Perceptual learning in sensorimotor adaptation

The Consolidation of Newly Learned Movements Depends upon the Somatosensory Cortex in Humans

Studies using magnetic brain stimulation indicate the involvement of somatosensory regions in the acquisition and retention of newly learned movements. Recent work found an impairment in motor memory when retention was tested shortly after the application of continuous theta-burst stimulation (cTBS) to the primary somatosensory cortex, compared with stimulation of the primary motor cortex or a control zone. This finding that the somatosensory cortex is involved in motor memory retention whereas the motor cortex is not, if confirmed, could alter our understanding of human motor learning. It would indicate that plasticity in sensory systems underlies newly learned movements, which is different than the commonly held view that adaptation learning involves updates to a motor controller. Here we test this idea. Participants were trained in a visuomotor adaptation task, with visual feedback gradually shifted. Following adaptation, cTBS was applied either to M1, S1, or an occipital cortex control area. Participants were tested for retention 24 h later. It was observed that S1 stimulation led to reduced retention of prior learning, compared with stimulation of M1 or the control area (with no significant difference between M1 and control). In a further control, cTBS was applied to S1 following training with unrotated feedback, in which no learning occurred. This had no effect on movement in the retention test indicating the effects of S1 stimulation on movement are learning specific. The findings are consistent with the S1 participation in the encoding of learning-related changes to movements and in the retention of human motor memory.

No effect of whole-hand water flow stimulation on skill acquisition and retention during sensorimotor adaptation

Introduction

Repetitive somatosensory stimulation (RSS) is a conventional approach to modulate the neural states of both the primary somatosensory cortex (S1) and the primary motor cortex (M1). However, the impact of RSS on skill acquisition and retention in sensorimotor adaptation remains debated. This study aimed to investigate whether whole-hand water flow (WF), a unique RSS-induced M1 disinhibition, influences sensorimotor adaptation by examining the hypothesis that whole-hand WF leads to M1 disinhibition; thereby, enhancing motor memory retention.

Methods

Sixty-eight young healthy participants were randomly allocated to three groups based on the preconditioning received before motor learning: control, whole-hand water immersion (WI), and whole-hand WF. The experimental protocol for all the participants spanned two consecutive days. On the initial day (day 1), baseline transcranial magnetic stimulation (TMS) assessments (T0) were executed before any preconditioning. Subsequently, each group underwent their respective 30 min preconditioning protocol. To ascertain the influence of each preconditioning on the excitability of the M1, subsequent TMS assessments were conducted (T1). Following this, all participants engaged in the motor learning (ML) of a visuomotor tracking task, wherein they were instructed to align a cursor with a target trajectory by modulating the pinch force. Upon completion of the ML session, final TMS assessments (T2) were conducted. All participants were required to perform the same motor learning 24 h later on day 2.

Results

The results revealed that whole-hand WF did not significantly influence skill acquisition during sensorimotor adaptation, although it did reduce intracortical inhibition. This phenomenon is consistent with the idea that S1, rather than M1, is involved in skill acquisition during the early stages of sensorimotor adaptation. Moreover, memory retention 24 h after skill acquisition did not differ significantly across the three groups, challenging our initial hypothesis that whole-hand WF enhances memory retention throughout sensorimotor adaptation. This could be due to the inability of whole-hand WF to alter sensorimotor connectivity and integration, as well as the nature of the plastic response elicited by the preconditioning.

Discussion

In conclusion, these findings suggest that although whole-hand WF attenuates intracortical inhibition, it does not modulate skill acquisition or motor memory retention during sensorimotor adaptation.

Disruption of somatosensory cortex impairs motor learning and retention

This study tests for a function of the somatosensory cortex, that, in addition to its role in processing somatic afferent information, somatosensory cortex contributes both to motor learning and the stabilization of motor memory. Continuous theta-burst magnetic stimulation (cTBS) was applied, before force-field training to disrupt activity in either the primary somatosensory cortex, primary motor cortex, or a control zone over the occipital lobe. Tests for retention and relearning were conducted after a 24 h delay. Analysis of movement kinematic measures and force-channel trials found that cTBS to somatosensory cortex disrupted both learning and subsequent retention, whereas cTBS to motor cortex had little effect on learning but possibly impaired retention. Basic movement variables are unaffected by cTBS suggesting that the stimulation does not interfere with movement but instead disrupts changes in the cortex that are necessary for learning. In all experimental conditions, relearning in an abruptly introduced force field, which followed retention testing, showed extensive savings, which is consistent with previous work suggesting that more cognitive aspects of learning and retention are not dependent on either of the cortical zones under test. Taken together, the findings are consistent with the idea that motor learning is dependent on learning-related activity in the somatosensory cortex.NEW & NOTEWORTHY This study uses noninvasive transcranial magnetic stimulation to test the contribution of somatosensory and motor cortex to human motor learning and retention. Continuous theta-burst stimulation is applied before learning; participants return 24 h later to assess retention. Disruption of the somatosensory cortex is found to impair both learning and retention, whereas disruption of the motor cortex has no effect on learning. The findings are consistent with the idea that motor learning is dependent upon learning-related plasticity in somatosensory cortex.

