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Xu J, Mawase F, Schieber MH. Evolution, biomechanics, and neurobiology converge to explain selective finger motor control. Physiol Rev 2024; 104:983-1020. [PMID: 38385888 PMCID: PMC11380997 DOI: 10.1152/physrev.00030.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
Humans use their fingers to perform a variety of tasks, from simple grasping to manipulating objects, to typing and playing musical instruments, a variety wider than any other species. The more sophisticated the task, the more it involves individuated finger movements, those in which one or more selected fingers perform an intended action while the motion of other digits is constrained. Here we review the neurobiology of such individuated finger movements. We consider their evolutionary origins, the extent to which finger movements are in fact individuated, and the evolved features of neuromuscular control that both enable and limit individuation. We go on to discuss other features of motor control that combine with individuation to create dexterity, the impairment of individuation by disease, and the broad extent of capabilities that individuation confers on humans. We comment on the challenges facing the development of a truly dexterous bionic hand. We conclude by identifying topics for future investigation that will advance our understanding of how neural networks interact across multiple regions of the central nervous system to create individuated movements for the skills humans use to express their cognitive activity.
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Affiliation(s)
- Jing Xu
- Department of Kinesiology, University of Georgia, Athens, Georgia, United States
| | - Firas Mawase
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa, Israel
| | - Marc H Schieber
- Departments of Neurology and Neuroscience, University of Rochester, Rochester, New York, United States
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Di Libero T, Carissimo C, Cerro G, Abbatecola AM, Marino A, Miele G, Ferrigno L, Rodio A. An Overall Automated Architecture Based on the Tapping Test Measurement Protocol: Hand Dexterity Assessment through an Innovative Objective Method. SENSORS (BASEL, SWITZERLAND) 2024; 24:4133. [PMID: 39000912 PMCID: PMC11244415 DOI: 10.3390/s24134133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
The present work focuses on the tapping test, which is a method that is commonly used in the literature to assess dexterity, speed, and motor coordination by repeatedly moving fingers, performing a tapping action on a flat surface. During the test, the activation of specific brain regions enhances fine motor abilities, improving motor control. The research also explores neuromuscular and biomechanical factors related to finger dexterity, revealing neuroplastic adaptation to repetitive movements. To give an objective evaluation of all cited physiological aspects, this work proposes a measurement architecture consisting of the following: (i) a novel measurement protocol to assess the coordinative and conditional capabilities of a population of participants; (ii) a suitable measurement platform, consisting of synchronized and non-invasive inertial sensors to be worn at finger level; (iii) a data analysis processing stage, able to provide the final user (medical doctor or training coach) with a plethora of useful information about the carried-out tests, going far beyond state-of-the-art results from classical tapping test examinations. Particularly, the proposed study underscores the importance interdigital autonomy for complex finger motions, despite the challenges posed by anatomical connections; this deepens our understanding of upper limb coordination and the impact of neuroplasticity, holding significance for motor abilities assessment, improvement, and therapeutic strategies to enhance finger precision. The proof-of-concept test is performed by considering a population of college students. The obtained results allow us to consider the proposed architecture to be valuable for many application scenarios, such as the ones related to neurodegenerative disease evolution monitoring.
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Affiliation(s)
- Tommaso Di Libero
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Chiara Carissimo
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Gianni Cerro
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Angela Marie Abbatecola
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, 03043 Cassino, Italy
- Alzheimer's Disease Day Clinics, Azienda ria Locale, 03100 Frosinone, Italy
| | - Alessandro Marino
- Department of Electrical and Information Engineering, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Gianfranco Miele
- Department of Electrical and Information Engineering, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Luigi Ferrigno
- Department of Electrical and Information Engineering, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Angelo Rodio
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, 03043 Cassino, Italy
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van Ravestyn C, Gerardin E, Térémetz M, Hamdoun S, Baron JC, Calvet D, Vandermeeren Y, Turc G, Maier MA, Rosso C, Mas JL, Dupin L, Lindberg PG. Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity. Neurorehabil Neural Repair 2024; 38:373-385. [PMID: 38572686 DOI: 10.1177/15459683241245416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
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Affiliation(s)
- Coralie van Ravestyn
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Eloïse Gerardin
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Maxime Térémetz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Claude Baron
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - David Calvet
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Yves Vandermeeren
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Mas
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Lucile Dupin
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
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Lemon R. The Corticospinal System and Amyotrophic Lateral Sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 160:56-67. [PMID: 38401191 DOI: 10.1016/j.clinph.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Abstract
Corticospinal neurons located in motor areas of the cerebral neocortex project corticospinal axons which synapse with the spinal network; a parallel corticobulbar system projects to the cranial motor network and to brainstem motor pathways. The primate corticospinal system has a widespread cortical origin and an extensive range of different fibre diameters, including thick, fast-conducting axons. Direct cortico-motoneuronal (CM) projections from the motor cortex to arm and hand alpha motoneurons are a recent evolutionary feature, that is well developed in dexterous primates and particularly in humans. Many of these projections originate from the caudal subdivision of area 4 ('new' M1: primary motor cortex). They arise from corticospinal neurons of varied soma size, including those with fast- and relatively slow-conducting axons. This CM system has been shown to be involved in the control of skilled movements, carried out with fractionation of the distal extremities and at low force levels. During movement, corticospinal neurons are activated quite differently from 'lower' motoneurons, and there is no simple or fixed functional relationship between a so-called 'upper' motoneuron and its target lower motoneuron. There are key differences in the organisation and function of the corticospinal and CM system in primates versus non-primates, such as rodents. These differences need to be recognized when making the choice of animal model for understanding disorders such as amyotrophic lateral sclerosis (ALS). In this neurodegenerative brain disease there is a selective loss of fast-conducting corticospinal axons, and their synaptic connections, and this is reflected in responses to non-invasive cortical stimuli and measures of cortico-muscular coherence. The loss of CM connections influencing distal limb muscles results in a differential loss of muscle strength or 'split-hand' phenotype. Importantly, there is also a unique impairment in the coordination of skilled hand tasks that require fractionation of digit movement. Scores on validated tests of skilled hand function could be used to assess disease progression.
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Affiliation(s)
- Roger Lemon
- Department of Clinical and Movement Sciences, Queen Square Institute of Neurology, UCL, London WC1N 3BG, UK.
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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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Xu J, Ma T, Kumar S, Olds K, Brown J, Carducci J, Forrence A, Krakauer J. Loss of finger control complexity and intrusion of flexor biases are dissociable in finger individuation impairment after stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.29.555444. [PMID: 37693573 PMCID: PMC10491249 DOI: 10.1101/2023.08.29.555444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The ability to control each finger independently is an essential component of human hand dexterity. A common observation of hand function impairment after stroke is the loss of this finger individuation ability, often referred to as enslavement, i.e., the unwanted coactivation of non-intended fingers in individuated finger movements. In the previous literature, this impairment has been attributed to several factors, such as the loss of corticospinal drive, an intrusion of flexor synergy due to upregulations of the subcortical pathways, and/or biomechanical constraints. These factors may or may not be mutually exclusive and are often difficult to tease apart. It has also been suggested, based on a prevailing impression, that the intrusion of flexor synergy appears to be an exaggerated pattern of the involuntary coactivations of task-irrelevant fingers seen in a healthy hand, often referred to as a flexor bias. Most previous studies, however, were based on assessments of enslavement in a single dimension (i.e., finger flexion/extension) that coincide with the flexor bias, making it difficult to tease apart the other aforementioned factors. Here, we set out to closely examine the nature of individuated finger control and finger coactivation patterns in all dimensions. Using a novel measurement device and a 3D finger-individuation paradigm, we aim to tease apart the contributions of lower biomechanical, subcortical constraints, and top-down cortical control to these patterns in both healthy and stroke hands. For the first time, we assessed all five fingers' full capacity for individuation. Our results show that these patterns in the healthy and paretic hands present distinctly different shapes and magnitudes that are not influenced by biomechanical constraints. Those in the healthy hand presented larger angular distances that were dependent on top-down task goals, whereas those in the paretic hand presented larger Euclidean distances that arise from two dissociable factors: a loss of complexity in finger control and the dominance of an intrusion of flexor bias. These results suggest that finger individuation impairment after stroke is due to two dissociable factors: the loss of finger control complexity present in the healthy hand reflecting a top-down neural control strategy and an intrusion of flexor bias likely due to an upregulation of subcortical pathways. Our device and paradigm are demonstrated to be a promising tool to assess all aspects of the dexterous capacity of the hand.
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Affiliation(s)
- Jing Xu
- Department of Kinesiology, University of Georgia, Athens, GA, USA
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy Ma
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Center for Neural Science, New York University, New York, NY, USA
| | - Sapna Kumar
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Kevin Olds
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Brown
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jacob Carducci
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alex Forrence
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychology, Yale University, New Haven, NJ, USA
| | - John Krakauer
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Térémetz M, Hamdoun S, Colle F, Gerardin E, Desvilles C, Carment L, Charron S, Cuenca M, Calvet D, Baron JC, Turc G, Maier MA, Rosso C, Mas JL, Lindberg PG. Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial. J Neuroeng Rehabil 2023; 20:93. [PMID: 37464404 PMCID: PMC10355015 DOI: 10.1186/s12984-023-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).
