Changes in multifinger interaction and coordination in Parkinson's disease

Three Levels of Neural Control Contributing to Performance-stabilizing Synergies in Multi-finger Tasks

We tested a hypothesis on force-stabilizing synergies during four-finger accurate force production at three levels: (1) The level of the reciprocal and coactivation commands, estimated as the referent coordinate and apparent stiffness of all four fingers combined; (2) The level of individual finger forces; and (3) The level of firing of individual motor units (MU). Young, healthy participants performed accurate four-finger force production at a comfortable, non-fatiguing level under visual feedback on the total force magnitude. Mechanical reflections of the reciprocal and coactivation commands were estimated using small, smooth finger perturbations applied by the "inverse piano" device. Firing frequencies of motor units in the flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC) were estimated using surface recording. Principal component analysis was used to identify robust MU groups (MU-modes) with parallel changes in the firing frequency. The framework of the uncontrolled manifold hypothesis was used to compute synergy indices in the spaces of referent coordinate and apparent stiffness, finger forces, and MU-mode magnitudes. Force-stabilizing synergies were seen at all three levels. They were present in the MU-mode spaces defined for MUs in FDS, in EDC, and pooled over both muscles. No effects of hand dominance were seen. The synergy indices defined at different levels of analysis showed no correlations across the participants. The findings are interpreted within the theory of control with spatial referent coordinates for the effectors. We conclude that force stabilization gets contributions from three levels of neural control, likely associated with cortical, subcortical, and spinal circuitry.

Force matching: motor effects that are not reported by the actor

We explored unintentional drifts of finger forces during force production and matching task. Based on earlier studies, we predicted that force matching with the other hand would reduce or stop the force drift in instructed fingers while uninstructed (enslaved) fingers remain unaffected. Twelve young, healthy, right-handed participants performed two types of tasks with both hands (task hand and match hand). The task hand produced constant force at 20% of MVC level with the Index and Ring fingers pressing in parallel on strain gauge force sensors. The Middle finger force wasn't instructed, and its enslaved force was recorded. Visual feedback on the total force by the instructed fingers was either present throughout the trial or only during the first 5 s (no-feedback condition). The other hand matched the perceived force level of the task hand starting at either 4, 8, or 15 s from the trial initiation. No feedback was ever provided for the match hand force. After the visual feedback was removed, the task hand showed a consistent drift to lower magnitudes of total force. Contrary to our prediction, over all conditions, force matching caused a brief acceleration of force drift in the task hand, which then reached a plateau. There was no effect of matching on drifts in enslaved finger force. We interpret the force drifts within the theory of control with spatial referent coordinates as consequences of drifts in the command (referent coordinate) to the antagonist muscles. This command is not adequately incorporated into force perception.

Two classes of action-stabilizing synergies reflecting spinal and supraspinal circuitry

We explored force-stabilizing synergies during accurate four-finger constant force production tasks in spaces of finger modes (commands to fingers computed to account for the finger interdependence) and of motor unit (MU) firing frequencies. The main specific hypothesis was that the multifinger synergies would disappear during unintentional force drifts without visual feedback on the force magnitude, whereas MU-based synergies would be robust to such drifts. Healthy participants performed four-finger accurate cyclical force production trials followed by trials of constant force production. Individual MUs were identified in the flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). Principal component analysis was applied to motor unit frequencies to identify robust MU groups (MU-modes) with parallel scaling of the firing frequencies in FDS, in EDC, and the combined MUs of FDS + EDC. The framework of the uncontrolled manifold hypothesis was used to quantify force-stabilizing synergies when visual feedback on the force magnitude was available and 15 s after turning the visual feedback off. Removing visual feedback led to a force drift toward lower magnitudes, accompanied by the disappearance of multifinger synergies. In contrast, MU-mode synergies were minimally affected by removing visual feedback off and continued to be robust for the FDS and for the EDC, while being absent for the (FDS + EDC) analysis. We interpret the findings within the theory of hierarchical control of action with spatial referent coordinates. The qualitatively different behavior of the multifinger and MU-mode-based synergies likely reflects the difference in the involved neural circuitry, supraspinal for the former and spinal for the latter.NEW & NOTEWORTHY Two types of synergies, in the space of commands to individual fingers and in the space of motor unit groups, show qualitatively different behaviors during accurate multifinger force-production tasks. After removing visual feedback, finger force synergies disappear, whereas motor unit-based synergies persist. These results point at different neural circuitry involved in these two basic classes of synergies: supraspinal for multieffector synergies, and spinal for motor unit-based synergies.

Effects of fatigue on intramuscle force-stabilizing synergies

We applied the recently introduced concept of intramuscle synergies in spaces of motor units (MUs) to quantify indexes of such synergies in the tibialis anterior during ankle dorsiflexion force production tasks and their changes with fatigue. We hypothesized that MUs would be organized into robust groups (MU modes), which would covary across trials to stabilize force magnitude, and the indexes of such synergies would drop under fatigue. Healthy, young subjects (n = 15; 8 females) produced cyclical, isometric dorsiflexion forces while surface electromyography was used to identify action potentials of individual MUs. Principal component analysis was used to define MU modes. The framework of the uncontrolled manifold (UCM) was used to analyze intercycle variance and compute the synergy index, ΔVZ. Cyclical force production tasks were repeated after a nonfatiguing exercise (control) and a fatiguing exercise. Across subjects, fatigue led, on average, to a 43% drop in maximal force and fewer identified MUs per subject (29.6 ± 2.1 vs. 32.4 ± 2.1). The first two MU modes accounted for 81.2 ± 0.08% of variance across conditions. Force-stabilizing synergies were present across all conditions and were diminished after fatiguing exercise (1.49 ± 0.40) but not control exercise (1.76 ± 0.75). Decreased stability after fatigue was caused by an increase in the amount of variance orthogonal to the UCM. These findings contrast with earlier studies of multieffector synergies demonstrating increased synergy index under fatigue. We interpret the results as reflections of a drop in the gain of spinal reflex loops under fatigue. The findings corroborate an earlier hypothesis on the spinal nature of intramuscle synergies.NEW & NOTEWORTHY Across multielement force production tasks, fatigue of an element leads to increased indexes of force stability (synergy indexes). Here, however, we show that groups of motor units in the tibialis anterior show decreased indexes of force-stabilizing synergies after fatiguing exercise. These findings align intramuscle synergies with spinal mechanisms, in contrast to the supraspinal control of multimuscle synergies.

Integrating Motor Variability Evaluation Into Movement System Assessment

Common assessment tools for determining therapeutic success in rehabilitation typically focus on task-based outcomes. Task-based outcomes provide some understanding of the individual's functional ability and motor recovery; however, these clinical outcomes may have limited translation to a patient's functional ability in the real world. Limitations arise because (1) the focus on task-based outcome assessment often disregards the complexity of motor behavior, including motor variability, and (2) mobility in highly variable real-world environments requires movement adaptability that is made possible by motor variability. This Perspective argues that incorporating motor variability measures that reflect movement adaptability into routine clinical assessment would enable therapists to better evaluate progress toward optimal and safe real-world mobility. The challenges and opportunities associated with incorporating variability-based assessment of pathological movements are also discussed. This Perspective also indicates that the field of rehabilitation needs to leverage technology to advance the understanding of motor variability and its impact on an individual's ability to optimize movement.