Proprioceptive short-term memory in passive motor learning

A physical trainer often physically guides a learner's limbs to teach an ideal movement, giving the learner proprioceptive information about the movement to be reproduced later. This instruction requires the learner to perceive kinesthetic information and store the instructed information temporarily. Therefore, (1) proprioceptive acuity to accurately perceive the taught kinesthetics and (2) short-term memory to store the perceived information are two critical functions for reproducing the taught movement. While the importance of proprioceptive acuity and short-term memory has been suggested for active motor learning, little is known about passive motor learning. Twenty-one healthy adults (mean age 25.6 years, range 19-38 years) participated in this study to investigate whether individual learning efficiency in passively guided learning is related to these two functions. Consequently, learning efficiency was significantly associated with short-term memory capacity. In particular, individuals who could recall older sensory stimuli showed better learning efficiency. However, no significant relationship was observed between learning efficiency and proprioceptive acuity. A causal graph model found a direct influence of memory on learning and an indirect effect of proprioceptive acuity on learning via memory. Our findings suggest the importance of a learner's short-term memory for effective passive motor learning.

Similar somatotopy for active and passive digit representation in primary somatosensory cortex

Scientists traditionally use passive stimulation to examine the organisation of primary somatosensory cortex (SI). However, given the close, bidirectional relationship between the somatosensory and motor systems, active paradigms involving free movement may uncover alternative SI representational motifs. Here, we used 7 Tesla functional magnetic resonance imaging to compare hallmark features of SI digit representation between active and passive tasks which were unmatched on task or stimulus properties. The spatial location of digit maps, somatotopic organisation, and inter-digit representational structure were largely consistent between tasks, indicating representational consistency. We also observed some task differences. The active task produced higher univariate activity and multivariate representational information content (inter-digit distances). The passive task showed a trend towards greater selectivity for digits versus their neighbours. Our findings highlight that, while the gross features of SI functional organisation are task invariant, it is important to also consider motor contributions to digit representation.

Improved proprioception does not benefit visuomotor adaptation

Visuomotor adaptation arises when reaching in an altered visual environment, where one's seen hand position does not match their felt (i.e., proprioceptive) hand position in space. Here, we asked if proprioceptive training benefits visuomotor adaptation, and if these benefits arise due to implicit (unconscious) or explicit (conscious strategy) processes. Seventy-two participants were divided equally into 3 groups: proprioceptive training with feedback (PTWF), proprioceptive training no feedback (PTNF), and Control (CTRL). The PTWF and PTNF groups completed passive proprioceptive training, where a participant's hand was moved to an unknown reference location and they judged the felt position of their unseen hand relative to their body midline on every trial. The PTWF group received verbal feedback with respect to their response accuracy on the middle 60% of trials, whereas the PTNF did not receive any feedback during training. The CTRL group did not complete proprioceptive training and instead sat quietly during this time. Following proprioceptive training or time delay, all three groups reached when seeing a cursor that was rotated 30° clockwise relative to their hand motion. The experiment ended with participants completing a series of no-cursor reaches to assess implicit and explicit adaptation. Results indicated that the PTWF group improved the accuracy of their sense of felt hand position following proprioceptive training. However, this improved proprioceptive acuity (i.e., the accuracy of their sense of felt hand) did not benefit visuomotor adaptation, as all three groups showed similar visuomotor adaptation across rotated reach training trials. Visuomotor adaptation arose implicitly, with minimal explicit contribution for all three groups. Together, these results suggest that passive proprioceptive training does not benefit, nor hinder, the extent of implicit visuomotor adaptation established immediately following reach training with a 30° cursor rotation.

Motor learning in hemi-Parkinson using VR-manipulated sensory feedback

AIMS

Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation.

METHODS

We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training.

RESULTS

Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity.

DISCUSSION

Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia.Implications for rehabilitationAssistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel - constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.

Passive Proprioceptive Training Alters the Sensitivity of Muscle Spindles to Imposed Movements

Humans rely on precise proprioceptive feedback from our muscles, which is important in both the acquisition and execution of movements, to perform daily activities. Somatosensory input from the body shapes motor learning through central processes, as demonstrated for tasks using the arm, under active (self-generated) and passive conditions. Presently, we investigated whether passive movement training of the ankle increased proprioceptive acuity (psychophysical experiment) and whether it changed the peripheral proprioceptive afferent signal (microneurography experiment). In the psychophysical experiment, the ankle of 32 healthy human participants was moved passively using pairs of ramp-and-hold movements in different directions. In a pretraining test, participants made judgements about the movement direction in a two-alternative forced choice paradigm. Participants then underwent passive movement training, but only half were cued for learning, where a reference position was signaled by a sound and the participant had to learn to recognize this position; they then completed a post-training test. In a paradigm using the same setup, nine healthy participants underwent microneurography recordings of Ia muscle afferents from the peroneal nerve, where all were cued during training. In the psychophysical experiment, proprioceptive acuity improved with training only in the cued group. In the microneurography experiment, we found that muscle afferent firing was modulated, via an increase in the dynamic index, after training. We suggest that changes in muscle afferent input from the periphery can contribute to and support central perceptual and motor learning, as shown under passive conditions using ankle movements, which may be exploited for movement rehabilitation.