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Affiliation(s)
- Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sonia Hamdoun
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Médecine Physique et de Réadaptation, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - Florence Colle
- SSR Neurologique, Hôpitaux de Saint-Maurice, 12/14 Rue du Val d'Osne, 94410, Saint-Maurice, France
| | - Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain/CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Claire Desvilles
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Marc A Maier
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, 75006, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jean-Louis Mas
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France.
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8
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Conway BJ, Taquet L, Boerger TF, Young SC, Krucoff KB, Schmit BD, Krucoff MO. Quantifying Hand Strength and Isometric Pinch Individuation Using a Flexible Pressure Sensor Grid. SENSORS (BASEL, SWITZERLAND) 2023; 23:5924. [PMID: 37447773 DOI: 10.3390/s23135924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Modulating force between the thumb and another digit, or isometric pinch individuation, is critical for daily tasks and can be impaired due to central or peripheral nervous system injury. Because surgical and rehabilitative efforts often focus on regaining this dexterous ability, we need to be able to consistently quantify pinch individuation across time and facilities. Currently, a standardized metric for such an assessment does not exist. Therefore, we tested whether we could use a commercially available flexible pressure sensor grid (Tekscan F-Socket [Tekscan Inc., Norwood, MA, USA]) to repeatedly measure isometric pinch individuation and maximum voluntary contraction (MVC) in twenty right-handed healthy volunteers at two visits. We developed a novel equation informed by the prior literature to calculate isometric individuation scores that quantified percentage of force on the grid generated by the indicated digit. MVC intra-class correlation coefficients (ICCs) for the left and right hands were 0.86 (p < 0.0001) and 0.88 (p < 0.0001), respectively, suggesting MVC measurements were consistent over time. However, individuation score ICCs, were poorer (left index ICC 0.41, p = 0.28; right index ICC -0.02, p = 0.51), indicating that this protocol did not provide a sufficiently repeatable individuation assessment. These data support the need to develop novel platforms specifically for repeatable and objective isometric hand dexterity assessments.
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Affiliation(s)
| | - Léon Taquet
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah C Young
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kate B Krucoff
- Department of Plastic & Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
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9
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Conway BJ, Taquet L, Boerger TF, Young SC, Krucoff KB, Schmit BD, Krucoff MO. Quantitative assessments of finger individuation with an instrumented glove. J Neuroeng Rehabil 2023; 20:48. [PMID: 37081513 PMCID: PMC10120262 DOI: 10.1186/s12984-023-01173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND In clinical and research settings, hand dexterity is often assessed as finger individuation, or the ability to move one finger at a time. Despite its clinical importance, there is currently no standardized, sufficiently sensitive, or fully objective platform for these evaluations. METHODS Here we developed two novel individuation scores and tested them against a previously developed score using a commercially available instrumented glove and data collected from 20 healthy adults. Participants performed individuation for each finger of each hand as well as whole hand open-close at two study visits separated by several weeks. Using the three individuation scores, intra-class correlation coefficients (ICC) and minimal detectable changes (MDC) were calculated. Individuation scores were further correlated with subjective assessments to assess validity. RESULTS We found that each score emphasized different aspects of individuation performance while generating scores on the same scale (0 [poor] to 1 [ideal]). These scores were repeatable, but the quality of the metrics varied by both equation and finger of interest. For example, index finger intra-class correlation coefficients (ICC's) were 0.90 (< 0.0001), 0.77 (< 0.001), and 0.83 (p < 0.0001), while pinky finger ICC's were 0.96 (p < 0.0001), 0.88 (p < 0.0001), and 0.81 (p < 0.001) for each score. Similarly, MDCs also varied by both finger and equation. In particular, thumb MDCs were 0.068, 0.14, and 0.045, while index MDCs were 0.041, 0.066, and 0.078. Furthermore, objective measurements correlated with subjective assessments of finger individuation quality for all three equations (ρ = - 0.45, p < 0.0001; ρ = - 0.53, p < 0.0001; ρ = - 0.40, p < 0.0001). CONCLUSIONS Here we provide a set of normative values for three separate finger individuation scores in healthy adults with a commercially available instrumented glove. Each score emphasizes a different aspect of finger individuation performance and may be more uniquely applicable to certain clinical scenarios. We hope for this platform to be used within and across centers wishing to share objective data in the physiological study of hand dexterity. In sum, this work represents the first healthy participant data set for this platform and may inform future translational applications into motor physiology and rehabilitation labs, orthopedic hand and neurosurgery clinics, and even operating rooms.
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Affiliation(s)
- Brian J Conway
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Léon Taquet
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy F Boerger
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah C Young
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate B Krucoff
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Max O Krucoff
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Fercho KA, Scholl JL, Kc B, Bosch TJ, Baugh LA. Sensorimotor control of object manipulation following middle cerebral artery (MCA) stroke. Neuropsychologia 2023; 182:108525. [PMID: 36858282 DOI: 10.1016/j.neuropsychologia.2023.108525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
Methods for assessing the loss of hand function post-stroke examine limited aspects of motor performance and are not sensitive to subtle changes that can cause deficits in everyday object manipulation tasks. Efficiently lifting an object entails a prediction of required forces based on intrinsic features of the object (sensorimotor integration), short-term updates in the forces required to lift objects that are poorly predicted (sensorimotor memory), as well as the ability to modulate distal fingertip forces, which are not measured by existing assessment tools used in clinics for both diagnostic and rehabilitative purposes. The presented research examined these three components of skilled object manipulation in 60 chronic, unilateral middle cerebral artery stroke participants. Performance was compared to age-matched control participants, and linear regressions were used to predict performance based on clinical scores. Most post-stroke participants performed below control levels in at least one of the tasks. Post-stroke participants presented with combinations of deficits in each of the tasks performed, regardless of the hemisphere damaged by the stroke. Surprisingly, the ability to modulate distal forces was impaired in those patients with damage ipsilateral (right hemisphere) to the hand being used. Sensorimotor integration was also impaired in patients with right hemisphere damage, though they performed at control levels in later lifts, whereas left-hemisphere-damaged patients did not. Lastly, during a task requiring sensorimotor memory, neither patient group performed outside of control ranges on initial lifts, with patients with right hemisphere damage showing impaired performance in later lifts suggesting they were unable to learn the mapping novel mapping of color and mass of the objects. The presented research demonstrates unilateral MCA stroke patients can have deficits in one or more components required for the successful manipulation of hand-held objects and that skillful object lifting requires intact bilateral systems. Further, this information may be used in future studies to aid efforts that target rehabilitation regimens to a stroke survivor's specific pattern of deficits.
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Affiliation(s)
| | - Jamie L Scholl
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Bikash Kc
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Taylor J Bosch
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA
| | - Lee A Baugh
- Basic Biomedical Sciences & Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, USA.
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11
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Buetefisch CM, Haut MW, Revill KP, Shaeffer S, Edwards L, Barany DA, Belagaje SR, Nahab F, Shenvi N, Easley K. Stroke Lesion Volume and Injury to Motor Cortex Output Determines Extent of Contralesional Motor Cortex Reorganization. Neurorehabil Neural Repair 2023; 37:119-130. [PMID: 36786394 PMCID: PMC10079613 DOI: 10.1177/15459683231152816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND After stroke, increases in contralesional primary motor cortex (M1CL) activity and excitability have been reported. In pre-clinical studies, M1CL reorganization is related to the extent of ipsilesional M1 (M1IL) injury, but this has yet to be tested clinically. OBJECTIVES We tested the hypothesis that the extent of damage to the ipsilesional M1 and/or its corticospinal tract (CST) determines the magnitude of M1CL reorganization and its relationship to affected hand function in humans recovering from stroke. METHODS Thirty-five participants with a single subacute ischemic stroke affecting M1 or CST and hand paresis underwent MRI scans of the brain to measure lesion volume and CST lesion load. Transcranial magnetic stimulation (TMS) of M1IL was used to determine the presence of an electromyographic response (motor evoked potential (MEP+ and MEP-)). M1CL reorganization was determined by TMS applied to M1CL at increasing intensities. Hand function was quantified with the Jebsen Taylor Hand Function Test. RESULTS The extent of M1CL reorganization was related to greater lesion volume in the MEP- group, but not in the MEP+ group. Greater M1CL reorganization was associated with more impaired hand function in MEP- but not MEP+ participants. Absence of an MEP (MEP-), larger lesion volumes and higher lesion loads in CST, particularly in CST fibers originating in M1 were associated with greater impairment of hand function. CONCLUSIONS In the subacute post-stroke period, stroke volume and M1IL output determine the extent of M1CL reorganization and its relationship to affected hand function, consistent with pre-clinical evidence.ClinicalTrials.gov Identifier: NCT02544503.
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Affiliation(s)
- Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Kate P Revill
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott Shaeffer
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Lauren Edwards
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Samir R Belagaje
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Neeta Shenvi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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12
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Cherry-Allen KM, French MA, Stenum J, Xu J, Roemmich RT. Opportunities for Improving Motor Assessment and Rehabilitation After Stroke by Leveraging Video-Based Pose Estimation. Am J Phys Med Rehabil 2023; 102:S68-S74. [PMID: 36634334 DOI: 10.1097/phm.0000000000002131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation-an emerging technology that uses artificial intelligence to track human movement kinematics from simple videos recorded using household devices (e.g., smartphones, tablets)-to improve motor assessment and rehabilitation after stroke are discussed. The focus is on the potential of two key applications: (1) improving access to quantitative, objective motor assessment and (2) advancing telerehabilitation for persons post-stroke.