IMPACT

This Perspective contends that traditional therapeutic assessments do not adequately evaluate the ability of individuals to adapt their movements to the challenges faced when negotiating the dynamic environments encountered during daily life. Assessment of motor variability derived during movement execution can address this issue and provide better insight into a patient's movement stability and maneuverability in the real world. Creating such a shift in motor system assessment would advance understanding of rehabilitative approaches to motor system recovery and intervention.

Multi-muscle synergies in preparation for gait initiation in Parkinson's disease

OBJECTIVE

We investigated changes in indices of muscle synergies prior to gait initiation and the effects of gaze shift in patients with Parkinson's disease (PD). A long-term objective of the study is to develop a method for quantitative assessment of gait-initiation problems in PD.

METHODS

PD patients without clinical signs of postural instability and two control groups (age-matched and young) performed a gait initiation task in a self-paced manner, with and without a quick prior gaze shift produced by turning the head. Muscle groups with parallel scaling of activation levels (muscle modes) were identified as factors in the muscle activation space. Synergy index stabilizing center of pressure trajectory in the anterior-posterior and medio-lateral directions (indices of stability) was quantified in the muscle mode space. A drop in the synergy index in preparation to gait initiation (anticipatory synergy adjustment, ASA) was quantified.

RESULTS

Compared to the control groups, PD patients showed significantly smaller synergy indices and ASA for both directions of the center of pressure shift. Both PD and age-matched controls, but not younger controls, showed detrimental effects of the prior gaze shift on the ASA indices.

CONCLUSIONS

PD patients without clinically significant posture or gait disorders show impaired stability of the center of pressure and its diminished adjustment during gait initiation.

SIGNIFICANCE

The indices of stability and ASA may be useful to monitor pre-clinical gait disorders, and lower ASA may be relevant to emergence of freezing of gait in PD.

Motor unit-based synergies in a non-compartmentalized muscle

The concept of synergies has been used to address the grouping of motor elements contributing to a task with the covariation of these elements reflecting task stability. This concept has recently been extended to groups of motor units with parallel scaling of the firing frequencies with possible contributions of intermittent recruitment (MU-modes) in compartmentalized flexor and extensor muscles of the forearm stabilizing force magnitude in finger pressing tasks. Here, we directly test for the presence and behavior of MU-modes in the tibialis anterior, a non-compartmentalized muscle. Ten participants performed an isometric cyclical dorsiflexion force production task at 1 Hz between 20 and 40% of maximal voluntary contraction and electromyographic (EMG) data were collected from two high-density wireless sensors placed on the skin over the right tibialis anterior. EMG data were decomposed into individual motor unit frequencies and resolved into sets of MU-modes. Inter-cycle analysis of MU-mode magnitudes within the framework of the uncontrolled manifold (UCM) hypothesis was used to quantify force-stabilizing synergies. Two or three MU-modes were identified in all participants and trials accounting, on average, for 69% of variance and were robust to cross-validation measurements. Strong dorsiflexion force-stabilizing synergies in the space of MU-modes were present in all participants and for both electrode locations as reflected in variance within the UCM (median 954, IQR 511-1924) exceeding variance orthogonal to the UCM (median 5.82, IQR 2.9-17.4) by two orders of magnitude. In contrast, MU-mode-stabilizing synergies in the space of motor unit frequencies were not present. This study offers strong evidence for the existence of synergic control mechanisms at the level of motor units independent of muscle compartmentalization, likely organized within spinal cord circuitry.

Unintentional force drifts in the lower extremities

We explored the phenomenon of unintentional force drift seen in the absence of visual feedback during knee extension contractions in isometric conditions. Based on the importance of knee extensors for the anti-gravity function, we hypothesized that such force drifts would be slower and smaller compared to those reported for the upper extremities. We also explored possible effects of foot dominance and gender on the force drifts. Young healthy persons produced isometric knee extension contractions to different levels, ranging from 15 to 25% of maximal voluntary contraction force, with the help of visual feedback, and then, the visual feedback was turned off. Force change over the time interval without visual feedback was quantified. In the absence of visual feedback, force drifted to smaller magnitudes. The drift magnitude expressed in percent of the initial force magnitude was smaller for smaller initial force levels, ranging between 8 and 15% of the initial force for the initial force magnitude of 15% and 25% of maximal voluntary contraction force. The time exponent of the force drift was independent of the initial force magnitude and was, on average, 6.45 s. There were no significant effects of foot dominance or gender, although the male subjects tended to show stronger scaling of the drift magnitude with the initial force level compared to the female subjects. The results show that unintentional force drift is a common phenomenon across limbs and muscle groups. This conclusion fits the theory of control with spatial referent coordinates and the general tendency of all natural systems to drift to states with lower potential energy.

Unintentional drifts in performance during one-hand and two-hand finger force production

We explored the phenomena of force drifts and unintentional finger force production (enslaving), and their dependence on visual feedback. Predictions have been drawn based on the theory of control with spatial referent coordinates for condition with feedback on instructed (master) finger force, enslaved finger force, and total force for one-hand and two-hand tasks. Subjects produced force under the different feedback conditions without their knowledge. No feedback condition was also used for the one-hand tasks. Overall, feedback of master finger force led to an increase in the enslaved force, feedback on the slave finger force led to a drop in the master force, feedback on the total force led to balanced drifts in the master force down and enslaved force up, and under the no-feedback condition, master and total force drifted down with large variability in the enslaved force drifts. The patterns were the same in both hands in the two-hand tasks when feedback was provided on the forces of one hand only (without subject's knowledge). The index of enslaving always drifted toward higher values. We interpret the findings as reflecting three main factors: drifts in the referent coordinates toward actual finger coordinates, spread of cortical excitation over representations of the fingers, and robust sharing of referent coordinates between the two hands in bimanual tasks. The large consistent drifts in enslaving toward higher values have to be considered in studies of multi-finger synergies.

Optimality, Stability, and Agility of Human Movement: New Optimality Criterion and Trade-Offs

This review of movement stability, optimality, and agility is based on the theory of motor control with changes in spatial referent coordinates for the effectors, the principle of abundance, and the uncontrolled manifold hypothesis. A new optimality principle is suggested based on the concept of optimal sharing corresponding to a vector in the space of elemental variables locally orthogonal to the uncontrolled manifold. Motion along this direction is associated with minimal components along the relatively unstable directions within the uncontrolled manifold leading to a minimal motor equivalent motion. For well-practiced actions, this task-specific criterion is followed in spaces of referent coordinates. Consequences of the suggested framework include trade-offs among stability, optimality, and agility, unintentional changes in performance, hand dominance, finger specialization, individual traits in performance, and movement disorders in neurological patients.

