inter-, intra-, and inter-/intradigit distances were calculated from peak activation coordinates in BA 3 for each combination. With regard to interdigit dimensions, the somatotopic coordinates proceeded in the lateral-to-medial direction for the index, middle, ring, and little fingers consecutively. This trend is comparable to that generated from low-frequency stimulation modalities (flutter stimulation). The somatotopic distances between fingers were greatest when p1 was compared across fingers. From an intradigit perspective, stimulation on p1, p2, and p3 yielded BA 3 peak coordinates aligned along the anterior-to-posterior and inferior-to-superior directions for all fingers. An inter-/intradigit map exhibited a radially propagating trend of distances calculated with respect to index p1 as a reference point; this provided an integrated view of inter- and intradigit somatotopies, which are traditionally discussed separately. We expect such an inter-/intradigit somatotopic map approach to contribute in generating a comprehensive somatotopic model of fingers.

Assessing proprioception: A critical review of methods

To control movement, the brain has to integrate proprioceptive information from a variety of mechanoreceptors. The role of proprioception in daily activities, exercise, and sports has been extensively investigated, using different techniques, yet the proprioceptive mechanisms underlying human movement control are still unclear. In the current work we have reviewed understanding of proprioception and the three testing methods: threshold to detection of passive motion, joint position reproduction, and active movement extent discrimination, all of which have been used for assessing proprioception. The origin of the methods, the different testing apparatus, and the procedures and protocols used in each approach are compared and discussed. Recommendations are made for choosing an appropriate technique when assessing proprioceptive mechanisms in different contexts.

Vibrotactile stimulation of fast-adapting cutaneous afferents from the foot modulates proprioception at the ankle joint

It has previously been shown that cutaneous sensory input from across a broad region of skin can influence proprioception at joints of the hand. The present experiment tested whether cutaneous input from different skin regions across the foot can influence proprioception at the ankle joint. The ability to passively match ankle joint position (17° and 7° plantar flexion and 7° dorsiflexion) was measured while cutaneous vibration was applied to the sole (heel, distal metatarsals) or dorsum of the target foot. Vibration was applied at two different frequencies to preferentially activate Meissner's corpuscles (45 Hz, 80 μm) or Pacinian corpuscles (255 Hz, 10 μm) at amplitudes ∼3 dB above mean perceptual thresholds. Results indicated that cutaneous input from all skin regions across the foot could influence joint-matching error and variability, although the strongest effects were observed with heel vibration. Furthermore, the influence of cutaneous input from each region was modulated by joint angle; in general, vibration had a limited effect on matching in dorsiflexion compared with matching in plantar flexion. Unlike previous results in the upper limb, we found no evidence that Pacinian input exerted a stronger influence on proprioception compared with Meissner input. Findings from this study suggest that fast-adapting cutaneous input from the foot modulates proprioception at the ankle joint in a passive joint-matching task. These results indicate that there is interplay between tactile and proprioceptive signals originating from the foot and ankle.

Foot sole skin vibration perceptual thresholds are elevated in a standing posture compared to sitting

Foot sole sensitivity is commonly assessed while individuals are seated or prone; however the primary role of foot sole cutaneous feedback is for the control of upright stance and gait. The aim of this study was to compare vibration perceptual thresholds across the foot sole between sitting and standing postures. Vibration perceptual thresholds were measured in sitting and standing postures in 18 healthy participants (8 male) using a custom vibration device. Two foot sole locations (heels and metatarsals) were tested at four vibration frequencies (3, 15, 40, and 250Hz) selected to target different cutaneous afferent populations. At each frequency, perceptual thresholds across the foot sole were significantly higher in the standing posture compared to the sitting posture; this is indicative of lower sensitivity while standing. In addition, threshold differences between the heels and metatarsals for lower frequency vibratory stimuli were more pronounced while standing, with higher thresholds observed at the heels. Our results demonstrate that standing significantly alters sensitivity across the foot sole. Therefore, conducting perceptual tests at the foot sole during stance could potentially provide more direct information about the ability of cutaneous afferents to signal tactile information in a state where this feedback can contribute to postural control.