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Affiliation(s)
- Kendra M Cherry-Allen
- From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (KMC-A, MAF, JS, RTR); Department of Physical Therapy Education, Western University of Health Sciences, Lebanon, Oregon (KMC-A); Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland (JS, RTR); and Department of Kinesiology, University of Georgia, Athens, Georgia (JX)
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13
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Revill KP, Barany DA, Vernon I, Rellick S, Caliban A, Tran J, Belagaje SR, Nahab F, Haut MW, Buetefisch CM. Evaluating the Abnormality of Bilateral Motor Cortex Activity in Subacute Stroke Patients Executing a Unimanual Motor Task With Increasing Demand on Precision. Front Neurol 2022; 13:836716. [PMID: 35693005 PMCID: PMC9174784 DOI: 10.3389/fneur.2022.836716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Abnormal contralesional M1 activity is consistently reported in patients with compromised upper limb and hand function after stroke. The underlying mechanisms and functional implications of this activity are not clear, which hampers the development of treatment strategies targeting this brain area. The goal of the present study was to determine the extent to which contralesional M1 activity can be explained by the demand of a motor task, given recent evidence for increasing ipsilateral M1 activity with increasing demand in healthy age-matched controls. We hypothesized that higher activity in contralesional M1 is related to greater demand on precision in a hand motor task. fMRI data were collected from 19 patients with ischemic stroke affecting hand function in the subacute recovery phase and 31 healthy, right-handed, age-matched controls. The hand motor task was designed to parametrically modulate the demand on movement precision. Electromyography data confirmed strictly unilateral task performance by all participants. Patients showed significant impairment relative to controls in their ability to perform the task in the fMRI scanner. However, patients and controls responded similarly to an increase in demand for precision, with better performance for larger targets and poorer performance for smaller targets. Patients did not show evidence of elevated ipsilesional or contralesional M1 blood oxygenation level-dependent (BOLD) activation relative to healthy controls and mean BOLD activation levels were not elevated for patients with poorer performance relative to patients with better task performance. While both patients and healthy controls showed demand-dependent increases in BOLD activation in both ipsilesional/contralateral and contralesional/ipsilateral hemispheres, patients with stroke were less likely to show evidence of a linear relationship between the demand on precision and BOLD activation in contralesional M1 than healthy controls. Taken together, the findings suggest that task demand affects the BOLD response in contralesional M1 in patients with stroke, though perhaps less strongly than in healthy controls. This has implications for the interpretation of reported abnormal bilateral M1 activation in patients with stroke because in addition to contralesional M1 reorganization processes it could be partially related to a response to the relatively higher demand of a motor task when completed by patients rather than by healthy controls.
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Affiliation(s)
- Kate Pirog Revill
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Deborah A. Barany
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Isabelle Vernon
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stephanie Rellick
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Alexandra Caliban
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Julie Tran
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Samir R. Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Radiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Cathrin M. Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
- Department of Radiology, Emory University, Atlanta, GA, United States
- *Correspondence: Cathrin M. Buetefisch
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14
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Effect of novel training to normalize altered finger force direction post-stroke: study protocol for a double-blind randomized controlled trial. Trials 2022; 23:301. [PMID: 35413931 PMCID: PMC9003156 DOI: 10.1186/s13063-022-06224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional task performance requires proper control of both movement and force generation in three-dimensional space, especially for the hand. Control of force in three dimensions, however, is not explicitly treated in current physical rehabilitation. To address this gap in treatment, we have developed a tool to provide visual feedback on three-dimensional finger force. Our objective is to examine the effectiveness of training with this tool to restore hand function in stroke survivors. METHODS Double-blind randomized controlled trial. All participants undergo 18 1-h training sessions to practice generating volitional finger force of various target directions and magnitudes. The experimental group receives feedback on both force direction and magnitude, while the control group receives feedback on force magnitude only. The primary outcome is hand function as measured by the Action Research Arm Test. Other outcomes include the Box and Block Test, Stroke Impact Scale, ability to direct finger force, muscle activation pattern, and qualitative interviews. DISCUSSION The protocol for this clinical trial is described in detail. The results of this study will reveal whether explicit training of finger force direction in stroke survivors leads to improved motor control of the hand. This study will also improve the understanding of neuromuscular mechanisms underlying the recovery of hand function. TRIAL REGISTRATION ClinicalTrials.gov NCT03995069 . Registered on June 21, 2019.
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15
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Davis M, Wang Y, Bao S, Buchanan JJ, Wright DL, Lei Y. The Interactions Between Primary Somatosensory and Motor Cortex during Human Grasping Behaviors. Neuroscience 2021; 485:1-11. [PMID: 34848261 DOI: 10.1016/j.neuroscience.2021.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/26/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Afferent inputs to the primary somatosensory cortex (S1) are differentially processed during precision and power grip in humans. However, it remains unclear how S1 interacts with the primary motor cortex (M1) during these two grasping behaviors. To address this question, we measured short-latency afferent inhibition (SAI), reflecting S1-M1 interactions via thalamo-cortical pathways, using paired-pulse transcranial magnetic stimulation (TMS) during precision and power grip. The TMS coil over the hand representation of M1 was oriented in the posterior-anterior (PA) and anterior-posterior (AP) direction to activate distinct sets of corticospinal neurons. We found that SAI increased during precision compared with power grip when AP, but not PA, currents were applied. Notably, SAI tested in the AP direction were similar during two-digit than five-digit precision grip. The M1 receives movement information from S1 through direct cortico-cortical pathways, so intra-hemispheric S1-M1 interactions using dual-site TMS were also evaluated. Stimulation of S1 attenuated M1 excitability (S1-M1 inhibition) during precision and power grip, while the S1-M1 inhibition ratio remained similar across tasks. Taken together,our findings suggest that distinct neural mechanisms for S1-M1 interactions mediate precision and power grip, presumably by modulating neural activity along thalamo-cortical pathways.
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Affiliation(s)
- Madison Davis
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - Yiyu Wang
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - Shancheng Bao
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - John J Buchanan
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - David L Wright
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - Yuming Lei
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States.
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16
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Quantitative Investigation of Hand Grasp Functionality: Thumb Grasping Behavior Adapting to Different Object Shapes, Sizes, and Relative Positions. Appl Bionics Biomech 2021; 2021:2640422. [PMID: 34819994 PMCID: PMC8608516 DOI: 10.1155/2021/2640422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/01/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
This paper is the first in the two-part series quantitatively modelling human grasp functionality and understanding the way human grasp objects. The aim is to investigate the thumb movement behavior influenced by object shapes, sizes, and relative positions. Ten subjects were requested to grasp six objects (3 shapes × 2 sizes) in 27 different relative positions (3 X deviation × 3 Y deviation × 3 Z deviation). Thumb postures were investigated to each specific joint. The relative position (X, Y, and Z deviation) significantly affects thumb opposition rotation (Rot) and flexion (interphalangeal (IP) and metacarpo-phalangeal (MCP)), while the object property (object shape and size) significantly affects thumb abduction/adduction (ABD) motion. Based on the F value, the Y deviation has the primary effects on thumb motion. When the Y deviation changing from proximal to distal, thumb opposition rotation (Rot) and flexion (IP and MCP joint) angles were increased and decreased, respectively. For principal component analysis (PCA) results, thumb grasp behavior can be accurately reconstructed by first two principal components (PCs) which variance explanation ratio reached 93.8% and described by the inverse and homodromous coordination movement between thumb opposition and IP flexion. This paper provides a more comprehensive understanding of thumb grasp behavior. The postural synergies can reproduce the anthropomorphic motion, reduce the robot hardware, and control dimensionality. All of these provide a more accurate and general basis for the design and control of the bionic thumb and novel wearable assistant robot, thumb function assessment, and rehabilitation.
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17
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Sobinov AR, Bensmaia SJ. The neural mechanisms of manual dexterity. Nat Rev Neurosci 2021; 22:741-757. [PMID: 34711956 DOI: 10.1038/s41583-021-00528-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/22/2023]
Abstract
The hand endows us with unparalleled precision and versatility in our interactions with objects, from mundane activities such as grasping to extraordinary ones such as virtuoso pianism. The complex anatomy of the human hand combined with expansive and specialized neuronal control circuits allows a wide range of precise manual behaviours. To support these behaviours, an exquisite sensory apparatus, spanning the modalities of touch and proprioception, conveys detailed and timely information about our interactions with objects and about the objects themselves. The study of manual dexterity provides a unique lens into the sensorimotor mechanisms that endow the nervous system with the ability to flexibly generate complex behaviour.
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Affiliation(s)
- Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.,Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA. .,Neuroscience Institute, University of Chicago, Chicago, IL, USA. .,Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA.