Synergic control in asymptomatic welders during multi-finger force exertion and load releasing while standing

Motor synergies, i.e., neural mechanisms that organize multiple motor elements to ensure stability of actions, are affected by several neurological condition. Asymptomatic welders showed impaired synergy controlling the stability of multi-finger action compared to non-welders and this impairment was associated with microstructural damage in the globus pallidus. We further explored the effect of welding-related metal exposure on multi-finger synergy and extended our investigation to posture-stabilizing synergy during a standing task. Occupational, MRI, and performance-stabilizing synergies during multi-finger accurate force production and load releasing while standing were obtained from 29 welders and 19 age- and sex-matched controls. R2* and R1 relaxation rate values were used to estimate brain iron and manganese content, respectively, and diffusion tensor imaging was used to reflect brain microstructural integrity. Associations of brain MRI (caudate, putamen, globus pallidus, and red nucleus), and motor synergy were explored by group status. The results revealed that welders had higher R2* values in the caudate (p = 0.03), putamen (p = 0.01), and red nucleus (p = 0.08, trend) than controls. No group effect was revealed on multi-finger synergy index during steady-state phase of action (ΔVZss). Compared to controls, welders exhibited lower ΔVZss (-0.106 ± 0.084 vs. 0.160 ± 0.092, p = 0.04) and variance that did not affect the performance variable (VUCM, 0.022 ± 0.003 vs. 0.038 ± 0.007, p = 0.03) in the load releasing, postural task. The postural synergy index, ΔVZss, was associated negatively with higher R2* in the red nucleus in welders (r = -0.44, p = 0.03), but not in controls. These results suggest that the synergy index in the load releasing during a standing task may reflect welding-related neurotoxicity in workers with chronic metals exposure. This finding may have important clinical and occupational health implications.

Parkinson's disease is characterized by sub-second resting-state spatio-oscillatory patterns: A contribution from deep convolutional neural network

Deep convolutional neural network (DCNN) provides a multivariate framework to detect relevant spatio-oscillatory patterns in the data beyond common mass-univariate statistics. Yet, its practical application is limited due to the low interpretability of the results beyond accuracy. We opted to use DCNN with a minimalistic architecture design and large penalized terms to yield a generalizable and clinically relevant network model. Our network was trained based on the scalp topology of the electroencephalography (EEG) from an open access dataset, constituting our primary sample of healthy controls (n = 25) and Parkinson's disease (PD) patients (n = 25), with and without medication. Next, we validated the model on another independent, yet comparable open access EEG dataset (healthy controls (n = 20) and PD patients (n = 20)), which was unseen to the network. We applied Gradient-weighted Class Activation Mapping (Grad-CAM) interpretability technique to create a localization map exhibiting the key network predictors, based on the gradients of the classification score flowing into the last convolutional layer. Accordingly, our results indicated that a sub-second of intrinsic oscillatory power pattern in the beta band over the occipitoparietal, gamma band over the left motor cortex as well as theta band over the frontoparietal cluster, had the largest impact on the network score for dissociating the PD patients from age- and gender-matched healthy controls, across the two datasets. We further found that the off-medication motor symptoms were related to the occipitoparietal off-medication beta power whereas the disease duration was associated with the off-medication beta power of the motor cortex. The on-medication theta power of the frontoparietal was related to the improvement of the motor symptoms. In conclusion, our method enabled us to characterize PD patho-electrophysiology according to the multivariate topographic analysis approach, where both spatial and frequency aspects of the oscillations were simultaneously considered. Moreover, our approach was free from common reference problem of the EEG data analyses.

Higher visual gain contributions to bilateral motor synergies and force control

This study investigated the effects of altered visual gain levels on bilateral motor synergies determined by the uncontrolled manifold (UCM) hypothesis and force control. Twelve healthy participants performed bimanual index finger abduction force control tasks at 20% of their maximal voluntary contraction across four different visual gain conditions: 8, 80, 256, and 512 pixels/N. Quantifying force accuracy and variability within a trial provided a bimanual force control outcome. The UCM analysis measured bilateral motor synergies, a proportion of good variance to bad variance across multiple trials. Correlation analyses determined whether changes in the UCM variables were related to changes in force control variables from the lowest to highest visual gain conditions, respectively. Multiple analyses indicated that the three highest visual gain conditions in comparison to the lowest visual gain increased values of bilateral motor synergies and target force accuracy. The correlation findings showed that a reduction of bad variance from the lowest to three highest visual gain conditions was related to increased force accuracy. These findings reveal that visual gain greater than 8 pixels/N facilitates bimanual force control.

Finger dexterity measured by the Grooved Pegboard test indexes Parkinson's motor severity in a tremor-independent manner

Fine motor impairments are frequent complaints in people with Parkinson's disease (PD). While they may develop at an early stage of the disease, they become more problematic as the disease progresses. Tremors and fine motor symptoms may seem related, but evidence suggests two distinct phenomena. The purpose of our study was to investigate the relationships between fine motor skills and clinical characteristics of PD patients. We hypothesized worse fine motor skills to be associated with greater motor severity that is independent of tremor. We measured fine motor abilities using the Grooved Pegboard test (GPT) in each hand separately and collected clinical and demographics data in a cohort of 82 persons with PD. We performed regression analyses between GPT scores and a range of outcomes: motor severity, time from diagnosis, age and tremors. We also explored similar associations using finger and hand dexterity scores from a standardized PD rating scale. Our results indicate that scores on the GPT for each hand, as measures of manual dexterity, are associated with motor severity and time from diagnosis. The presence of tremors was not a confounding factor, as hypothesized, but age was associated with GPT scores for the dominant hand. Motor severity was also associated with hand and finger dexterity as measured by single items from the clinical Parkinson's rating scale. These findings suggest that the GPT to be useful tool for motor severity assessments of people with PD.

A Dynamical Approach to the Uncontrolled Manifold: Predicting Performance Error During Steady-State Isometric Force Production

The uncontrolled manifold (UCM) approach quantifies the presence of compensatory variability between musculoskeletal elements involved in a motor task. This approach has proved useful for identifying synergistic control strategies for a variety of everyday motor tasks and for investigating how control strategies are affected by motor pathology. However, the UCM approach is limited in its ability to relate compensatory motor variance directly to task performance because variability along the UCM is mathematically agnostic to performance. We present a new approach to UCM analysis that quantifies patterns of irregularity in the compensatory variability between motor elements over time. In a bimanual isometric force stabilization task, irregular patterns of compensation between index fingers predicted greater performance error associated with difficult task conditions, in particular for individuals who exploited a larger set of compensatory strategies (i.e., a larger subspace of the UCM). This relationship between the amount and structure of compensatory motor variance might be an expression of underlying processes supporting performance resilience.

Effects of hand muscle function and dominance on intra-muscle synergies

The goal of the study was to explore the effects of hand dominance and muscle function (prime mover vs. supporting muscle) on recently discovered intra-muscle synergies as potential windows into their neural origin. Healthy right-handed subjects performed accurate cyclical force production tasks while pressing with the middle phalanges and distal phalanges of the fingers of the dominant and non-dominant hand. Surface electromyography was used to identify individual motor unit action potentials in two muscles, flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). Stable motor unit groups (MU-modes) were defined in each muscle and in both muscles together. The composition of the MU-modes allowed linking them to the reciprocal and co-activation command. Force-stabilizing synergies were quantified in each hand and during force production at both sites using the framework of the uncontrolled manifold hypothesis. Force-stabilizing synergies were seen in the spaces of MU-modes from FDS and EDC separately, but not of MU-modes defined for both muscles together. Synergy indices were similar for both hands and both sites of force application. In contrast, force-stabilizing synergies in the space of finger forces were present in the non-dominant hand and absent in the dominant hand. The data suggest existence of distributed mechanisms of synergic control. Finger force synergies are likely to reflect functioning of subcortical loops involving the basal ganglia and cerebellum, while MU-mode synergies are likely to reflect spinal circuitry. Studies of both force-based and motor-unit-based synergies may be clinically valuable for distinguishing effects of spinal and supraspinal disorders.