Robotic-based ACTive somatoSENSory (Act.Sens) retraining on upper limb functions with chronic stroke survivors: study protocol for a pilot randomised controlled trial

Background

Prior studies have established that senses of the limb position in space (proprioception and kinaesthesia) are important for motor control and learning. Although nearly one-half of stroke patients have impairment in the ability to sense their movements, somatosensory retraining focusing on proprioception and kinaesthesia is often overlooked. Interventions that simultaneously target motor and somatosensory components are thought to be useful for relearning somatosensory functions while increasing mobility of the affected limb. For over a decade, robotic technology has been incorporated in stroke rehabilitation for more controlled therapy intensity, duration, and frequency. This pilot randomised controlled trial introduces a compact robotic-based upper-limb reaching task that retrains proprioception and kinaesthesia concurrently.

Methods

Thirty first-ever chronic stroke survivors (> 6-month post-stroke) will be randomly assigned to either a treatment or a control group. Over a 5-week period, the treatment group will receive 15 training sessions for about an hour per session. Robot-generated haptic guidance will be provided along the movement path as somatosensory cues while moving. Audio-visual feedback will appear following every successful movement as a reward. For the same duration, the control group will complete similar robotic training but without the vision occluded and robot-generated cues. Baseline, post-day 1, and post-day 30 assessments will be performed, where the last two sessions will be conducted after the last training session. Robotic-based performance indices and clinical assessments of upper limb functions after stroke will be used to acquire primary and secondary outcome measures respectively. This work will provide insights into the feasibility of such robot-assisted training clinically.

Discussion

The current work presents a study protocol to retrain upper-limb somatosensory and motor functions using robot-based rehabilitation for community-dwelling stroke survivors. The training promotes active use of the affected arm while at the same time enhances somatosensory input through augmented feedback. The outcomes of this study will provide preliminary data and help inform the clinicians on the feasibility and practicality of the proposed exercise.

Trial registration

ClinicalTrials.gov NCT04490655. Registered 29 July 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00948-3.

Does proprioceptive acuity influence the extent of implicit sensorimotor adaptation in young and older adults?

The ability to adjust movements to changes in the environment declines with aging. This age-related decline is caused by the decline of explicit adjustments. However, implicit adaptation remains intact and might even be increased with aging. Since proprioceptive information has been linked to implicit adaptation, it might well be that an age-related decline in proprioceptive acuity might be linked to the performance of older adults in implicit adaptation tasks. Indeed, age-related proprioceptive deficits could lead to altered sensory integration with an increased weighting of the visual sensory-prediction error. Another possibility is that reduced proprioceptive acuity results in an increased reliance on predicted sensory consequences of the movement. Both these explanations led to our preregistered hypothesis: we expected a relation between the decline of proprioception and the amount of implicit adaptation across ages. However, we failed to support this hypothesis. Our results question the existence of reliability-based integration of visual and proprioceptive signals during motor adaptation.

Promoting neuroplasticity and neuropsychological functioning in frailty through an app-based sensorimotor training: study protocol for a randomized trial

BACKGROUND

Frailty is characterized by an age-related decline in multiple physiological systems, leading to a high vulnerability to stressors, adverse health outcomes, and low quality of life. Neuroscientific models of pathological aging emphasize the loss of sensorimotor stimulation and reduced neuromodulatory capacities as core processes in age-related cognitive and bodily decline, which may be associated with maladaptive plastic changes in the brain. We plan to increase sensorimotor stimulation in frail persons through a newly developed app-based training program and link the training trials to biological and psychological correlates of age-associated vulnerability and health indices.

METHODS

We will conduct a randomized trial, applying an app-based sensorimotor home training (N = 30) in people suffering from frailty. An app-based relaxation training will serve as an active control condition (N = 30). Both interventions will last for 90 days each. The sensorimotor training includes unimodal and multimodal sensory discrimination tasks in the visual, auditory, and tactile domain, as well as sensorimotor precision tasks. The tasks will be implemented using an adaptive training algorithm and enriched with motivational components embedded in a virtual training environment. We expect a pre-post reduction of frailty status and associated functional decline related to refinement of representational maps within the sensorimotor system and improved sensorimotor function such as extremity function. Secondary analyses will study the influence of BDNF genotype as moderating variable. Additional outcomes will include measures of perceptual and cognitive functioning, quality of life as well as BDNF serum levels. Measurements will take place before training (baseline), after 60 days (assessment 1), and at the end of the training after 90 days (assessment 2).

DISCUSSION

In our randomized trial, we aim to characterize a multidimensional concept of frailty and to target maladaptive behaviors and neuroplasticity using an app-based sensorimotor training. This type of intervention might provide further knowledge and new possibilities for preventing decline and preserving function in older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03666039 . Registered 11 September 2018 - Retrospectively registered. Protocol version: Version 4 revised (issue date: 19 May 2021).