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18
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A cortical injury model in a non-human primate to assess execution of reach and grasp actions: implications for recovery after traumatic brain injury. J Neurosci Methods 2021; 361:109283. [PMID: 34237383 PMCID: PMC9969347 DOI: 10.1016/j.jneumeth.2021.109283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Technological advances in developing experimentally controlled models of traumatic brain injury (TBI) are prevalent in rodent models and these models have proven invaluable in characterizing temporal changes in brain and behavior after trauma. To date no long-term studies in non-human primates (NHPs) have been published using an experimentally controlled impact device to follow behavioral performance over time. NEW METHOD We have employed a controlled cortical impact (CCI) device to create a focal contusion to the hand area in primary motor cortex (M1) of three New World monkeys to characterize changes in reach and grasp function assessed for 3 months after the injury. RESULTS The CCI destroyed most of M1 hand representation reducing grey matter by 9.6 mm3, 12.9 mm3, and 15.5 mm3 and underlying corona radiata by 7.4 mm3, 6.9 mm3, and 5.6 mm3 respectively. Impaired motor function was confined to the hand contralateral to the injury. Gross hand-use was only mildly affected during the first few days of observation after injury while activity requiring skilled use of the hand was impaired over three months. COMPARISON WITH EXISTING METHOD(S) This study is unique in establishing a CCI model of TBI in an NHP resulting in persistent impairments in motor function evident in volitional use of the hand. CONCLUSIONS Establishing an NHP model of TBI is essential to extend current rodent models to the complex neural architecture of the primate brain. Moving forward this model can be used to investigate novel therapeutic interventions to improve or restore impaired motor function after trauma.
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19
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Malesevic J, Kostic M, Kojic V, Dordevic O, Konstantinovic L, Keller T, Strbac M. BEAGLE-A Kinematic Sensory System for Objective Hand Function Assessment in Technology-Mediated Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1817-1826. [PMID: 34460377 DOI: 10.1109/tnsre.2021.3108848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present a hand functions assessment system (BEAGLE) for kinematic tracking of hand and finger movements, envisioned as a technology-mediated rehabilitation tool. The system is custom-designed for fast and easy placement on an impaired hand (spastic or flaccid), featuring inertial sensors integrated into simple finger caps and a hand strap. An algorithm for a range of motion (ROM) estimation was implemented to provide an objective assessment of hand functions. The efficacy and feasibility of the BEAGLE system were examined in a pilot clinical study performed with ten stroke survivors in the subacute phase. Participants received therapy within two consecutive intensity-matched rehabilitation cycles. The first consisted of conventional therapy, while the second involved a combination of conventional therapy and advanced functional electrical stimulation. Assessments were performed before and after each phase. These included BEAGLE estimates of active voluntary ROM for wrist and various digits, as well as two referent clinical measures for hand functions assessment, Fugl-Meyer and Action Research Arm Test. The results indicate that the ROM assessments can detect change with sensitivity comparable to the standardized clinical scales. Statistically significant changes between the beginning and the end of the second cycle existed in all observed measures, whereas none of these measurements showed a statistically significant improvement in the first therapy cycle. The noted usability metrics indicate that the BEAGLE could be integrated into the rehabilitation workflow in a clinical environment.
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20
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Madarshahian S, Latash ML. Synergies at the level of motor units in single-finger and multi-finger tasks. Exp Brain Res 2021; 239:2905-2923. [PMID: 34312703 DOI: 10.1007/s00221-021-06180-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
We explored the organization of motor units recorded in the flexor digitorum superficialis into stable groups (MU-modes) and force-stabilizing synergies in spaces of MU-modes. Young, healthy participants performed one-finger and three-finger accurate cyclical force production tasks. Two wireless sensor arrays (Trigno Galileo, Delsys, Inc.) were placed over the proximal and distal portions of the muscle for surface recording and identification of motor unit action potentials. Principal component analysis with Varimax rotation and factor extraction was used to identify MU-modes. The framework of the uncontrolled manifold hypothesis was used to analyze inter-cycle variance in the space of MU-modes and compute the index of force-stabilizing synergy. Multiple linear regression between the first MU-mode in the three-finger task and the first MU-modes in the three single-finger tasks showed no differences between the data recorded by the two electrodes suggesting that MU-modes were unlikely to be synonymous with muscle compartments. Multi-MU-mode synergies stabilizing task force were documented across all tasks. In contrast, there were no force-stabilizing synergies in the three-finger task analyzed in the space of individual finger forces. Our results confirm the synergic organization of motor units in single-finger tasks and, for the first time, expand this result to multi-finger tasks. We offer an interpretation of the findings within the theoretical scheme of control with spatial referent coordinates expanded to the analysis of individual motor units. The results confirm trade-offs between synergies at different hierarchical levels and expand this notion to intra-muscle synergies.
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Affiliation(s)
- Shirin Madarshahian
- Department of Kinesiology, The Pennsylvania State University, Rec. Hall-267, University Park, PA, 16802, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, Rec. Hall-267, University Park, PA, 16802, USA.
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21
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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22
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Abstract
Background: Elderly people with severe finger weakness may need assistive health technology interventions. Finger weakness impedes the elderly in executing activities of daily living such as unbuttoning shirts and opening clothes pegs. While studies have related finger weakness with ageing effects, there appears to be no research that uses an algorithmic problem-solving approach such as the theory of inventive problem-solving (TRIZ) to recommend finger grip assistive technologies that resolve the issue of finger weakness among the elderly. Using TRIZ, this study aims to conceptualise finger grip enhancer designs for elderly people. Methods: Several TRIZ tools such as the cause-and-effect chain (CEC) analysis, engineering contradiction, physical contradiction, and substance-field analysis are used to conceptualise solutions that assist elderly people in their day-to-day pinching activities. Results: Based on the segmentation principle, a finger assistant concept powered by a miniature linear actuator is recommended. Specific product development processes are used to further conceptualise the actuation system. The study concluded that the chosen concept should use a DC motor to actuate fingers through tendon cables triggered by a push start button. Conclusions: Finger pinch degradation worsens the quality of life of the elderly. A finger grip enhancer that assists in day-to-day activities may be an effective option for elderly people, not only for their physical but also their mental well-being in society.
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Affiliation(s)
- Dominic Wen How Tan
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
| | - Poh Kiat Ng
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
| | - Ervina Efzan Mhd Noor
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
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23
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Weightman M, Brittain JS, Miall RC, Jenkinson N. Direct and indirect effects of cathodal cerebellar TDCS on visuomotor adaptation of hand and arm movements. Sci Rep 2021; 11:4464. [PMID: 33627717 PMCID: PMC7904798 DOI: 10.1038/s41598-021-83656-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Adaptation of movements involving the proximal and distal upper-limb can be differentially facilitated by anodal transcranial direct current stimulation (TDCS) over the cerebellum and primary motor cortex (M1). Here, we build on this evidence by demonstrating that cathodal TDCS impairs motor adaptation with a differentiation of the proximal and distal upper-limbs, relative to the site of stimulation. Healthy young adults received M1 or cerebellar cathodal TDCS while making fast 'shooting' movements towards targets under 60° rotated visual feedback conditions, using either whole-arm reaching or fine hand and finger movements. As predicted, we found that cathodal cerebellar TDCS resulted in impairment of adaptation of movements with the whole arm compared to M1 and sham groups, which proved significantly different during late adaptation. However, cathodal cerebellar TDCS also significantly enhanced adaptation of hand movements, which may reflect changes in the excitability of the pathway between the cerebellum and M1. We found no evidence for change of adaptation rates using arm or finger movements following cathodal TDCS directly over M1. These results are further evidence to support movement specific effects of TDCS, and highlight how the connectivity and functional organisation of the cerebellum and M1 must be considered when designing TDCS-based therapies.
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Affiliation(s)
- Matthew Weightman
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - John-Stuart Brittain
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - R. Chris Miall
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Ned Jenkinson
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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24
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Kilmarx J, Oblak E, Sulzer J, Lewis-Peacock J. Towards a common template for neural reinforcement of finger individuation. Sci Rep 2021; 11:1065. [PMID: 33441742 PMCID: PMC7806844 DOI: 10.1038/s41598-020-80166-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
The inability to individuate finger movements is a common impairment following stroke. Conventional physical therapy ignores underlying neural changes with recovery, leaving it unclear why sensorimotor function often remains impaired. Functional MRI neurofeedback can monitor neural activity and reinforce it towards a healthy template to restore function. However, identifying an individualized training template may not be possible depending on the severity of impairment. In this study, we investigated the use of functional alignment of brain data across healthy participants to create an idealized neural template to be used as a training target for new participants. We employed multi-voxel pattern analyses to assess the prediction accuracy and robustness to missing data of pre-trained functional templates corresponding to individual finger presses. We found a significant improvement in classification accuracy (p < 0.001) of individual finger presses when group data was aligned based on function (88%) rather than anatomy (46%). Importantly, we found no significant drop in performance when aligning a new participant to a pre-established template as compared to including this new participant in the creation of a new template. These results indicate that functionally aligned templates could provide an effective surrogate training target for patients following neurological injury.
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Affiliation(s)
- Justin Kilmarx
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA.
| | - Ethan Oblak
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - James Sulzer
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - Jarrod Lewis-Peacock
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
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25
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Perturbation-induced fast drifts in finger enslaving. Exp Brain Res 2021; 239:891-902. [PMID: 33423068 DOI: 10.1007/s00221-020-06027-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
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.