The role of vibration in tactile speed perception

The relative motion between the surface of an object and our fingers produces patterns of skin deformation such as stretch, indentation, and vibrations. In this study, we hypothesized that motion-induced vibrations are combined with other tactile cues for the discrimination of tactile speed. Specifically, we hypothesized that vibrations provide a critical cue to tactile speed on surfaces lacking individually detectable features like dots or ridges. Thus masking vibrations unrelated to slip motion should impair the discriminability of tactile speed, and the effect should be surface-dependent. To test this hypothesis, we measured the precision of participants in discriminating the speed of moving surfaces having either a fine or a ridged texture, while adding masking vibratory noise in the working range of the fast-adapting mechanoreceptive afferents. Vibratory noise significantly reduced the precision of speed discrimination, and the effect was much stronger on the fine-textured than on the ridged surface. On both surfaces, masking vibrations at intermediate frequencies of 64 Hz (65-μm peak-to-peak amplitude) and 128 Hz (10 μm) had the strongest effect, followed by high-frequency vibrations of 256 Hz (1 μm) and low-frequency vibrations of 32 Hz (50 and 25 μm). These results are consistent with our hypothesis that slip-induced vibrations concur to the discrimination of tactile speed.

Neck muscle vibration can improve sensorimotor function in patients with neck pain

BACKGROUND CONTEXT

People with neck pain display a diminished joint position sense and disturbed postural control, which is thought to be a result of impaired somatosensory afferent activity and/or integration. Afferent processing can be artificially manipulated by vibration and was shown to reduce motor performance in healthy subjects. However, the effect of vibration on sensorimotor function in neck pain patients is scarcely investigated.

PURPOSE

To assess the effect of neck muscle vibration on joint position sense and postural control in neck pain subjects and healthy controls.

STUDY DESIGN

Case control study.

PATIENT SAMPLE

Thirteen neck pain patients and 10 healthy controls participated in the present study.

OUTCOME MEASUREMENTS

Cervical joint position sense and dynamic and static postural stability.

METHODS

Short-term, targeted neck muscle vibration with 100 Hz was applied after baseline measurement.

RESULTS

Vibration had opposite effects in patients and healthy subjects. Patients showed improved joint position sense (p<.01) and reduced dynamic postural sway (p<.05) after vibration, whereas vibration resulted in reduced joint position sense acuity (p<.05) and a nonsignificant increase in postural sway in healthy controls.

CONCLUSIONS

This is the first study showing an improved motor performance after neck muscle vibration in patients with neck pain. Thus, vibration may be used to counteract sensorimotor impairment of the cervical spine. Potential underlying mechanisms are discussed.

A cutaneous positioning system

Our previous work revealed that torso cutaneous information contributes to the internal representation of the torso and plays a role in postural control. Hence, the aims of this study were to assess whether posture could be manipulated by patterns of vibrotactile stimulation and to determine whether resulting modified postures were associated with specific and consistent spatial attitudes. Ten healthy young adults stood in normal and Romberg stances with six vibrating actuators positioned on the torso in contact with the skin over the anatomical locations corresponding to left and right external oblique, internal oblique and erector spinae muscles at the L4/L5 vertebrae level. A 250-Hz tactile vibration was applied for 5 s either at a single location or consecutively at each location in clockwise or counterclockwise sequences. Kinematic analysis of the body segments indicated that postural responses observed in response to single and sequential stimulation patterns were similar, while the center of pressure remained unaltered in any situations. Moreover, torso inclinations followed rectilinear-like path segments chartered by stimuli loci during sequential stimulations. Comparison of torso attitudes with previous results obtained with co-vibration patterns of the same duration showed that torso inclination amplitudes are equivalent for single (one location) and co-vibration (pairs of locations) patterns inducing the same directional effect. Hence, torso cutaneous information exhibits kinesthetic properties, appears to provide a map of upper body spatial configuration, and could assume the role of an internal positioning system for the upper body.