Unintentional force drifts across the human fingers: implications for the neural control of finger tasks

We explored the unintentional force drift across the four fingers of the dominant hand during accurate force production in isometric conditions caused by turning the visual feedback on force off. Our hypotheses were that the Index finger would show smallest drifts and best ability to eliminate the drifts with knowledge of performance in previous trials. Young healthy subjects produced force at 20% of the maximal force level by one finger at a time. There was no significant difference among the fingers in the root mean square error of force during performance with visual feedback. Turning visual feedback off caused force drift to lower magnitudes. The magnitude of force drift was the largest during tasks performed by the Index finger. After each block of twelve trials, the subjects were given feedback on the drift magnitude in that block and used it to correct performance in future trials. There was a total of six blocks. The magnitude of drift correction between consecutive blocks correlated with the magnitude of drift in the earlier block only after the second and fourth blocks. The Index finger failed to improve its performance more than other fingers and demonstrated significant residual drifts to lower force magnitudes in the sixth block of trials. These findings falsified both our hypotheses. Taken together with earlier studies showing advantage of the Index finger across a variety of tasks that require quick and accurate changes in performance, our results suggest that effector specialization along the stability-agility continuum is not limited to the phenomenon of cortical arm/hand dominance but can also be seen across fingers of a hand controlled by the same hemisphere, possibly reflecting the differences in the finger role in prehensile tasks.

Intramuscle Synergies: Their Place in the Neural Control Hierarchy

We accept a definition of synergy introduced by Nikolai Bernstein and develop it for various actions, from those involving the whole body to those involving a single muscle. Furthermore, we use two major theoretical developments in the field of motor control—the idea of hierarchical control with spatial referent coordinates and the uncontrolled manifold hypothesis—to discuss recent studies of synergies within spaces of individual motor units (MUs) recorded within a single muscle. During the accurate finger force production tasks, MUs within hand extrinsic muscles form robust groups, with parallel scaling of the firing frequencies. The loading factors at individual MUs within each of the two main groups link them to the reciprocal and coactivation commands. Furthermore, groups are recruited in a task-specific way with gains that covary to stabilize muscle force. Such force-stabilizing synergies are seen in MUs recorded in the agonist and antagonist muscles but not in the spaces of MUs combined over the two muscles. These observations reflect inherent trade-offs between synergies at different levels of a control hierarchy. MU-based synergies do not show effects of hand dominance, whereas such effects are seen in multifinger synergies. Involuntary, reflex-based, force changes are stabilized by intramuscle synergies but not by multifinger synergies. These observations suggest that multifinger (multimuscle synergies) are based primarily on supraspinal circuitry, whereas intramuscle synergies reflect spinal circuitry. Studies of intra- and multimuscle synergies promise a powerful tool for exploring changes in spinal and supraspinal circuitry across patient populations.

Frequency-Dependent Effects on Coordination and Prefrontal Hemodynamics During Finger Force Production Tasks

Behavioral stability partially depends on the variability of net outcomes by means of the co-varied adjustment of individual elements such as multi-finger forces. The properties of cyclic actions affect stability and variability of the performance as well as the activation of the prefrontal cortex that is an origin of subcortical structure for the coordinative actions. Little research has been done on the issue of the relationship between stability and neuronal response. The purpose of the study was to investigate the changes in the neural response, particularly at the prefrontal cortex, to the frequencies of isometric cyclic finger force production. The main experimental task was to produce finger forces while matching the produced force to sine-wave templates as accurately as possible. Also, the hemodynamics responses of the prefrontal cortex, including oxy-hemoglobin concentration (ΔHbO) and the functional connectivity, were measured using functional near-infrared spectroscopy. The frequency conditions comprised 0.1, 1, and 2 Hz. The uncontrolled manifold (UCM) approach was applied to compute synergy indices in time-series. The relative phase (RP), the coefficient of variation (CV) of the peak and trough force values were computed as the indices of performance accuracy. The statistical parametric mapping (SPM) was implemented to compare the synergy indices of three frequency conditions in time-series. A less accurate performance in the high-frequency condition was caused not by the RP, but mainly by the inconsistent peak force values (CV; p < 0.01, η p 2 = 0.90). The SPM analysis revealed that the synergy indices were larger in the low-frequency than in high-frequency conditions. Further, the ΔHbO remained unchanged under all frequency conditions, while the functional connectivity decreased with an increase in the frequency of cyclic force production. The current results suggested that the concurrent activation of the prefrontal region mainly depends on the frequency of cyclic force production, which was associated with the strength of stability indices and performance errors. The current study is the first work to uncover the effect of frequency on the multi-finger synergies as to the hemodynamic response in the prefrontal cortex, which possibly provides a clue of the neural mechanism of synergy formation and its changes.

Recent Advances in the Neural Control of Movements: Lessons for Functional Recovery

We review the current views on the control and coordination of movements following the traditions set by Nikolai Bernstein. In particular, we focus on the theory of neural control of effectors - from motor units to individual muscles, to joints, limbs, and to the whole body - with spatial referent coordinates organized into a hierarchy with multiple few-to-many mappings. Further, we discuss synergies ensuring stability of natural human movements within the uncontrolled manifold hypothesis. Synergies are organized within the neural control hierarchy based on the principle of motor abundance. Movement disorders are discussed as consequences of an inability to use the whole range of changes in referent coordinates (as in spasticity) and an inability to ensure controlled stability of salient variables as reflected in indices of multi-element synergies and their adjustments in preparation to actions (as in brain disorders, including Parkinson's disease, multiple-system atrophy, and stroke). At the end of the review, we discuss possible implications of this theoretical approach to peripheral disorders and their rehabilitations using, as an example, osteoarthritis. In particular, "joint stiffening" is viewed as a maladaptive strategy, which can compromise stability of salient variables during walking.

The Nature of Finger Enslaving: New Results and Their Implications

We present a review on the phenomenon of unintentional finger action seen when other fingers of the hand act intentionally. This phenomenon (enslaving) has been viewed as a consequence of both peripheral (e.g., connective tissue links and multifinger muscles) and neural (e.g., projections of corticospinal pathways) factors. Recent studies have shown relatively large and fast drifts in enslaving toward higher magnitudes, which are not perceived by subjects. These and other results emphasize the defining role of neural factors in enslaving. We analyze enslaving within the framework of the theory of motor control with spatial referent coordinates. This analysis suggests that unintentional finger force changes result from drifts of referent coordinates, possibly reflecting the spread of cortical excitation.

Movement analysis of pick-and-place virtual reality exergaming in patients with Parkinson's disease

BACKGROUND

Reduced coordination of precise small movements of the hand, wrist and fingers in Parkinson's disease (PD) has been mostly solved by medications and deep brain stimulation. The effects have been evaluated by clinical tests only.

OBJECTIVE

Virtual reality-based exergaming may enhance fine movements, decrease the medications dosage and provide an additional non-subjective evaluation.

METHODS

3D pick-and-place task (10Cubes) has been developed in a virtual world. The person placed the virtual cubes by the virtual hand, an avatar of the real hand tracked by a Leap Motion Controller (LMC). The system computed the time of manipulating the cube, the total time, the average time, the speed, and the distance. It counted and managed the number of cubes touched, and calculated the hand shake level, i.e. the average tremor index. A pilot test was carried out in a healthy neurologically intact person and a patient with PD using a 3D head-mounted device (HMD) or LCD screen.