Passive training with upper extremity exoskeleton robot affects proprioceptive acuity and performance of motor learning

Sports trainers often grasp and move trainees' limbs to give instructions on desired movements, and a merit of this passive training is the transferring of instructions via proprioceptive information. However, it remains unclear how passive training affects the proprioceptive system and improves learning. This study examined changes in proprioceptive acuity due to passive training to understand the underlying mechanisms of upper extremity training. Participants passively learned a trajectory of elbow-joint movement as per the instructions of a single-arm upper extremity exoskeleton robot, and the performance of the target movement and proprioceptive acuity were assessed before and after the training. We found that passive training improved both the reproduction performance and proprioceptive acuity. We did not identify a significant transfer of the training effect across arms, suggesting that the learning effect is specific to the joint space. Furthermore, we found a significant improvement in learning performance in another type of movement involving the trained elbow joint. These results suggest that participants form a representation of the target movement in the joint space during the passive training, and intensive use of proprioception improves proprioceptive acuity.

Postural control of arm and fingers through integration of movement commands

Every movement ends in a period of stillness. Current models assume that commands that hold the limb at a target location do not depend on the commands that moved the limb to that location. Here, we report a surprising relationship between movement and posture in primates: on a within-trial basis, the commands that hold the arm and finger at a target location depend on the mathematical integration of the commands that moved the limb to that location. Following damage to the corticospinal tract, both the move and hold period commands become more variable. However, the hold period commands retain their dependence on the integral of the move period commands. Thus, our data suggest that the postural controller possesses a feedforward module that uses move commands to calculate a component of hold commands. This computation may arise within an unknown subcortical system that integrates cortical commands to stabilize limb posture.

Effects of visuomotor delays on the control of movement and on perceptual localization in the presence and absence of visual targets

The sensory system constantly deals with delayed feedback. Recent studies showed that playing a virtual game of pong with delayed feedback caused hypermetric reaching movements. We investigated whether this effect is associated with a perceptual bias. In addition, we examined the importance of the target in causing hypermetric movements. In a first experiment, participants played a delayed pong game and blindly reached to presented targets. Following each reaching movement, they assessed the position of the invisible cursor. We found that participants performed hypermetric movements but reported that the invisible cursor reached the target, suggesting that they were unaware of the hypermetria and that their perception was biased toward the target rather than toward their hand position. In a second experiment, we removed the visual target, and strikingly, the hypermetria vanished. Moreover, participants reported that the invisible cursor was located with their hand. Taking these results together, we conclude that the adaptation to the visuomotor delay during the pong game selectively affected the execution of goal directed movements, resulting in hypermetria and perceptual bias when movements are directed toward visual targets but not when such targets are absent.NEW & NOTEWORTHY Recent studies showed that adaptation to visuomotor delays causes hypermetric movements in the absence of visual feedback, suggesting that visuomotor delay is represented using current state information. We report that this adaptation also affects perception. Importantly, both the motor and perceptual effects are selective to the representations that are used in the execution of goal-directed movements toward visual targets.

Adaptation to Laterally Asymmetrical Visuomotor Delay Has an Effect on Action But Not on Perception

When interacting with the environment, the sensorimotor system faces temporal and spatial discrepancies between sensory inputs, such as delay in sensory information transmission, and asymmetrical visual inputs across space. These discrepancies can affect motor control and the representation of space. We recently showed that adaptation to a laterally asymmetric delay in the visual feedback induces neglect-like effects in blind drawing movements, expressed by asymmetrical elongation of circles that are drawn in different workspaces and directions; this establishes a possible connection between delayed feedback and asymmetrical spatial processing in the control of action. In the current study, we investigate whether such adaptation also influences visual perception. In addition, we examined transfer to another motor task – a line bisection task that is commonly used to detect spatial disorders, and extend these results to examine the mapping of these neglect-like effects. We performed two sets of experiments in which participants executed lateral reaching movements, and were exposed to visual feedback delay only in the left workspace. We examined transfer of adaptation to a perceptual line bisection task – answers about the perceived midline of lines that were presented in different directions and workspaces, and to a blind motor line bisection task – reaching movements toward the centers of similar lines. We found that the adaptation to the asymmetrical delay transferred to the control of lateral movements, but did not affect the perceived location of the midlines. Our results clarify the effect of asymmetrical delayed visual feedback on perception and action, and provide potential insights on the link between visuomotor delay and neurological disorders such as the hemispatial neglect syndrome.

Increase in weighting of vision vs. proprioception associated with force field adaptation

Hand position can be estimated by vision and proprioception (position sense). The brain is thought to weight and integrate these percepts to form a multisensory estimate of hand position with which to guide movement. Force field adaptation, a type of cerebellum-dependent motor learning, is associated with both motor and proprioceptive changes. The cerebellum has connections with multisensory parietal regions; however, it is unknown if force adaptation is associated with changes in multisensory perception. If force adaptation affects all relevant sensory modalities similarly, the brain’s weighting of vision vs. proprioception should be maintained. Alternatively, if force perturbation is interpreted as somatosensory unreliability, vision may be up-weighted relative to proprioception. We assessed visuo-proprioceptive weighting with a perceptual estimation task before and after subjects performed straight-ahead reaches grasping a robotic manipulandum. Each subject performed one session with a clockwise or counter-clockwise velocity-dependent force field, and one session in a null field. Subjects increased their weight of vision vs. proprioception in the force field session relative to the null session, regardless of force field direction, in the straight-ahead dimension (F_1,44 = 5.13, p = 0.029). This suggests that force field adaptation is associated with an increase in the brain’s weighting of vision vs. proprioception.