Passive or simulated displacement of one arm (but not its mirror reflection) modulates the involuntary motor behavior of the other arm

Recent studies of both healthy and patient populations have cast doubt on the mirror paradigm's beneficial effect on motor behavior. Indeed, the voluntary arm displacement that accompanies reflection in the mirror may be the determining factor in terms of the motor behavior of the contralateral arm. The objective of the present study was to assess the respective effects of mirror reflection and arm displacement (whether real or simulated) on involuntary motor behavior of the contralateral arm following sustained, isometric contraction (Kohnstamm phenomenon). Our results revealed that (i) passive displacement of one arm (displacement of the left arm via a motorized manipulandum moving at 4°/s) influenced the velocity of the Kohnstamm phenomenon (forearm flexion occurring shortly after the cessation of muscle contraction) in the contralateral arm and (ii) mirror vision had no effect. Indeed, the velocity of the Kohnstamm phenomenon tended to be adjusted to match the velocity of the passive displacement of the other arm. In a second experiment, arm displacement was simulated by vibrating the triceps at 25, 50 or 75 Hz. Results showed that the velocity of the Kohnstamm phenomenon in one arm increased with the vibration frequency applied to the other arm. Our results revealed the occurrence of bimanual coupling because involuntary displacement of one arm was regulated by muscle-related information generated by the actual or simulated displacement of the other arm. In line with the literature data on voluntary motor behavior, our study failed to evidence an additional impact of mirror vision on involuntary motor behavior.

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.

Does whole body vibration training affect knee kinematics and neuromuscular control in healthy people?

This study aimed to investigate the effect of whole body vibration (WBV) training on the knee kinematics and neuromuscular control after single-legged drop landings. Surface electromyographic (EMG) activity of the rectus femoris and hamstring muscles and knee and ankle accelerometry signals were acquired from 42 healthy volunteers. Participants performed three pre-test landings and after a recovery period of three minutes, they completed one set of six bouts of WBV each of one minute duration (30 Hz - 4 mm), followed by a single-leg drop landing. After the WBV intervention no significant changes were observed in the kinematic outcomes measured, although the time to stabilise the lower-limb was significantly lower after the vibration training (F(8,41) = 6.55; P < 0.01). EMG analysis showed no significant differences in the amplitude of rectus femoris or hamstring muscles after WBV training, however, significant differences in EMG frequency of the rectus femoris were found before (F(8,41) = 7.595; P < 0.01) and after toe-down (F(8,41) = 4.440; P < 0.001). Finally, no significant changes were observed in knee or ankle acceleration after WBV. Results suggest that WBV can help to acutely enhance knee neuromuscular control, which may have clinical significance and help in the design of rehabilitation programmes.

A functional role for modality-specific perceptual systems in conceptual representations

Theories of embodied cognition suggest that conceptual processing relies on the same neural resources that are utilized for perception and action. Evidence for these perceptual simulations comes from neuroimaging and behavioural research, such as demonstrations of somatotopic motor cortex activations following the presentation of action-related words, or facilitation of grasp responses following presentation of object names. However, the interpretation of such effects has been called into question by suggestions that neural activation in modality-specific sensorimotor regions may be epiphenomenal, and merely the result of spreading activations from “disembodied”, abstracted, symbolic representations. Here, we present two studies that focus on the perceptual modalities of touch and proprioception. We show that in a timed object-comparison task, concurrent tactile or proprioceptive stimulation to the hands facilitates conceptual processing relative to control stimulation. This facilitation occurs only for small, manipulable objects, where tactile and proprioceptive information form part of the multimodal perceptual experience of interacting with such objects, but facilitation is not observed for large, nonmanipulable objects where such perceptual information is uninformative. Importantly, these facilitation effects are independent of motor and action planning, and indicate that modality-specific perceptual information plays a functionally constitutive role in our mental representations of objects, which supports embodied assumptions that concepts are grounded in the same neural systems that govern perception and action.