RESULTS

The results indicate that substantial and also statistically significant (p< 0.05) differences exist between both participants in all objective parameters; the most noteworthy is the average tremor index. However, we found the parameters only marginally different with 2D equipment.

CONCLUSIONS

The evaluation system of 10Cubes has proved applicable at an unchanged medication plan, but its clinical effectiveness could be confirmed with a randomized study.

One more time about motor (and non-motor) synergies

We revisit the concept of synergy based on the recently translated classical book by Nikolai Bernstein (On the construction of movements, Medgiz, Moscow 1947; Latash, Bernstein's Construction of Movements, Routledge, Abingdon 2020b) and progress in understanding the physics and neurophysiology of biological action. Two aspects of synergies are described: organizing elements into stable groups (modes) and ensuring dynamical stability of salient performance variables. The ability of the central nervous system to attenuate synergies in preparation for a quick action-anticipatory synergy adjustments-is emphasized. Recent studies have demonstrated synergies at the level of hypothetical control variables associated with spatial referent coordinates for effectors. Overall, the concept of synergies fits naturally the hierarchical scheme of control with referent coordinates with an important role played by back-coupling loops within the central nervous system and from peripheral sensory endings. Further, we review studies showing non-trivial changes in synergies with development, aging, fatigue, practice, and a variety of neurological disorders. Two aspects of impaired synergic control-impaired stability and impaired agility-are introduced. The recent generalization of the concept of synergies for non-motor domains, including perception, is discussed. We end the review with a list of unresolved and troubling issues.

Changes in intersegmental stability during gait in patients with spastic cerebral palsy

BACKGROUND

Dysfunction in peripheral and neural structure with spastic cerebral palsy (CP) causes impaired performance and stability of various behaviors. Recent progress of quantification methods for the stability properties, which is based on the uncontrolled manifold hypothesis, has been applied to various neurological disorders. A prior study revealed that the ability for purposeful regulation of stability properties is weakened with CP during finger and hand actions. Successive regulation of stability properties is crucial for human locomotion; therefore, it is imperative to quantify the changes in the intersegmental coordination as to the stable performance in CP individuals during gait.

RESEARCH QUESTION

We hypothesized that (1) Spastic CP group will show smaller step length and gait velocity with larger variability, and (2) Spastic CP group will show no changes in average stability indices for both the COM and head position stabilization, while the smaller difference between stable and unstable posture during the gait cycle.

METHODS

Whole-body kinematic data during walking were collected from CP and control subjects. Step length, velocity, and coefficient of variation (CV) were calculated as spatiotemporal parameters. We quantified the intersegmental stability index in time-series during gait for the stabilization of the whole-body COM and head position.

RESULTS

The CP subjects showed smaller step length and velocity with larger CV than the controls. However, the CP group showed a significantly less difference in the stability indices between the single- and double-limb support phases as compared to the controls for both the COM and head position stabilization.

SIGNIFICANCE

Present study is the first to document the quantification of changing intersegmental stability in the spastic CP during locomotion. The dysfunction of intentional modulation of stability properties in CP individuals may be a more common problem, which is not limited to a specific body effector.

Stability of Action and Kinesthetic Perception in Parkinson's Disease

We present a review of action and perception stability within the theoretical framework based on the idea of control with spatial referent coordinates for the effectors at a number of hierarchical levels. Stability of salient variables is ensured by synergies, neurophysiological structures that act in multi-dimensional spaces of elemental variables and limit variance to the uncontrolled manifold during action and iso-perceptual manifold during perception. Patients with Parkinson’s disease show impaired synergic control reflected in poor stability (low synergy indices) and poor agility (low indices of anticipatory synergy adjustments prior to planned quick actions). They also show impaired perception across modalities, including kinesthetic perception. We suggest that poor stability at the level of referent coordinates can be the dominant factor leading to poor stability of percepts.

Step length synergy while crossing obstacles is weaker in patients with Parkinson's disease

BACKGROUND

Impaired movement stability is a common symptom of Parkinson's disease (PD) that leads to falls and mishandled objects. Decline in synergistic stabilization of movement in PD patients has been observed in manual and postural tasks. However, locomotor synergies have not been quantified in PD patients.

RESEARCH QUESTION

The purpose of this work was to quantify the strength of the synergy stabilizing the step length while crossing an obstacle in PD patients. We hypothesized that (1) the distances of the front and rear feet relative to the obstacle would display compensatory across-trial co-variance that stabilizes step length in PD patients and age-matched controls, and (2) the step-length stabilization would be weaker in PD patients.

METHODS

Thirteen PD patients and eleven healthy age-matched controls walked up to and stepped over a 15 cm high obstacle fifteen times.We measured the distances of the rear and front foot toes from the obstacle during the crossing step. We used the uncontrolled manifold method to parse the across-trial variance in toe distances into a component that maintains the step length and a component that changes the step length. These variance components yielded the synergy index that quantified the stability of step length.

RESULTS

Step length was stabilized in PD patients as well as controls. However, the synergy index was 53% lower in the PD patients (p < 0.01). Thus, both our hypotheses were supported.

SIGNIFICANCE

This is the first study reporting impaired locomotor synergies in PD patients. Most PD patients in our sample were early stage (10 out of 13 patients were Hoehn-Yahr ≤ 2). Therefore, this result motivates further studies to establish step-length synergy during adaptive locomotor tasks as a biomarker for early detection of locomotor impairments in PD patients.

Perturbation-induced fast drifts in finger enslaving

We explored changes in finger forces and in an index of unintentional finger force production (enslaving) under a variety of visual feedback conditions and positional finger perturbations. In particular, we tested a hypothesis that enslaving would show a consistent increase with time at characteristic times of about 1-2 s. Young healthy subjects performed accurate force production tasks under visual feedback on the total force of the instructed fingers (index and ring) or enslaved fingers (middle and little). Finger feedback was covertly alternated between master and enslaved fingers in a random fashion. The feedback could be presented over the first 5 s of the trial only or over the whole trial duration (21 s). After 5 s, the fingers were lifted by 1 cm, and after 15 s, the fingers were lowered to the initial position. The force of the instructed fingers drifted toward lower magnitudes in all conditions except the one with continuous feedback on that force. The force of enslaved fingers showed variable behavior across conditions. In all conditions, the index of enslaving showed a consistent increase with the time constant varying between 1 and 3 s. We interpret the results as pointing at the spread of excitation to enslaved fingers (possibly, in the cortical M1 areas). The relatively fast changes in enslaving under positional finger perturbations suggest that quick changes of the input into M1 from pre-M1 areas can accelerate the hypothesized spread of cortical excitation.