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26
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Structure of Population Activity in Primary Motor Cortex for Single Finger Flexion and Extension. J Neurosci 2020; 40:9210-9223. [PMID: 33087474 DOI: 10.1523/jneurosci.0999-20.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
How is the primary motor cortex (M1) organized to control fine finger movements? We investigated the population activity in M1 for single finger flexion and extension, using 7T functional magnetic resonance imaging (fMRI) in female and male human participants and compared these results to the neural spiking patterns recorded in two male monkeys performing the identical task. fMRI activity patterns were distinct for movements of different fingers, but were quite similar for flexion and extension of the same finger. In contrast, spiking patterns in monkeys were quite distinct for both fingers and directions, which is similar to what was found for muscular activity patterns. The discrepancy between fMRI and electrophysiological measurements can be explained by two (non-mutually exclusive) characteristics of the organization of finger flexion and extension movements. Given that fMRI reflects predominantly input and recurrent activity, the results can be explained by an architecture in which neural populations that control flexion or extension of the same finger produce distinct outputs, but interact tightly with each other and receive similar inputs. Additionally, neurons tuned to different movement directions for the same finger (or combination of fingers) may cluster closely together, while neurons that control different finger combinations may be more spatially separated. When measuring this organization with fMRI at a coarse spatial scale, the activity patterns for flexion and extension of the same finger would appear very similar. Overall, we suggest that the discrepancy between fMRI and electrophysiological measurements provides new insights into the general organization of fine finger movements in M1.SIGNIFICANCE STATEMENT The primary motor cortex (M1) is important for producing individuated finger movements. Recent evidence shows that movements that commonly co-occur are associated with more similar activity patterns in M1. Flexion and extension of the same finger, which never co-occur, should therefore be associated with distinct representations. However, using carefully controlled experiments and multivariate analyses, we demonstrate that human fMRI activity patterns for flexion or extension of the same finger are highly similar. In contrast, spiking patterns measured in monkey M1 are clearly distinct. This suggests that populations controlling opposite movements of the same finger, while producing distinct outputs, may cluster together and share inputs and local processing. These results provide testable hypotheses about the organization of hand control in M1.
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27
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Abolins V, Stremoukhov A, Walter C, Latash ML. On the origin of finger enslaving: control with referent coordinates and effects of visual feedback. J Neurophysiol 2020; 124:1625-1636. [PMID: 32997555 DOI: 10.1152/jn.00322.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Valters Abolins
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Institute of Electronics and Computer Science, Riga, Latvia
| | - Alex Stremoukhov
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Caroline Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
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28
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Revill KP, Haut MW, Belagaje SR, Nahab F, Drake D, Buetefisch CM. Hebbian-Type Primary Motor Cortex Stimulation: A Potential Treatment of Impaired Hand Function in Chronic Stroke Patients. Neurorehabil Neural Repair 2020; 34:159-171. [PMID: 31976804 DOI: 10.1177/1545968319899911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background. Stroke often involves primary motor cortex (M1) and its corticospinal (CST) projections. As hand function is critically dependent on these structures, its recovery is often incomplete. Objective. To determine whether impaired hand function in patients with chronic ischemic stroke involving M1 or CST benefits from the enhancing effect of Hebbian-type stimulation (pairing M1 afferent stimulation and M1 activity in a specific temporal relationship) on M1 plasticity and hand function. Methods. In a double-blind, randomized, sham-controlled design, 20 patients with chronic ischemic stroke affecting M1 or CST were randomly assigned to 5 days of hand motor training that was combined with either Hebbian-type (trainingHebb) or sham stimulation (trainingsham) of the lesioned M1. Measures of hand function and task-based M1 functional magnetic resonance imaging (fMRI) activity were collected prior to, immediately following, and 4 weeks after the intervention. Results. Both interventions were effective in improving affected hand function at the completion of training, but only participants in the trainingHebb group maintained functional gains. Changes in hand function and fMRI activity were positively correlated in both ipsilesional and contralesional M1. Compared with trainingsham, participants in the trainingHebb group showed a stronger relationship between improved hand function and changes in M1 functional activity. Conclusions. Only when motor training was combined with Hebbian-type stimulation were functional gains maintained over time and correlated with measures of M1 functional plasticity. As hand dexterity is critically dependent on M1 function, these results suggest that functional reorganization in M1 is facilitated by Hebbian-type stimulation. ClinicalTrials.gov Identifier: NCT01569607.
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Affiliation(s)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, WV, USA
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29
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Wallerian Degeneration of the Cerebral Peduncle and Association with Motor Outcome in Childhood Stroke. Pediatr Neurol 2020; 102:67-73. [PMID: 31607421 DOI: 10.1016/j.pediatrneurol.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/12/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND To evaluate the presence of Wallerian degeneration and its relationship with sensorimotor deficits following childhood-onset arterial ischemic stroke (AIS). METHODS Children surviving unilateral AIS older than one month of age were assessed for severity of sensorimotor neurological deficit with the Pediatric Stroke Outcome Measure at least one year post stroke (mean follow-up = 2.9 years, S.D. = ±1.6). The area (mm3) of each cerebral peduncle was measured on T2-weighted magnetic resonance images to calculate an Asymmetry Index (AI). The AI between patients with childhood stroke (cases) and controls (children with normal MRI) was compared. In the stroke group, the AI between patients with good and poor motor outcome, and the correlation between the AI and motor outcome was calculated. RESULTS Asymmetry was compared in 52 children with stroke (cases) and 20 controls (normal brain MRIs). The AI was greater in patients with stroke (mean = 6.8%, S.D. = ±5.9) compared with controls (mean = 3.4%, S.D. = ±3.5, P < 0.02). Patients with poor outcome had an AI of 10% or greater compared with patients with good outcome (mean 10.4 versus 4, P < 0.001), and the AI was moderately correlated with motor deficit severity (r = 0.582, P = 0.001). CONCLUSIONS Asymmetry of the cerebral peduncle is a feasible method of assessing Wallerian degeneration in children with unilateral AIS. The degree of asymmetry in the cerebral peduncles was moderately correlated with neurological outcome severity and reflects the degree of motor deficit in children following stroke.
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30
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Baizer JS, Webster CJ, Baker JF. The Claustrum in the Squirrel Monkey. Anat Rec (Hoboken) 2019; 303:1439-1454. [DOI: 10.1002/ar.24253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/21/2019] [Accepted: 06/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Joan S. Baizer
- Department of Physiology and BiophysicsJacobs School of Medicine and Biomedical Sciences, University at Buffalo Buffalo New York
| | - Charles J. Webster
- Department of Physiology and BiophysicsJacobs School of Medicine and Biomedical Sciences, University at Buffalo Buffalo New York
| | - James F. Baker
- Department of PhysiologyNorthwestern University Medical School Chicago Illinois
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31
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Kwakkel G, van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2019; 33:951-958. [PMID: 31660781 DOI: 10.1177/1545968319886477] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - E E H van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J H Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - L E H van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - M F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - J W Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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32
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Burman DD. Hippocampal connectivity with sensorimotor cortex during volitional finger movements: Laterality and relationship to motor learning. PLoS One 2019; 14:e0222064. [PMID: 31536543 PMCID: PMC6752792 DOI: 10.1371/journal.pone.0222064] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/21/2019] [Indexed: 12/03/2022] Open
Abstract
Hippocampal interactions with the motor system are often assumed to reflect the role of memory in motor learning. Here, we examine hippocampal connectivity with sensorimotor cortex during two tasks requiring paced movements, one with a mnemonic component (sequence learning) and one without (repetitive tapping). Functional magnetic resonance imaging activity was recorded from thirteen right-handed subjects; connectivity was identified from sensorimotor cortex correlations with psychophysiological interactions in hippocampal activity between motor and passive visual tasks. Finger movements in both motor tasks anticipated the timing of the metronome, reflecting cognitive control, yet evidence of motor learning was limited to the sequence learning task; nonetheless, hippocampal connectivity was observed during both tasks. Connectivity from corresponding regions in the left and right hippocampus overlapped extensively, with improved sensitivity resulting from their conjunctive (global) analysis. Positive and negative connectivity were both evident, with positive connectivity in sensorimotor cortex ipsilateral to the moving hand during unilateral movements, whereas negative connectivity was prominent in whichever hemisphere was most active during movements. Results implicate the hippocampus in volitional finger movements even in the absence of motor learning or recall.
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Affiliation(s)
- Douglas D. Burman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, United States of America
- * E-mail:
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33
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Kwakkel G, Van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:783-791. [DOI: 10.1177/1747493019873519] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - EEH Van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - JH Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - CJ Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - LEH van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - MF Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - JW Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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34
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Does the Neurological Examination Correlate with Patient-Perceived Outcomes in Degenerative Cervical Myelopathy? World Neurosurg 2019; 132:e885-e890. [PMID: 31382071 DOI: 10.1016/j.wneu.2019.07.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM. METHODS A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes. RESULTS The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01). CONCLUSIONS Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.