Proprioceptive signals contribute to the sense of body ownership

The sense of body ownership, knowledge that parts of our body ‘belong’ to us, is presumably developed using sensory information. Cutaneous signals seem ideal for this and can modify the sense of ownership. For example, an illusion of ownership over an artificial rubber hand can be induced by synchronously stroking both the subject’s hidden hand and a visible artificial hand. Like cutaneous signals, proprioceptive signals (e.g. frommuscle receptors) exclusively signal events occurring in the body, but the influence of proprioceptors on the sense of body ownership is not known. We developed a technique to generate an illusion of ownership over an artificial plastic finger, using movement at the proximal interphalangeal joint as the stimulus. We then examined this illusion in 20 subjects when their index finger was intact and when the cutaneous and joint afferents from the finger had been blocked by local anaesthesia of the digital nerves. Subjects still experienced an illusion of ownership, induced by movement, over the plastic finger when the digital nerves were blocked. This shows that local cutaneous signals are not essential for the illusion and that inputs arising proximally, presumably from receptors in muscles which move the finger, can influence the sense of body ownership. Contrary to other studies, we found no evidence that voluntary movements induce stronger illusions of body ownership than those induced by passive movement. It seems that the congruence of sensory stimuli ismore important to establish body ownership than the presence of multiple sensory signals.

Multisensory integration in dynamical behaviors: maximum likelihood estimation across bimanual skill learning

Optimal integration of different sensory modalities weights each modality as a function of its degree of certainty (maximum likelihood). Humans rely on near-optimal integration in decision-making tasks (involving e.g., auditory, visual, and/or tactile afferents), and some support for these processes has also been provided for discrete sensorimotor tasks. Here, we tested optimal integration during the continuous execution of a motor task, using a cyclical bimanual coordination pattern in which feedback was provided by means of proprioception and augmented visual feedback (AVF, the position of both wrists being displayed as the orthogonal coordinates of a single cursor). Assuming maximum likelihood integration, the following predictions were addressed: (1) the coordination variability with both AVF and proprioception available is smaller than with only one of the two modalities, and should reach an optimal level; (2) if the AVF is artificially corrupted by noise, variability should increase but saturate toward the level without AVF; (3) if the AVF is imperceptibly phase shifted, the stabilized pattern should be partly adapted to compensate for this phase shift, whereby the amount of compensation reflects the weight assigned to AVF in the computation of the integrated signal. Whereas performance variability gradually decreased over 5 d of practice, we showed that these model-based predictions were already observed on the first day. This suggests not only that the performer integrated proprioceptive feedback and AVF online during task execution by tending to optimize the signal statistics, but also that this occurred before reaching an asymptotic performance level.

The kinaesthetic senses

This review of kinaesthesia, the senses of limb position and limb movement, has been prompted by recent new observations on the role of motor commands in position sense. They make it necessary to reassess the present-day views of the underlying neural mechanisms. Peripheral receptors which contribute to kinaesthesia are muscle spindles and skin stretch receptors. Joint receptors do not appear to play a major role at most joints. The evidence supports the existence of two separate senses, the sense of limb position and the sense of limb movement. Receptors such as muscle spindle primary endings are able to contribute to both senses. While limb position and movement can be signalled by both skin and muscle receptors, new evidence has shown that if limb muscles are contracting, an additional cue is provided by centrally generated motor command signals. Observations using neuroimaging techniques indicate the involvement of both the cerebellum and parietal cortex in a multi-sensory comparison, involving operation of a forward model between the feedback during a movement and its expected profile, based on past experience. Involvement of motor command signals in kinaesthesia has implications for interpretations of certain clinical conditions.

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.