Synergic control of action in levodopa-naïve Parkinson's disease patients: II. Multi-muscle synergies stabilizing vertical posture

Postural instability is a major disabling feature in Parkinson's disease (PD). We quantified the organization of leg and trunk muscles into synergies stabilizing the center of pressure (COP) coordinate within the uncontrolled manifold hypothesis in levodopa-naïve patients with PD and age-matched control subjects. The main hypothesis was that changes in the synergic control of posture are present early in the PD process even before levodopa exposure. Eleven levodopa-naïve patients with PD and 11 healthy controls performed whole-body cyclical voluntary sway tasks and a self-initiated load-release task during standing on a force plate. Surface electromyographic activity in 13 muscles on the right side of the body was analyzed to identify muscle groups with parallel scaling of activation levels (M-modes). Data were collected both before ("off-drug") and approximately 60 min after the first dose of 25/100 carbidopa/levodopa ("on-drug"). COP-stabilizing synergies were quantified for the load-release task. Levodopa-naïve patients with PD showed no COP-stabilizing synergy "off-drug", whereas controls showed posture-stabilizing multi-M-mode synergy. "On-drug", patients with PD demonstrated a significant increase in the synergy index. There were no significant drug effects on the M-mode composition, anticipatory postural adjustments, indices of motor equivalence, or indices of COP variability. The results suggest that levodopa-naïve patients with PD already show impaired posture-stabilizing multi-muscle synergies that may be used as promising behavioral biomarkers for emerging postural disorders in PD. Moreover, levodopa modified synergy metrics differently in these levodopa-naïve patients compared to a previous study of patients on chronic antiparkinsonian medications (Falaki et al. in J Electromyogr Kinesiol 33:20-26, 2017a), suggesting different neurocircuitry involvement.

Movement Quality: A Novel Biomarker Based on Principles of Neuroscience

A major problem in neurorehabilitation is the lack of objective outcomes to measure movement quality. Movement quality features, such as coordination and stability, are essential for everyday motor actions. These features allow reacting to continuously changing environment or to resist external perturbations. Neurological disorders affect movement quality, leading to functionally impaired movements. Recent findings suggest that the central nervous system organizes motor elements (eg, muscles, joints, fingers) into task-specific ensembles to stabilize motor tasks performance. A method to quantify this feature has been previously developed based on the uncontrolled manifold (UCM) hypothesis. UCM quantifies movement quality in a spatial-temporal domain using intertrial analysis of covariation between motor elements. In this point-of-view article, we first describe major obstacles (eg, the need for group analysis) that interfere with UCM application in clinical settings. Then, we propose a process of quantifying movement quality for a single individual with a novel use of bootstrapping simulations and UCM analysis. Finally, we reanalyze previously published data from individuals with neurological disorders performing a wide range of motor tasks, that is, multi-digit pressing and postural balance tasks. Our method allows one to assess motor quality impairments in a single individual and to detect clinically important motor behavior changes. Our solution may be incorporated into a clinical setting to assess sensorimotor impairments, evaluate the effects of specific neurological treatments, or track movement quality recovery over time. We also recommended the proposed solution to be used jointly with a typical statistical analysis of UCM parameters in cohort studies.

Finger interdependence and unintentional force drifts: Lessons from manipulations of visual feedback

We explored the phenomenon of unintentional finger force drift by using visual feedback on the force produced either by explicitly instructed (master) finger pairs or by non-instructed (enslaved) finger pairs. In particular, we drew contrasting predictions from two hypotheses: that force drifts represented consequences of drifts in effector referent coordinates at the level of individual fingers vs. at the level of finger modes (hypothetical variables accounting for the finger force interdependence). Subjects performed accurate force production with two fingers of a hand, index-ring or middle-little. They received visual feedback on the force produced either by the master fingers or by the other two, enslaved, fingers. The feedback scale was adjusted to ensure that the subjects did not know the difference between these two, randomly presented, conditions. Under feedback on the master finger force, enslaved force showed a consistent drift upward. Under feedback on the enslaved finger force, master force showed a consistent drift downward. The subjects were unaware of the force drifts, which could reach over 35% of the initial force magnitude. The data support the hypothesis on drifts in the referent coordinate at the level of individual digits, not finger modes, as the origin of unintentional force drifts. The consistent increase in the relative amount of force produced by the enslaved fingers suggests that the commonly used methods to quantify enslaving should include relatively brief force production tasks.

On the origin of finger enslaving: control with referent coordinates and effects of visual feedback

When a person tries to press with a finger, other fingers of the hand produce force unintentionally. We explored this phenomenon of enslaving during unintentional force drifts in the course of continuous force production by pairs of fingers of a hand. Healthy subjects performed accurate force production tasks by finger pairs Index-Middle, Middle-Ring, and Ring-Little with continuous visual feedback on the combined force of the instructed (master) fingers or of the noninstructed (enslaved) fingers. The feedback scale was adjusted to ensure that the subjects did not know the difference between these two, randomly presented, conditions. Across all finger pairs, enslaved force showed a drift upward under feedback on the master finger force, and master force showed a drift downward under feedback on the enslaved finger force. The subjects were unaware of the force drifts, which could reach over 50% of the initial force magnitude over 15 s. Across all conditions, the index of enslaving increased by ∼50% over the trial duration. The initial moment of force magnitude in pronation-supination was not a consistent predictor of the force drift magnitude. These results falsify the hypothesis that the counter-directional force drifts reflected drifts in the moment of force. They suggest that during continuous force production, enslaving increases with time, possibly due to the spread of excitation over cortical finger representations or other mechanisms, such as increased synchronization of firing of α-motoneurons innervating different compartments of extrinsic flexors. These changes in enslaving, interpreted at the level of control with referent coordinates for the fingers, can contribute to a variety of phenomena, including unintentional force drifts.NEW & NOTEWORTHY We report a consistent slow increase in finger enslaving (force production by noninstructed fingers) when visual feedback was presented on the force produced by either two instructed fingers or two noninstructed fingers of the hand. In contrast, force drifts could be in opposite directions depending on the visual feedback. We interpret enslaving and its drifts at the level of control with referent coordinates for the involved muscles, possibly reflecting spread of cortical excitation.

Finger Force Matching and Verbal Reports: Testing Predictions of the Iso-Perceptual Manifold Concept

We used force matching and verbal reports of finger force to explore a prediction of the iso-perceptual manifold concept, which assumes that stable percepts are associated with a manifold in the afferent-efferent space. Young subjects produced various force magnitudes with the index finger, middle finger, or both fingers together. Further, they reported the force level using a verbal scale and by matching the force with fingers of the contralateral hand. Force matching, but not verbal reports, showed larger variable errors for individual fingers in the two-finger task compared to the single-finger tasks. We discuss possible differences in afferent and efferent contributions to force perception at low and high forces based on the idea of motor control with referent coordinates for the effectors. The differences between the force matching and verbal reports are possibly related to neural circuitry differences between perceiving without action and perceiving-to-act.

Laws of nature that define biological action and perception

We describe a physical approach to biological functions, with the emphasis on the motor and sensory functions. The approach assumes the existence of biology-specific laws of nature uniting salient physical variables and parameters. In contrast to movements in inanimate nature, actions are produced by changes in parameters of the corresponding laws of nature. For movements, parameters are associated with spatial referent coordinates (RCs) for the effectors. Stability of motor actions is ensured by the abundant mapping of RCs across hierarchical control levels. The sensory function is viewed as based on an interaction of efferent and afferent signals leading to an iso-perceptual manifold where percepts of salient sensory variables are stable. This approach offers novel interpretations for a variety of known neurophysiological and behavioral phenomena and makes a number of novel testable predictions. In particular, we discuss novel interpretations for the well-known phenomena of agonist-antagonist co-activation and vibration-induced illusions of both position and force. We also interpret results of several new experiments with unintentional force changes and with analysis of accuracy of perception of variables produced by elements of multi-element systems. Recently, this approach has been expanded to interpret motor disorders including spasticity and consequences of subcortical disorders (such as Parkinson's disease). We suggest that the approach can be developed for cognitive functions.