Visuomotor control of ankle joint using position vs. force

Ankle joint plays a critical role in daily activities involving interactions with environment using force and position control. Neuromechanical dysfunctions (e.g., due to stroke or brain injury), therefore, have a major impact on individuals' quality of life. The effective design of neuro-rehabilitation protocols for robotic rehabilitation platforms relies on understanding the control characteristics of the ankle joint in interaction with external environment using force and position, as the findings in upper limb may not be generalizable to the lower limb. This study aimed to characterize the skilled performance of ankle joint in visuomotor position and force control. A two-degree-of-freedom (DOF) robotic footplate was used to measure individuals' force and position. Healthy individuals (n = 27) used ankle force or position for point-to-point and tracking control tasks in 1-DOF and 2-DOF virtual game environments. Subjects' performance was quantified as a function of accuracy and completion time. In contrast to comparable performance in 1-DOF control tasks, the performance in 2-DOF tasks was different and had characteristic patterns in the position and force conditions, with a significantly better performance for position. Subjective questionnaires on the perceived difficulty matched the objective experimental results, suggesting that the poor performance in force control was not due to experimental set-up or fatigue but can be attributed to the different levels of challenge needed in neural control. It is inferred that in visuomotor coordination, the neuromuscular specialization of ankle provides better control over position rather than force. These findings can inform the design of neuro-rehabilitation platforms, selection of effective tasks and therapeutic protocols.

Movements following force-field adaptation are aligned with altered sense of limb position

Previous work has shown that motor learning is associated with changes to both movements and to the somatosensory perception of limb position. In an earlier study that motivates the current work, it appeared that following washout trials, movements did not return to baseline but rather were aligned with associated changes to sensed limb position. Here, we provide a systematic test of this relationship, examining the idea that adaptation-related changes to sensed limb position and to the path of the limb are linked, not only after washout trials but at all stages of the adaptation process. We used a force-field adaptation paradigm followed by washout trials in which subjects performed movements without visual feedback of the limb. Tests of sensed limb position were conducted at each phase of adaptation, specifically before and after baseline movements in a null field, after force-field adaptation, and following washout trials in a null field. As in previous work, sensed limb position changed in association with force-field adaptation. At each stage of adaptation, we observed a correlation between the sensed limb position and associated path of the limb. At a group level, there were differences between the clockwise and counter-clockwise conditions. However, whenever there were changes in sensed limb position, movements following washout did not return to baseline. This suggests that adaptation in sensory and motor systems is not independent processes but rather sensorimotor adaptation is linked to sensory change. Sensory change and limb movement remain in alignment throughout adaptation such that the path of the limb is aligned with the altered sense of limb position.

A Single Session of Robot-Controlled Proprioceptive Training Modulates Functional Connectivity of Sensory Motor Networks and Improves Reaching Accuracy in Chronic Stroke

BACKGROUND

Passive robot-generated arm movements in conjunction with proprioceptive decision making and feedback modulate functional connectivity (FC) in sensory motor networks and improve sensorimotor adaptation in normal individuals. This proof-of-principle study investigates whether these effects can be observed in stroke patients.

METHODS

A total of 10 chronic stroke patients with a range of stable motor and sensory deficits (Fugl-Meyer Arm score [FMA] 0-65, Nottingham Sensory Assessment [NSA] 10-40) underwent resting-state functional magnetic resonance imaging before and after a single session of robot-controlled proprioceptive training with feedback. Changes in FC were identified in each patient using independent component analysis as well as a seed region-based approach. FC changes were related to impairment and changes in task performance were assessed.

RESULTS

A single training session improved average arm reaching accuracy in 6 and proprioception in 8 patients. Two networks showing training-associated FC change were identified. Network C1 was present in all patients and network C2 only in patients with FM scores >7. Relatively larger C1 volume in the ipsilesional hemisphere was associated with less impairment ( r = 0.83 for NSA, r = 0.73 for FMA). This association was driven by specific regions in the contralesional hemisphere and their functional connections (supramarginal gyrus with FM scores r = 0.82, S1 with NSA scores r = 0.70, and cerebellum with NSA score r = -0.82).

CONCLUSION

A single session of robot-controlled proprioceptive training with feedback improved movement accuracy and induced FC changes in sensory motor networks of chronic stroke patients. FC changes are related to functional impairment and comprise bilateral sensory and motor network nodes.