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Jang SH, Kim TH, Lee HD. The effect of walnut rolling training on hand function and corticospinal tract. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:131. [PMID: 31157252 DOI: 10.21037/atm.2019.02.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We investigated the effect of the walnut rolling training for two weeks on the hand function and corticospinal tract (CST) in normal subjects. Methods Seventeen right-handed normal subjects performed walnut rolling training with their non-dominant (left) hand, with the right hand defined as the control side. The walnut rolling training was performed three times daily, for 30 minutes at a time, over two weeks. The Purdue Pegboard Test (PPT), tip pinch and grip strength (GS) were used evaluate the change of hand function, and diffusion tensor tractography (DTT) evaluated change of the CST and transcallosal fibers for the hand motor somatotopy. Results All of the clinical scores in terms of PPT, tip pinch and GS increased significantly in the post-training (PPT: 16.59±1.09, tip pinch: 5.03±2.18, GS: 40.61±10.99) in the left hand compared with pre-training (PPT: 14.94±1.36, tip pinch: 3.66±1.44, GS: 33.58±11.08) (P<0.05). By contrast, the clinical scores for the right hand did not differ significantly between pre- (PPT: 16.25±1.98, tip pinch: 5.75±2.26, GS: 37.58±14.61) and post-training (PPT: 16.97±1.67, tip pinch: 5.66±2.31, GS: 37.82±14.25). The fiber numbers (FN) of the right CST increased significantly in post-training DTT (2,123.05±529.07) compared with pre-training DTT (1,734.73±581.84) (P<0.05), whereas fractional anisotropy (FA) (pre-training: 0.50±0.02, post-training: 0.51±0.01) did not change significantly. Neither FA nor FN of the left CST and transcallosal fibers changed significantly from pre- (FA: 0.44±0.02, FN: 1,871.15±636.36) to post-training DTTs (FA: 0.45±0.03, FN: 1,823.84±701.14). Conclusions We demonstrated improvement of hand function and facilitation of the contralateral CST by walnut rolling training in normal subjects. Our results suggest that walnut rolling training can be used for improvement of hand function and facilitation of the contralateral CST.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsangbuk-do, Korea
| | - Tae Ho Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsangbuk-do, Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsangbuk-do, Korea
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Edwards LL, King EM, Buetefisch CM, Borich MR. Putting the "Sensory" Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke. Front Integr Neurosci 2019; 13:16. [PMID: 31191265 PMCID: PMC6539545 DOI: 10.3389/fnint.2019.00016] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022] Open
Abstract
Integration of sensory and motor information is one-step, among others, that underlies the successful production of goal-directed hand movements necessary for interacting with our environment. Disruption of sensorimotor integration is prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis of the hand reduces function and overall quality of life. Current rehabilitative methods are based on neuroplastic principles to promote motor learning that focuses on regaining motor function lost due to paresis, but the sensory contributions to motor control and learning are often overlooked and currently understudied. There is a need to evaluate and understand the contribution of both sensory and motor function in the rehabilitation of skilled hand movements after stroke. Here, we will highlight the importance of integration of sensory and motor information to produce skilled hand movements in healthy individuals and individuals after stroke. We will then discuss how compromised sensorimotor integration influences relearning of skilled hand movements after stroke. Finally, we will propose an approach to target sensorimotor integration through manipulation of sensory input and motor output that may have therapeutic implications.
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Affiliation(s)
- Lauren L Edwards
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
| | - Erin M King
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
| | - Cathrin M Buetefisch
- Department of Rehabilitation Medicine, Laney Graduate School, Emory University, Atlanta, GA, United States.,Department of Neurology, Emory University, Atlanta, GA, United States.,Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Michael R Borich
- Department of Rehabilitation Medicine, Laney Graduate School, Emory University, Atlanta, GA, United States
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Birchenall J, Térémetz M, Roca P, Lamy JC, Oppenheim C, Maier MA, Mas JL, Lamy C, Baron JC, Lindberg PG. Individual recovery profiles of manual dexterity, and relation to corticospinal lesion load and excitability after stroke -a longitudinal pilot study. Neurophysiol Clin 2018; 49:149-164. [PMID: 30391148 DOI: 10.1016/j.neucli.2018.10.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In this longitudinal pilot study, we investigated how manual dexterity recovery was related to corticospinal tract (CST) injury and excitability, in six patients undergoing conventional rehabilitation. METHODS Key components of manual dexterity, namely finger force control, finger tapping rate and independence of finger movements, were quantified. Structural MRI was obtained to calculate CST lesion load. CST excitability was assessed by measuring rest motor threshold (RMT) and the amplitude of motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS). Measurements were obtained at two weeks, three and six months post-stroke. RESULTS At six months post-stroke, complete recovery of hand gross motor impairment (i.e., maximal Fugl-Meyer score for hand) had occurred in three patients and four patients had recovered ability to accurately control finger force. However, tapping rate and independence of finger movements remained impaired in all six patients at six months. Recovery in hand gross motor impairment and finger force control occurred in patients with smaller CST lesion load and almost complete recovery of CST excitability, although RMT or MEP size remained slightly altered in the stroke-affected hemisphere compared to the unaffected hemisphere. The two patients with poorest recovery showed persistent absence of MEPs and greatest structural injury to CST. DISCUSSION The findings support good motor recovery being overall correlated with smaller CST lesion, and with almost complete recovery of CST excitability. However, impairment of manual dexterity persisted despite recovery in gross hand movements and grasping abilities, suggesting involvement of additional brain structures for fine manual tasks.
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Affiliation(s)
- Julia Birchenall
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Maxime Térémetz
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - Pauline Roca
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne universités, UPMC université Paris 06 UMR S 1127, institut du cerveau et de la Moelle épinière, ICM, centre de neuro-imagerie de recherche (CENIR), 75013 Paris, France
| | - Catherine Oppenheim
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Marc A Maier
- FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France
| | - Jean-Louis Mas
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Catherine Lamy
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Claude Baron
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Påvel G Lindberg
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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Heindorf M, Arber S, Keller GB. Mouse Motor Cortex Coordinates the Behavioral Response to Unpredicted Sensory Feedback. Neuron 2018; 99:1040-1054.e5. [PMID: 30146302 PMCID: PMC6127035 DOI: 10.1016/j.neuron.2018.07.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 01/16/2023]
Abstract
Motor cortex (M1) lesions result in motor impairments, yet how M1 contributes to the control of movement remains controversial. To investigate the role of M1 in sensory guided motor coordination, we trained mice to navigate a virtual corridor using a spherical treadmill. This task required directional adjustments through spontaneous turning, while unexpected visual offset perturbations prompted induced turning. We found that M1 is essential for execution and learning of this visually guided task. Turn-selective layer 2/3 and layer 5 pyramidal tract (PT) neuron activation was shaped differentially with learning but scaled linearly with turn acceleration during spontaneous turns. During induced turns, however, layer 2/3 neurons were activated independent of behavioral response, while PT neurons still encoded behavioral response magnitude. Our results are consistent with a role of M1 in the detection of sensory perturbations that result in deviations from intended motor state and the initiation of an appropriate corrective response.
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Affiliation(s)
- Matthias Heindorf
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland; Biozentrum, Department of Cell Biology, University of Basel, 4056 Basel, Switzerland
| | - Silvia Arber
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland; Biozentrum, Department of Cell Biology, University of Basel, 4056 Basel, Switzerland.
| | - Georg B Keller
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland; Faculty of Natural Sciences, University of Basel, 4056 Basel, Switzerland.
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StartReact during gait initiation reveals differential control of muscle activation and inhibition in patients with corticospinal degeneration. J Neurol 2018; 265:2531-2539. [PMID: 30155740 PMCID: PMC6182706 DOI: 10.1007/s00415-018-9027-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022]
Abstract
Corticospinal lesions cause impairments in voluntary motor control. Recent findings suggest that some degree of voluntary control may be taken over by a compensatory pathway involving the reticulospinal tract. In humans, evidence for this notion mainly comes from StartReact studies. StartReact is the acceleration of reaction times by a startling acoustic stimulus (SAS) simultaneously presented with the imperative stimulus. As previous StartReact studies mainly focused on isolated single-joint movements, the question remains whether the reticulospinal tract can also be utilized for controlling whole-body movements. To investigate reticulospinal control, we applied the StartReact paradigm during gait initiation in 12 healthy controls and 12 patients with ‘pure’ hereditary spastic paraplegia (HSP; i.e., retrograde axonal degeneration of corticospinal tract). Participants performed three consecutive steps in response to an imperative visual stimulus. In 25% of 16 trials a SAS was applied. We determined reaction times of muscle (de)activation, anticipatory postural adjustments (APA) and steps. Without SAS, we observed an overall delay in HSP patients compared to controls. Administration of the SAS accelerated tibialis anterior and rectus femoris onsets in both groups, but more so in HSP patients, resulting in (near-)normal latencies. Soleus offsets were accelerated in controls, but not in HSP patients. The SAS also accelerated APA and step reaction times in both groups, yet these did not normalize in the HSP patients. The reticulospinal tract is able to play a compensatory role in voluntary control of whole-body movements, but seems to lack the capacity to inhibit task-inappropriate muscle activity in patients with corticospinal lesions.
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Norman SL, Lobo-Prat J, Reinkensmeyer DJ. How do strength and coordination recovery interact after stroke? A computational model for informing robotic training. IEEE Int Conf Rehabil Robot 2018; 2017:181-186. [PMID: 28813815 DOI: 10.1109/icorr.2017.8009243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robotic devices can train strength, coordination, or a combination of both. If a robotic device focuses on coordination, what happens to strength recovery, and vice versa? Understanding this interaction could help optimize robotic training. We developed a computational neurorehabilitation model to gain insight into the interaction between strength and coordination recovery after stroke. In the model, the motor system recovers by optimizing the activity of residual corticospinal cells (focally connected, excitatory and inhibitory) and reticulospinal cells (diffusely connected and excitatory) to achieve a motor task. To do this, the model employs a reinforcement learning algorithm that uses stochastic search based on a reward signal produced by task execution. We simulated two tasks that require strength and coordination: a finger movement task and a bilateral wheelchair propulsion task. We varied the reward signal to value strength versus coordination, determined by a weighting factor. The model predicted a nonlinear relationship between strength and coordination recovery consistent with clinical data obtained for each task. The model also predicted that stroke can cause a competition between strength and coordination recovery, due to a scarcity of focal and inhibitory cells. These results provide a rationale for implementing robotic movement therapy that can adaptively alter the combination of force and coordination training to target desired components of motor recovery.