The Influence of Recent Actions and Anticipated Actions on the Stability of Finger Forces During a Tracking Task

The authors examined how the stability of the current total isometric force (FT) produced by four fingers is influenced by previous and expected voluntary changes in FT. The authors employed the synergy index obtained from the across-trial uncontrolled manifold analysis to quantify the stability of FT. The authors compared two tasks with similar histories of FT changes; one in which participants expected changes in FT in the future, and one in which they expected no changes in FT. The stability of FT was lower in the former task, indicating the existence of a novel type of anticipatory synergy adjustment. Disparate histories of FT changes yield inconsistent changes in stability, driven by individual differences in the covariation in the finger forces that leave FT invariant. Future research should focus on exploring these individual differences to better understand how previous and expected behavior changes influence the stability of the current motor behavior.

Postural Behavior in Medicated Parkinson Disease Patients: A Preliminary Study Searching for Indicators to Track Progress

Purpose:

The establishment of early diagnostic methods for Parkinson disease (PD) is one of the key features to clinically control the rate of PD progression. This study aimed to give a first step toward recognizing the efficacy of multiple postural indices of balance control in differentiating medicated PD patients from health participants.

Methods:

Nine individuals with PD (Hoehn and Yahr Stage up to 2), 9 staged 2.5 and up, and 9 healthy age-matched Controls performed bipedal stances for 120 seconds with eyes either open or closed on a stable force platform. All participants with PD were under anti-Parkinsonian medication. Non-parametric tests investigated the effects of PD and visual input on postural indices extracted from the center of pressure coordinates.

Results:

Independent of the stage of the disease, individuals with PD presented faster and shakier body sway compared with Controls. Advanced stages of PD also revealed increased body sway length and variability. In addition, medio-lateral postural instability was more pronounced in all stages of PD when visual inputs were not allowed.

Conclusion and Significance:

Body sway velocity, jerkiness, length, and its variability revealed to be potential markers for subclinical signs of adjustments in the neuromechanisms of balance control and postural instability even at early stages of disease and under anti-Parkinsonian medication. Results produced here will direct future studies aiming to investigate the efficacy of these same indices on recognizing subclinical development of PD as well as those individuals susceptible to faster rates of progression.

What do people match when they try to match force? Analysis at the level of hypothetical control variables

We used the theory of control with spatial referent coordinates (RC) to explore how young, healthy persons modify finger pressing force and match forces between the two hands. Three specific hypotheses were tested related to patterns of RC and apparent stiffness (defined as the slope of force-coordinate relation) used in the presence of visual feedback on the force and in its absence. The subjects used the right hand to produce accurate force under visual feedback; further the force could be increased or decreased, intentionally or unintentionally (induced by controlled lifting or lowering of the fingertips). The left hand was used to match force without visual feedback before and after the force change; the match hand consistently underestimated the actual force change in the task hand. The "inverse piano" device was used to compute RC and apparent stiffness. We found very high coefficients of determination for the inter-trial hyperbolic regressions between RC and apparent stiffness in the presence of visual feedback; the coefficients of determination dropped significantly without visual feedback. There were consistent preferred sharing patterns in the space of RC and apparent stiffness between the task and match hands across subjects. In contrast, there was much less consistency between the task and match hands in the magnitudes of RC and apparent stiffness observed in individual trials. Compared to the task hand, the match hand showed consistently lower magnitudes of apparent stiffness and, correspondingly, larger absolute magnitudes of RC. Involuntary force changes produced by lifting and lowering the force sensors led to significantly lower force changes compared to what could be expected based on the computed values of apparent stiffness and sensor movement amplitude. The results confirm the importance of visual feedback for stabilization of force in the space of hypothetical control variables. They suggest the existence of personal traits reflected in preferred ranges of RC and apparent stiffness across the two hands. They also show that subjects react to external perturbations, even when instructed "not to interfere": Such perturbations cause unintentional and unperceived drifts in both RC and apparent stiffness.

On Primitives in Motor Control

The concept of primitives has been used in motor control both as a theoretical construct and as a means of describing the results of experimental studies involving multiple moving elements. This concept is close to Bernstein’s notion of engrams and level of synergies. Performance primitives have been explored in spaces of peripheral variables but interpreted in terms of neural control primitives. Performance primitives reflect a variety of mechanisms ranging from body mechanics to spinal mechanisms and to supraspinal circuitry. This review suggests that primitives originate at the task level as preferred time functions of spatial referent coordinates or at mappings from higher level referent coordinates to lower level, frequently abundant, referent coordinate sets. Different patterns of performance primitives can emerge depending, in particular, on the external force field.

Digit Force Controls and Corresponding Brain Activities in Finger Pressing Performance: A Comparison Between Older Adults and Young Individuals

This study aims toward an investigation and comparison of the digital force control and the brain activities of older adults and young groups during digital pressing tasks. A total of 15 young and 15 older adults were asked to perform force ramp tasks at different force levels with a custom pressing system. Near-infrared spectroscopy was used to collect the brain activities in the prefrontal cortex and primary motor area. The results showed that the force independence and hand function of the older adults were worse than that of the young adults. The cortical activations in the older adults were higher than those in the young group during the tasks. A significant hemodynamic between-group response and mild negative correlations between brain activation and force independence ability were found. Older adults showed poor force independence ability and manual dexterity and required additional brain activity to compensate for the degeneration.

Synergic control of action in levodopa-naïve Parkinson's disease patients: I. Multi-finger interaction and coordination

We explored the origin of the impaired control of action stability in Parkinson's disease (PD) by testing levodopa-naïve PD patients to disambiguate effects of PD from possible effects of long-term exposure to levodopa. Thirteen levodopa-naïve PD patients and 13 controls performed single- and multi-finger force production tasks, including producing a self-paced quick force pulse into a target. A subgroup of patients (n = 10) was re-tested about 1 h after the first dose of levodopa. Compared to controls, PD patients showed lower maximal forces and synergy indices stabilizing total force (reflecting the higher inter-trial variance component affecting total force). In addition, PD patients showed a trend toward shorter anticipatory synergy adjustments (a drop in the synergy index in preparation to a quick action) and larger non-motor equivalent finger force deviations. Lower maximal force, higher unintentional force production (enslaving) and higher inter-trial variance indices occurred in PD patients after one dosage of levodopa. We conclude that impairment in synergies is present in levodopa-naïve patients, mainly in indices reflecting stability (synergy index), but not agility (anticipatory synergy adjustments). A single dose of levodopa, however, did not improve synergy indices, as it did in PD patients on chronic anti-PD medication, suggesting a different mechanism of action. The results suggest that indices of force-stabilizing synergies may be used as an early behavioral sign of PD, although it may not be sensitive to acute drug effects in drug-naïve patients.