Somatosensory perceptual training enhances motor learning by observing

Action observation activates brain regions involved in sensory-motor control. Recent research has shown that action observation can also facilitate motor learning; observing a tutor undergoing motor learning results in functional plasticity within the motor system and gains in subsequent motor performance. However, the effects of observing motor learning extend beyond the motor domain. Converging evidence suggests that observation also results in somatosensory functional plasticity and somatosensory perceptual changes. This work has raised the possibility that the somatosensory system is also involved in motor learning that results from observation. Here we tested this hypothesis using a somatosensory perceptual training paradigm. If the somatosensory system is indeed involved in motor learning by observing, then improving subjects' somatosensory function before observation should enhance subsequent motor learning by observing. Subjects performed a proprioceptive discrimination task in which a robotic manipulandum moved the arm, and subjects made judgments about the position of their hand. Subjects in a Trained Learning group received trial-by-trial feedback to improve their proprioceptive perception. Subjects in an Untrained Learning group performed the same task without feedback. All subjects then observed a learning video showing a tutor adapting her reaches to a left force field. Subjects in the Trained Learning group, who had superior proprioceptive acuity before observation, benefited more from observing learning than subjects in the Untrained Learning group. Improving somatosensory function can therefore enhance subsequent observation-related gains in motor learning. This study provides further evidence in favor of the involvement of the somatosensory system in motor learning by observing. NEW & NOTEWORTHY We show that improving somatosensory performance before observation can improve the extent to which subjects learn from watching others. Somatosensory perceptual training may prime the sensory-motor system, thereby facilitating subsequent observational learning. The findings of this study suggest that the somatosensory system supports motor learning by observing. This finding may be useful if observation is incorporated as part of therapies for diseases affecting movement, such as stroke.

Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee's hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.

Investigating three types of continuous auditory feedback in visuo-manual tracking

The use of continuous auditory feedback for motor control and learning is still understudied and deserves more attention regarding fundamental mechanisms and applications. This paper presents the results of three experiments studying the contribution of task-, error-, and user-related sonification to visuo-manual tracking and assessing its benefits on sensorimotor learning. First results show that sonification can help decreasing the tracking error, as well as increasing the energy in participant's movement. In the second experiment, when alternating feedback presence, the user-related sonification did not show feedback dependency effects, contrary to the error and task-related feedback. In the third experiment, a reduced exposure of 50% diminished the positive effect of sonification on performance, whereas the increase of the average energy with sound was still significant. In a retention test performed on the next day without auditory feedback, movement energy was still superior for the groups previously trained with the feedback. Although performance was not affected by sound, a learning effect was measurable in both sessions and the user-related group improved its performance also in the retention test. These results confirm that a continuous auditory feedback can be beneficial for movement training and also show an interesting effect of sonification on movement energy. User-related sonification can prevent feedback dependency and increase retention. Consequently, sonification of the user's own motion appears as a promising solution to support movement learning with interactive feedback.

Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time

Pharyngeal delay is a significant swallowing disorder often resulting in aspiration. It is suspected that pharyngeal delay originates from sensory impairment, but a direct demonstration of a link between oral sensation and pharyngeal delay is lacking. In this study involving six patients with complaints of dysphagia, taste sensation of the oral tongue was measured and subsequently related to swallowing kinematics. It was found that a response bias for sour taste was significantly correlated with pharyngeal delay time on paste, highlighting oral sensory contributions to swallow motor dysfunctions. Investigating the precise nature of such a link between oral sensation and dysphagia would constitute a basis for understanding the disorder. The results of this study highlight oral sensory contributions to pharyngeal swallow events and provide impetus to examine this link in larger samples of dysphagic patients.

The relationship between lower limb proprioceptive sense and locomotor skill acquisition

Sensorimotor integration is essential for controlling movement and acquiring new motor tasks in humans. The aim of this project was to understand how lower limb proprioceptive sense contributes to the acquisition of a skilled walking task. We assessed lower limb joint position and movement detection sense in healthy human subjects using the Lokomat robotic exoskeleton. Subjects walked on a treadmill to practice a skilled motor task (200 trials) requiring them to match their foot height during the swing phase to the height of a virtual obstacle displayed on a monitor in front of them. Subjects were given visual feedback on their error relative to the obstacle height after it was crossed. Lower limb joint position sense was related to the final performance error, but not the learning rate of the skilled walking task. The findings from this study support the role of lower limb proprioceptive sense on locomotor skill performance in healthy adult subjects.

A State Space Model for Spatial Updating of Remembered Visual Targets during Eye Movements

In the oculomotor system, spatial updating is the ability to aim a saccade toward a remembered visual target position despite intervening eye movements. Although this has been the subject of extensive experimental investigation, there is still no unifying theoretical framework to explain the neural mechanism for this phenomenon, and how it influences visual signals in the brain. Here, we propose a unified state-space model (SSM) to account for the dynamics of spatial updating during two types of eye movement; saccades and smooth pursuit. Our proposed model is a non-linear SSM and implemented through a recurrent radial-basis-function neural network in a dual Extended Kalman filter (EKF) structure. The model parameters and internal states (remembered target position) are estimated sequentially using the EKF method. The proposed model replicates two fundamental experimental observations: continuous gaze-centered updating of visual memory-related activity during smooth pursuit, and predictive remapping of visual memory activity before and during saccades. Moreover, our model makes the new prediction that, when uncertainty of input signals is incorporated in the model, neural population activity and receptive fields expand just before and during saccades. These results suggest that visual remapping and motor updating are part of a common visuomotor mechanism, and that subjective perceptual constancy arises in part from training the visual system on motor tasks.