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Buetefisch CM, Revill KP, Haut MW, Kowalski GM, Wischnewski M, Pifer M, Belagaje SR, Nahab F, Cobia DJ, Hu X, Drake D, Hobbs G. Abnormally reduced primary motor cortex output is related to impaired hand function in chronic stroke. J Neurophysiol 2018; 120:1680-1694. [PMID: 29924707 DOI: 10.1152/jn.00715.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Stroke often involves primary motor cortex (M1) and its corticospinal projections (CST). As hand function is critically dependent on these structures, its recovery is often incomplete. The neuronal substrate supporting affected hand function is not well understood but likely involves reorganized M1 and CST of the lesioned hemisphere (M1IL and CSTIL). We hypothesized that affected hand function in chronic stroke is related to structural and functional reorganization of M1IL and CSTIL. We tested 18 patients with chronic ischemic stroke involving M1 or CST. Their hand function was compared with 18 age-matched healthy subjects. M1IL thickness and CSTIL fractional anisotropy (FA) were determined with MRI and compared with measures of the other hemisphere. Transcranial magnetic stimulation (TMS) was applied to M1IL to determine its input-output function [stimulus response curve (SRC)]. The plateau of the SRC (MEPmax), inflection point, and slope parameters of the curve were extracted. Results were compared with measures in 12 age-matched healthy controls. MEPmax of M1IL was significantly smaller ( P = 0.02) in the patients, indicating reduced CSTIL motor output, and was correlated with impaired hand function ( P = 0.02). M1IL thickness ( P < 0.01) and CSTIL-FA ( P < 0.01) were reduced but did not correlate with hand function. The results indicate that employed M1IL or CSTIL structural measures do not explain the extent of impairment in hand function once M1 and CST are sufficiently functional for TMS to evoke a motor potential. Instead, impairment of hand function is best explained by the abnormally low output from M1IL. NEW & NOTEWORTHY Hand function often remains impaired after stroke. While the critical role of the primary motor cortex (M1) and its corticospinal output (CST) for hand function has been described in the nonhuman primate stroke model, their structure and function have not been systematically evaluated for patients after stroke. We report that in chronic stroke patients with injury to M1 and/or CST an abnormally reduced M1 output is related to impaired hand function.
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Affiliation(s)
- C M Buetefisch
- Department of Neurology, Emory University , Atlanta, Georgia.,Department of Rehabilitation Medicine, Emory University , Atlanta, Georgia
| | - K P Revill
- Department of Psychology, Emory University , Atlanta, Georgia
| | - M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Neurology, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Radiology, West Virginia University School of Medicine , Morgantown, West Virginia
| | - G M Kowalski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Wischnewski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Pifer
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia
| | - S R Belagaje
- Department of Neurology, Emory University , Atlanta, Georgia.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital , Atlanta, Georgia
| | - F Nahab
- Department of Neurology, Emory University , Atlanta, Georgia
| | - D J Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University , Provo, Utah
| | - X Hu
- Department of Bioengineering, University of California Riverside , Riverside, California
| | - D Drake
- Department of Biostatistics, The Mailman School of Public Health, Columbia University , New York, New York
| | - G Hobbs
- Department of Statistics, West Virginia University , Morgantown, West Virginia
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Federico P, Perez MA. Distinct Corticocortical Contributions to Human Precision and Power Grip. Cereb Cortex 2018; 27:5070-5082. [PMID: 27707769 DOI: 10.1093/cercor/bhw291] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022] Open
Abstract
The corticospinal tract contributes to the control of finger muscles during precision and power grip. The involvement of different sets of cortical interneuronal circuits during these distinct grasping behaviors remains unknown. To examine this question in humans we used noninvasive transcranial magnetic stimulation (TMS) over the hand representation of the primary motor cortex to elicit motor evoked potentials (MEPs) in an intrinsic finger muscle during index finger abduction (control task), precision grip, and power grip. The TMS coil was oriented to induce currents in the brain in the latero-medial (LM), posterior-anterior (PA), and anterior-posterior (AP) direction to preferentially activate corticospinal axons directly and early and late synaptic inputs to corticospinal neurons, respectively. We found that AP-LM MEP latency differences were consistently longer during power grip compared with index finger abduction and precision grip, while PA-LM differences remained similar across tasks. Short-interval intracortical facilitation, targeting AP but not PA inputs, increased during power grip compared with other tasks. Our novel findings suggest that cortical structures activated by PA and AP stimuli are differentially active during precision and power grip. We propose that a preferential recruitment of late synaptic inputs to corticospinal neurons may be achieved when humans perform a power grip.
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Affiliation(s)
- Paolo Federico
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL33136, USA
| | - Monica A Perez
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL33136, USA
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Wolbrecht ET, Rowe JB, Chan V, Ingemanson ML, Cramer SC, Reinkensmeyer DJ. Finger strength, individuation, and their interaction: Relationship to hand function and corticospinal tract injury after stroke. Clin Neurophysiol 2018; 129:797-808. [PMID: 29453171 PMCID: PMC5856636 DOI: 10.1016/j.clinph.2018.01.057] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 01/11/2018] [Accepted: 01/25/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine the relative contributions of finger weakness and reduced finger individuation to reduced hand function after stroke, and their association with corticospinal tract (CST) injury. METHODS We measured individuated and synergistic maximum voluntary contractions (MVCs) of the index and middle fingers, in both flexion and extension, of 26 individuals with a chronic stroke using a robotic exoskeleton. We quantified finger strength and individuation, and defined a novel metric that combines them - "multifinger capacity". We used stepwise linear regression to identify which measure best predicted hand function (Box and Blocks Test, Nine Hole Peg Test) and arm impairment (the Upper Extremity Fugl-Meyer Test). RESULTS Compared to metrics of strength or individuation, capacity survived the stepwise regression as the strongest predictor of hand function and arm impairment. Capacity was also most strongly related to presence or absence of lesion overlap with the CST. CONCLUSIONS Reduced strength and individuation combine to shrink the space of achievable finger torques, and it is the resulting size of this space - the multifinger capacity - that is of elevated importance for predicting loss of hand function. SIGNIFICANCE Multi-finger capacity may be an important target for rehabilitative hand training.
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Affiliation(s)
- Eric T Wolbrecht
- Department of Mech. Engineering, University of Idaho, United States.
| | - Justin B Rowe
- Department of Biomedical Engineering, University of California at Irvine, United States
| | - Vicky Chan
- Department of Neurology, University of California at Irvine, United States
| | - Morgan L Ingemanson
- Department of Anatomy and Neurobiology, University of California at Irvine, United States
| | - Steven C Cramer
- Department of Neurology, University of California at Irvine, United States; Department of Anatomy and Neurobiology, University of California at Irvine, United States; Department of Physical Medicine and Rehabilitation, University of California at Irvine, United States
| | - David J Reinkensmeyer
- Department of Biomedical Engineering, University of California at Irvine, United States; Department of Anatomy and Neurobiology, University of California at Irvine, United States; Department of Mechanical and Aerospace Engineering, University of California at Irvine, United States; Department of Physical Medicine and Rehabilitation, University of California at Irvine, United States
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Zaaimi B, Dean LR, Baker SN. Different contributions of primary motor cortex, reticular formation, and spinal cord to fractionated muscle activation. J Neurophysiol 2018; 119:235-250. [PMID: 29046427 PMCID: PMC5866475 DOI: 10.1152/jn.00672.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022] Open
Abstract
Coordinated movement requires patterned activation of muscles. In this study, we examined differences in selective activation of primate upper limb muscles by cortical and subcortical regions. Five macaque monkeys were trained to perform a reach and grasp task, and electromyogram (EMG) was recorded from 10 to 24 muscles while weak single-pulse stimuli were delivered through microelectrodes inserted in the motor cortex (M1), reticular formation (RF), or cervical spinal cord (SC). Stimulus intensity was adjusted to a level just above threshold. Stimulus-evoked effects were assessed from averages of rectified EMG. M1, RF, and SC activated 1.5 ± 0.9, 1.9 ± 0.8, and 2.5 ± 1.6 muscles per site (means ± SD); only M1 and SC differed significantly. In between recording sessions, natural muscle activity in the home cage was recorded using a miniature data logger. A novel analysis assessed how well natural activity could be reconstructed by stimulus-evoked responses. This provided two measures: normalized vector length L, reflecting how closely aligned natural and stimulus-evoked activity were, and normalized residual R, measuring the fraction of natural activity not reachable using stimulus-evoked patterns. Average values for M1, RF, and SC were L = 119.1 ± 9.6, 105.9 ± 6.2, and 109.3 ± 8.4% and R = 50.3 ± 4.9, 56.4 ± 3.5, and 51.5 ± 4.8%, respectively. RF was significantly different from M1 and SC on both measurements. RF is thus able to generate an approximation to the motor output with less activation than required by M1 and SC, but M1 and SC are more precise in reaching the exact activation pattern required. Cortical, brainstem, and spinal centers likely play distinct roles, as they cooperate to generate voluntary movements. NEW & NOTEWORTHY Brainstem reticular formation, primary motor cortex, and cervical spinal cord intermediate zone can all activate primate upper limb muscles. However, brainstem output is more efficient but less precise in producing natural patterns of motor output than motor cortex or spinal cord. We suggest that gross muscle synergies from the reticular formation are sculpted and refined by motor cortex and spinal circuits to reach the finely fractionated output characteristic of dexterous primate upper limb movements.