Fascial organisation of motor synergies: a hypothesis

In the field of biomechanics and motor control understanding movement coordination is paramount. Motor synergies represent the coordination of neural and physical elements embedded in our bodies in order to optimize the solutions to motor problems. Although we are able to measure and quantify the movement made manifested, we do not have confidence in explaining the anatomical bases of its organisation at different levels. It is our contention that the flexible hierarchical organization of movement relies on the fascial structurers to create functional linkages at different levels, and this concept attunes with the neural control of synergies. At the base of movement organization there is a (somatic) equilibrium point that exists on the fascia where the neurologically- and mechanically-generated tensions dynamically balance out. This somatic equilibrium point is at the base of postural control, afferent flow of information to the nervous system about the state of the muscles, and of the coordinative pre-activation of muscular contraction sequences specific for a synergy. Implications are discussed and suggestions for research and clinical applications are made.

Evaluation of Finger Force Control Ability in Terms of Multi-Finger Synergy

In this study, finger force control abilities are quantified by the concept of multi-finger synergy in conjunction with uncontrolled manifold (UCM) analysis. Two indices, namely, repeatability and flexibility, representing features of multi-finger synergy were proposed to overcome the limitation of previously introduced indices, such as floor effects and distortion problems. The proposed indices were applied to stroke patients and healthy adults through specifically designed experiments. The experimental results showed a clear difference between stroke patients and healthy adults. Also, interestingly, there was a difference in an outcome between two-stroke patient subgroups: stroke patients in whom the dominant hand was affected and non-dominant hand was affected groups.

Case Studies in Neuroscience: The central and somatosensory contributions to finger interdependence and coordination: lessons from a study of a "deafferented person"

We tested finger force interdependence and multifinger force-stabilizing synergies in a patient with large-fiber peripheral neuropathy ("deafferented person"). The subject performed a range of tasks involving accurate force production with one finger and with four fingers. In one-finger tasks, nontask fingers showed unintentional force production (enslaving) with an atypical pattern: very large indices for the lateral (index and little) fingers and relatively small indices for the central (middle and ring) fingers. Indices of multifinger synergies stabilizing total force and of anticipatory synergy adjustments in preparation to quick force pulses were similar to those in age-matched control females. During constant force production, removing visual feedback led to a slow force drift to lower values (by ~25% over 15 s). The results support the idea of a neural origin of enslaving and suggest that the patterns observed in the deafferented person were reorganized based on everyday manipulation tasks. The lack of significant changes in the synergy index shows that synergic control can be organized in the absence of somatosensory feedback. We discuss the control of the hand in deafferented persons within the α-model of the equilibrium-point hypothesis and suggest that force drift results from an unintentional drift of the control variables to muscles toward zero values. NEW & NOTEWORTHY We demonstrate atypical patterns of finger enslaving and unchanged force-stabilizing synergies in a person with large-fiber peripheral neuropathy. The results speak strongly in favor of central origin of enslaving and its reorganization based on everyday manipulation tasks. The data show that synergic control can be implemented in the absence of somatosensory feedback. We discuss the control of the hand in deafferented persons within the α-model of the equilibrium-point hypothesis.

Coordination in adults with neurological impairment - A systematic review of uncontrolled manifold studies

BACKGROUND

Analysis of sensorimotor synergies has been greatly advanced by the Uncontrolled Manifold (UCM) approach. The UCM method is based on partitioning inter-trial variance displayed by elemental variables into 'good' (V_UCM) and 'bad' (V_ORT) variability that, respectively, indicate maintenance or loss of task stability. In clinical populations, these indices can be used to investigate the strength, flexibility, stereotypy and agility of synergistic control.

RESEARCH QUESTION

How are synergies affected by neurological impairment in adults? Specifically, this study aimed to determine i) the impact of pathology on V_UCM, V_ORT, and their ratio (synergy index); ii) the relationship between synergy indices and functional performance; iii) changes in anticipatory synergy adjustments (ASAs); and iv) the effects of interventions on synergies.

METHODS

Systematic review of UCM studies on adults with neurological impairment.

RESULTS

Most of the 17 studies had moderate to high quality scores in the adapted Critical Review Form and the UCM reporting quality checklist developed for this review. i) Most of the studies found reduced synergy indices for patients with Parkinson's disease (PD), olivo-ponto-cerebellar atrophy, multiple sclerosis and spinocerebellar degeneration, with variable levels of change in V_UCM and V_ORT. Reduction in synergy indices was not as consistent for stroke, in three out of six studies it was unchanged. ii) Five of seven studies found no significant correlations between scores on motor function scales and UCM indices. iii) Seven studies consistently reported ASAs that are smaller in magnitude, delayed, or both, for patients compared to healthy controls. iv) Two studies reported increased synergy indices, either via increase in V_UCM or decrease in V_ORT, after dopaminergic drugs for patients with PD. There were similar synergy indices but improved ASAs after deep brain stimulation for patients with PD.

SIGNIFICANCE

UCM can provide reliable and sensitive indicators of altered synergistic control in adults with neurological impairment.

Exploring the Concept of Iso-perceptual Manifold (IPM): A Study of Finger Force-Matching Tasks

We used force-matching tasks between the two hands to test predictions of the recently introduced scheme of perception based on the concept of iso-perceptual manifold (IPM) in the combined afferent-efferent space of neural signals. The main hypothesis was that accuracy and variability of individual finger force matching would be worse in a four-finger task compared to one-finger tasks. The subjects produced accurate force levels under visual feedback by pressing with either all four fingers or by one of the fingers of a hand (task-hand). They tried to match the total four-finger force or individual finger forces by pressing with the other hand (match-hand, no visual feedback). The match-hand consistently overshot the task-hand force during single-finger matching episodes. It showed higher inter-trial force variability during single-finger matching when the task-hand performed the four-finger task compared to trials when the task-hand performed single-finger tasks. These findings confirm our main hypothesis by showing that perception of individual finger forces can vary in multi-finger tasks within a space (IPM) corresponding to veridical perception of total force. Matching hypothetical commands to fingers, rather than finger forces, could be responsible for the consistent force overshoots. Indices of inter-trial variance affecting and unaffecting total force showed strong stabilization of total force in the task-hand but not in the match-hand in support of an earlier hypothesis on the importance of visual feedback for force stabilization. No differences were seen between the right and left hands suggesting that the dynamic dominance hypothesis may not be generalizable to perceptual phenomena.

Recommendation for the minimum number of steps to analyze when performing the uncontrolled manifold analysis on walking data

The uncontrolled manifold (UCM) analysis quantifies the extent to which co-variation among a set of variables facilitates consistent performance by partitioning variance in those variables into two components then calculating their normalized difference (i.e., the synergy index). Although UCM-derived measures are thought to depend on the number of data points analyzed, the minimum number needed to reasonably approximate true values of these measures is unknown. For each of two performance variables related to mechanical stability of gait, we evaluated changes in UCM-derived measures when increasing the number of analyzed points, here steps. Fourteen older adults walked on a treadmill while motion capture tracked movement. For each subject, n steps (where n = 2-99) were randomly sampled from the first 100, then used to calculate UCM-derived variables. For each subject, variables were expressed as a percent of the subject-specific value with n = 100 and averaged across 50 simulations. For each n, 95% confidence intervals (CIs) were calculated from group data. The minimum number of steps to "reasonably approximate" a variables was defined as the value of n for which the lower CI was >90% of the value with n = 100. Regardless of performance variable, reasonable approximations of the synergy index were attained with n = 16 steps, whereas n = 50 steps were needed for each of the variance components However, the differences between using 16 steps and 50 steps were small. Collecting 15-20 steps is recommended for a reasonable approximation of the synergy indices considered herein, particularly when data collection is constrained to a limited number of steps.