Somatosensory Contribution to the Initial Stages of Human Motor Learning

The early stages of motor skill acquisition are often marked by uncertainty about the sensory and motor goals of the task, as is the case in learning to speak or learning the feel of a good tennis serve. Here we present an experimental model of this early learning process, in which targets are acquired by exploration and reinforcement rather than sensory error. We use this model to investigate the relative contribution of motor and sensory factors to human motor learning. Participants make active reaching movements or matched passive movements to an unseen target using a robot arm. We find that learning through passive movements paired with reinforcement is comparable with learning associated with active movement, both in terms of magnitude and durability, with improvements due to training still observable at a 1 week retest. Motor learning is also accompanied by changes in somatosensory perceptual acuity. No stable changes in motor performance are observed for participants that train, actively or passively, in the absence of reinforcement, or for participants who are given explicit information about target position in the absence of somatosensory experience. These findings indicate that the somatosensory system dominates learning in the early stages of motor skill acquisition.

SIGNIFICANCE STATEMENT

The research focuses on the initial stages of human motor learning, introducing a new experimental model that closely approximates the key features of motor learning outside of the laboratory. The finding indicates that it is the somatosensory system rather than the motor system that dominates learning in the early stages of motor skill acquisition. This is important given that most of our computational models of motor learning are based on the idea that learning is motoric in origin. This is also a valuable finding for rehabilitation of patients with limited mobility as it shows that reinforcement in conjunction with passive movement results in benefits to motor learning that are as great as those observed for active movement training.

Sensory Plasticity in Human Motor Learning

There is accumulating evidence from behavioral, neurophysiological, and neuroimaging studies that the acquisition of motor skills involves both perceptual and motor learning. Perceptual learning alters movements, motor learning, and motor networks of the brain. Motor learning changes perceptual function and the sensory circuits of the brain. Here, we review studies of both human limb movement and speech that indicate that plasticity in sensory and motor systems is reciprocally linked. Taken together, this points to an approach to motor learning in which perceptual learning and sensory plasticity have a fundamental role.

Transfer of tactile perceptual learning to untrained neighboring fingers reflects natural use relationships

Tactile learning transfers from trained to untrained fingers in a pattern that reflects overlap between the representations of fingers in the somatosensory system (e.g., neurons with multifinger receptive fields). While physical proximity on the body is known to determine the topography of somatosensory representations, tactile coactivation is also an established organizing principle of somatosensory topography. In this study we investigated whether tactile coactivation, induced by habitual inter-finger cooperative use (use pattern), shapes inter-finger overlap. To this end, we used psychophysics to compare the transfer of tactile learning from the middle finger to its adjacent fingers. This allowed us to compare transfer to two fingers that are both physically and cortically adjacent to the middle finger but have differing use patterns. Specifically, the middle finger is used more frequently with the ring than with the index finger. We predicted this should lead to greater representational overlap between the former than the latter pair. Furthermore, this difference in overlap should be reflected in differential learning transfer from the middle to index vs. ring fingers. Subsequently, we predicted temporary learning-related changes in the middle finger's representation (e.g., cortical magnification) would cause transient interference in perceptual thresholds of the ring, but not the index, finger. Supporting this, longitudinal analysis revealed a divergence where learning transfer was fast to the index finger but relatively delayed to the ring finger. Our results support the theory that tactile coactivation patterns between digits affect their topographic relationships. Our findings emphasize how action shapes perception and somatosensory organization.

The role of internal forward models and proprioception in hand position estimation

Our ability to properly move and react in different situations is largely dependent on our perception of our limbs' position. At least three sources - vision, proprioception, and internal forward models (FMs) - seem to contribute to this perception. To the best of our knowledge, the effect of each source has not been studied individually. Specifically, role of FM has been ignored in some previous studies. We hypothesized that FM has a critical role in subjects' perception which needs to be considered in the relevant studies to obtain more reliable results. Therefore, we designed an experiment with the goal of investigating FM and proprioception role in subjects' perception of their hand's position. Three groups of subjects were recruited in the study. Based on the experiment design, it was supposed that subjects in different groups relied on proprioception, FM, and both of them for estimating their unseen hand's position. Comparing the results of three groups revealed significant difference between their estimation' errors. FM provided minimum estimation error, while proprioception had a bias error in the tested region. Integrating proprioception with FM decreased this error. Integration of two Gaussian functions, fitted to the error distribution of FM and proprioception groups, was simulated and created a mean error value almost similar to the experimental observation. These results suggest that FM role needs to be considered when studying the perceived position of the limbs. This can lead to gain better insights into the mechanisms underlying the perception of our limbs' position which might have potential clinical and rehabilitation applications, e.g., in the postural control of elderly which are at high risk of falls and injury because of deterioration of their perception with age.

Transfer Effect of Speech-sound Learning on Auditory-motor Processing of Perceived Vocal Pitch Errors

Speech perception and production are intimately linked. There is evidence that speech motor learning results in changes to auditory processing of speech. Whether speech motor control benefits from perceptual learning in speech, however, remains unclear. This event-related potential study investigated whether speech-sound learning can modulate the processing of feedback errors during vocal pitch regulation. Mandarin speakers were trained to perceive five Thai lexical tones while learning to associate pictures with spoken words over 5 days. Before and after training, participants produced sustained vowel sounds while they heard their vocal pitch feedback unexpectedly perturbed. As compared to the pre-training session, the magnitude of vocal compensation significantly decreased for the control group, but remained consistent for the trained group at the post-training session. However, the trained group had smaller and faster N1 responses to pitch perturbations and exhibited enhanced P2 responses that correlated significantly with their learning performance. These findings indicate that the cortical processing of vocal pitch regulation can be shaped by learning new speech-sound associations, suggesting that perceptual learning in speech can produce transfer effects to facilitating the neural mechanisms underlying the online monitoring of auditory feedback regarding vocal production.