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Affiliation(s)
- Boubker Zaaimi
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , United Kingdom
| | - Lauren R Dean
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , United Kingdom
| | - Stuart N Baker
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , United Kingdom
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45
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Ranganathan R. Reorganization of finger coordination patterns through motor exploration in individuals after stroke. J Neuroeng Rehabil 2017; 14:90. [PMID: 28893292 PMCID: PMC5594488 DOI: 10.1186/s12984-017-0300-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impairment of hand and finger function after stroke is common and affects the ability to perform activities of daily living. Even though many of these coordination deficits such as finger individuation have been well characterized, it is critical to understand how stroke survivors learn to explore and reorganize their finger coordination patterns for optimizing rehabilitation. In this study, I examine the use of a body-machine interface to assess how participants explore their movement repertoire, and how this changes with continued practice. METHODS Ten participants with chronic stroke wore a data glove and the finger joint angles were mapped on to the position of a cursor on a screen. The task of the participants was to move the cursor back and forth between two specified targets on a screen. Critically, the map between the finger movements and cursor motion was altered so that participants sometimes had to generate coordination patterns that required finger individuation. There were two phases to the experiment - an initial assessment phase on day 1, followed by a learning phase (days 2-5) where participants trained to reorganize their coordination patterns. RESULTS Participants showed difficulty in performing tasks which had maps that required finger individuation, and the degree to which they explored their movement repertoire was directly related to clinical tests of hand function. However, over four sessions of practice, participants were able to learn to reorganize their finger movement coordination pattern and improve their performance. Moreover, training also resulted in improvements in movement repertoire outside of the context of the specific task during free exploration. CONCLUSIONS Stroke survivors show deficits in movement repertoire in their paretic hand, but facilitating movement exploration during training can increase the movement repertoire. This suggests that exploration may be an important element of rehabilitation to regain optimal function.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, 308 W Circle Dr Rm 126, East Lansing, MI, 48824, USA.
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Reticulospinal Contributions to Gross Hand Function after Human Spinal Cord Injury. J Neurosci 2017; 37:9778-9784. [PMID: 28871033 DOI: 10.1523/jneurosci.3368-16.2017] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022] Open
Abstract
Multiple descending motor pathways likely contribute to the recovery of hand motor function following spinal cord injury (SCI). Reticulospinal neurons project to spinal motor neurons controlling hand muscles and extensively sprout into gray matter structures after SCI; therefore, it has been proposed that the reticulospinal tract is one of the descending motor pathways involved in recovery of hand function after injury. To test this hypothesis, we examined the StartReact response, an involuntary release of a planned movement via a startling stimulus that engages the reticulospinal tract, by measuring reaction times from electromyographic activity in an intrinsic finger muscle during three motor tasks requiring different degrees of hand dexterity: index finger abduction, a precision grip, and a power grip. Males and females with and without incomplete chronic cervical SCI were tested. We found that although SCI participants voluntarily responded to all tasks, reaction times were shorter during a startle cue while performing a power grip but not index finger abduction or precision grip. Control subjects had similarly shorter reaction times during a startle cue in all motor tasks. These results provide the first evidence for a contribution of the reticulospinal tract to hand control in humans with SCI during gross finger manipulations and suggest that this contribution is less pronounced during fine dexterous finger movements.SIGNIFICANCE STATEMENT It has been long proposed that brainstem pathways contribute to the recovery of hand function in humans with spinal cord injury (SCI). Here, we show that individuals with anatomically incomplete chronic cervical SCI responded to a startle stimulus, a test that engages the reticulospinal tract, while performing a power grip but not during index finger abduction or precision grip. Control subjects responded to a startle stimulus similarly across tasks. These observations suggest that reticulospinal outputs after SCI contribute to hand motor tasks involving gross finger movements. Interestingly, this contribution is less pronounced during fine dexterous finger movements.
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Fricke C, Gentner R, Rumpf JJ, Weise D, Saur D, Classen J. Differential spatial representation of precision and power grasps in the human motor system. Neuroimage 2017; 158:58-69. [DOI: 10.1016/j.neuroimage.2017.06.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022] Open
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Xu J, Ejaz N, Hertler B, Branscheidt M, Widmer M, Faria AV, Harran MD, Cortes JC, Kim N, Celnik PA, Kitago T, Luft AR, Krakauer JW, Diedrichsen J. Separable systems for recovery of finger strength and control after stroke. J Neurophysiol 2017; 118:1151-1163. [PMID: 28566461 PMCID: PMC5547267 DOI: 10.1152/jn.00123.2017] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 11/22/2022] Open
Abstract
Impaired hand function after stroke is a major cause of long-term disability. We developed a novel paradigm that quantifies two critical aspects of hand function, strength, and independent control of fingers (individuation), and also removes any obligatory dependence between them. Hand recovery was tracked in 54 patients with hemiparesis over the first year after stroke. Most recovery of strength and individuation occurred within the first 3 mo. A novel time-invariant recovery function was identified: recovery of strength and individuation were tightly correlated up to a strength level of ~60% of estimated premorbid strength; beyond this threshold, strength improvement was not accompanied by further improvement in individuation. Any additional improvement in individuation was attributable instead to a second process that superimposed on the recovery function. We conclude that two separate systems are responsible for poststroke hand recovery: one contributes almost all of strength and some individuation; the other contributes additional individuation.NEW & NOTEWORTHY We tracked recovery of the hand over a 1-yr period after stroke in a large cohort of patients, using a novel paradigm that enabled independent measurement of finger strength and control. Most recovery of strength and control occurs in the first 3 mo after stroke. We found that two separable systems are responsible for motor recovery of hand: one contributes strength and some dexterity, whereas a second contributes additional dexterity.
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Affiliation(s)
- Jing Xu
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, Maryland;
| | - Naveed Ejaz
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Brain Mind Institute, Western University, London, Ontario, Canada
| | - Benjamin Hertler
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zürich, Switzerland
| | - Meret Branscheidt
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zürich, Switzerland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; and
| | - Mario Widmer
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zürich, Switzerland
| | - Andreia V Faria
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Juan C Cortes
- Department of Neurology, Columbia University, New York, New York
| | - Nathan Kim
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, Maryland
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; and
| | - Tomoko Kitago
- Department of Neurology, Columbia University, New York, New York
| | - Andreas R Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zürich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - John W Krakauer
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, Maryland
| | - Jörn Diedrichsen
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Brain Mind Institute, Western University, London, Ontario, Canada
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Lan Y, Yao J, Dewald JP. The Impact of Shoulder Abduction Loading on Volitional Hand Opening and Grasping in Chronic Hemiparetic Stroke. Neurorehabil Neural Repair 2017; 31:521-529. [PMID: 28506146 PMCID: PMC5505320 DOI: 10.1177/1545968317697033] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Up to 60% of individuals with moderate to severe chronic hemiparetic stroke experience excessive involuntary wrist/finger flexion that constrains functional hand movements including hand opening. It's not known how stroke-induced brain injury impacts volitional hand opening and grasping forces as a result of the expression of abnormal coupling between shoulder abduction and wrist/finger flexion or the flexion synergy. OBJECTIVE The goal of this study is to understand how shoulder abduction loading affects volitional hand opening and grasping forces in individuals with moderate to severe chronic hemiparetic stroke. METHODS Thirty-six individuals (stroke, 26; control, 10) were recruited for this study. Each participant was instructed to perform maximal hand opening and grasping forces while the arm was either fully supported or lifted with a weight equal to 25% or 50% of the participant's maximal shoulder abduction torque. Hand pentagon area, defined as the area formed by the tips of thumb and fingers, was calculated during hand opening. Forces were recorded during grasping. RESULTS In individuals with moderate stroke, increasing shoulder abduction loading reduced the ability to maximally open the hand. In individuals with severe stroke, who were not able to open the hand, grasping forces were generated and increased with shoulder abduction loading. Stroke individuals also showed a reduced ability to control volitional grasping forces due to the enhanced expression of flexion synergy. CONCLUSIONS Shoulder abduction loading reduced the ability to volitionally open the hand and control grasping forces after stroke. Neural mechanisms and clinical implications of these findings are discussed.
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Affiliation(s)
- Yiyun Lan
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, 60611
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611
| | - Jun Yao
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, 60611
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611
| | - Julius P.A. Dewald
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, 60611
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, 60611
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611
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Mosberger AC, Miehlbradt JC, Bjelopoljak N, Schneider MP, Wahl AS, Ineichen BV, Gullo M, Schwab ME. Axotomized Corticospinal Neurons Increase Supra-Lesional Innervation and Remain Crucial for Skilled Reaching after Bilateral Pyramidotomy. Cereb Cortex 2017; 28:625-643. [DOI: 10.1093/cercor/bhw405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/20/2016] [Indexed: 12/11/2022] Open
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