Redistribution of neural phase coherence reflects establishment of feedforward map in speech motor adaptation

Despite recent progress in our understanding of sensorimotor integration in speech learning, a comprehensive framework to investigate its neural basis is lacking at behaviorally relevant timescales. Structural and functional imaging studies in humans have helped us identify brain networks that support speech but fail to capture the precise spatiotemporal coordination within the networks that takes place during speech learning. Here we use neuronal oscillations to investigate interactions within speech motor networks in a paradigm of speech motor adaptation under altered feedback with continuous recording of EEG in which subjects adapted to the real-time auditory perturbation of a target vowel sound. As subjects adapted to the task, concurrent changes were observed in the theta-gamma phase coherence during speech planning at several distinct scalp regions that is consistent with the establishment of a feedforward map. In particular, there was an increase in coherence over the central region and a decrease over the fronto-temporal regions, revealing a redistribution of coherence over an interacting network of brain regions that could be a general feature of error-based motor learning in general. Our findings have implications for understanding the neural basis of speech motor learning and could elucidate how transient breakdown of neuronal communication within speech networks relates to speech disorders.

Robot-assisted training of the kinesthetic sense: enhancing proprioception after stroke

Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration, and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved seven chronic hemiparetic subjects over 3 weeks. The protocol included evaluation sessions that consisted of a psychometric estimate of the subject's kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their improvement in time.

Plasticity in the human speech motor system drives changes in speech perception

Recent studies of human speech motor learning suggest that learning is accompanied by changes in auditory perception. But what drives the perceptual change? Is it a consequence of changes in the motor system? Or is it a result of sensory inflow during learning? Here, subjects participated in a speech motor-learning task involving adaptation to altered auditory feedback and they were subsequently tested for perceptual change. In two separate experiments, involving two different auditory perceptual continua, we show that changes in the speech motor system that accompany learning drive changes in auditory speech perception. Specifically, we obtained changes in speech perception when adaptation to altered auditory feedback led to speech production that fell into the phonetic range of the speech perceptual tests. However, a similar change in perception was not observed when the auditory feedback that subjects' received during learning fell into the phonetic range of the perceptual tests. This indicates that the central motor outflow associated with vocal sensorimotor adaptation drives changes to the perceptual classification of speech sounds.

A new method for evaluating kinesthetic acuity during haptic interaction

Although proprioceptive impairment is likely to affect in a significant manner the capacity of stroke patients to recover functionality of upper limb, clinical assessment methods currently in use are rather crude, with a low level of reliability and a limited capacity to discriminate the relevant features of this severe deficit. In the present paper, we describe a new technique based on robot technology, with the goal of providing a reliable, accurate, and quantitative evaluation of kinesthetic acuity, which can be integrated in robot therapy. The proposed technique, based on a pulsed assistance paradigm, has been evaluated on a group of healthy subjects.

The effects of training breadth on motor generalization

To generate new movements, we have to generalize what we have learned from previously practiced movements. An important question, therefore, is how the breadth of training affects generalization: does practicing a broad or narrow range of movements lead to better generalization? We address this question with a force field learning experiment. One group adapted while making many reaches in a small region (narrow group), and another group adapted while making reaches in a large region (broad group). Subsequently, both groups were tested for their ability to generalize without visual feedback. Not surprisingly, the narrow group exhibited smaller adaptation errors, yet they did not generalize any better than the broad group. Path errors during generalization were indistinguishable across the two groups, whereas the broad group exhibited reduced terminal errors. These findings indicate that overall, practicing a variety of movements is advantageous for performance during generalization; movement paths are not hindered, and terminal errors are superior. Moreover, the evidence suggests a dissociation between the ability to generalize information about a novel dynamic disturbance, which generalizes narrowly, and the ability to locate the limb accurately in space, which generalizes broadly.

Structure of plasticity in human sensory and motor networks due to perceptual learning

As we begin to acquire a new motor skill, we face the dual challenge of determining and refining the somatosensory goals of our movements and establishing the best motor commands to achieve our ends. The two typically proceed in parallel, and accordingly it is unclear how much of skill acquisition is a reflection of changes in sensory systems and how much reflects changes in the brain's motor areas. Here we have intentionally separated perceptual and motor learning in time so that we can assess functional changes to human sensory and motor networks as a result of perceptual learning. Our subjects underwent fMRI scans of the resting brain before and after a somatosensory discrimination task. We identified changes in functional connectivity that were due to the effects of perceptual learning on movement. For this purpose, we used a neural model of the transmission of sensory signals from perceptual decision making through to motor action. We used this model in combination with a partial correlation technique to parcel out those changes in connectivity observed in motor systems that could be attributed to activity in sensory brain regions. We found that, after removing effects that are linearly correlated with somatosensory activity, perceptual learning results in changes to frontal motor areas that are related to the effects of this training on motor behavior and learning. This suggests that perceptual learning produces changes to frontal motor areas of the brain and may thus contribute directly to motor learning.