Efference copy in kinesthetic perception: a copy of what is it?

Neuromechanisms of simulation-based arthroscopic skills assessment: a fNIRS study

BACKGROUND

The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS).

METHODS

We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data.

RESULTS

Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446).

CONCLUSION

Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity.

Dynamic involvement of premotor and supplementary motor areas in bimanual pinch force control

Many activities of daily living require quick shifts between symmetric and asymmetric bimanual actions. Bimanual motor control has been mostly studied during continuous repetitive tasks, while little research has been carried out in experimental settings requiring dynamic changes in motor output generated by both hands. Here, we performed functional magnetic resonance imaging (MRI) while healthy volunteers performed a visually guided, bimanual pinch force task. This enabled us to map functional activity and connectivity of premotor and motor areas during bimanual pinch force control in different task contexts, requiring mirror-symmetric or inverse-asymmetric changes in discrete pinch force exerted with the right and left hand. The bilateral dorsal premotor cortex showed increased activity and effective coupling to the ipsilateral supplementary motor area (SMA) in the inverse-asymmetric context compared to the mirror-symmetric context of bimanual pinch force control while the SMA showed increased negative coupling to visual areas. Task-related activity of a cluster in the left caudal SMA also scaled positively with the degree of synchronous initiation of bilateral pinch force adjustments, irrespectively of the task context. The results suggest that the dorsal premotor cortex mediates increasing complexity of bimanual coordination by increasing coupling to the SMA while SMA provides feedback about motor actions to the sensory system.

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

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

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

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

Does idiopathic carpal tunnel syndrome deteriorate proprioception of the hand? A case-control study

OBJECTIVES

This study aims to investigate the deterioration in kinesthetic kinesthesia (KKS) and visual kinesthesia (VKS) of the hand as a component of proprioception in patients with idiopathic carpal tunnel syndrome (CTS).

PATIENTS AND METHODS

This study included a total of 90 hands of 60 patients (9 males, 51 females; mean age: 47.6±9.4 years; range, 28 to 60 years) who were diagnosed with CTS and 25 hands of 25 healthy individuals (8 males, 17 females; mean age: 42.6±14.4 years; range, 20 to 60 years) as the controls between January 2019 and January 2021. The KKS and VKS scores were compared between the groups. Clinical parameters such as pain levels, hand grip strength (HGS) values, and two-point discrimination (2PD) test scores were compared between the patients with and without KKS or VKS deficits. The association between the severity of electromyographic findings and KKS or VKS deficits was examined.

RESULTS

The mean VKS score of the CTS group was 22.9±1.6 and the KKS score was 20.8±3.4, which was significantly lower than that of the control group (p=0.002 and p<0.001, respectively). The CTS patients performed less accurate repetitions in visually cued (60%) and kinesthetically cued (40%) positions than the control group (100% both). There were significantly more patients with VKS and KKS deficits in the moderate or severe CTS groups than in the mild CTS group (p<0.001 and p=0.007, respectively), and KKS or VKS deficits were significantly associated with the impaired HGS (p=0.042 and p=0.048, respectively) and functional status (p=0.020 and p=0.016, respectively) accompanied by the increased symptom severity (p=0.010 and p=0.002, respectively).

CONCLUSION

Our study results suggest that idiopathic CTS is associated with impaired proprioception and kinesthetic sense of the hand. In addition, idiopathic CTS is related to impaired hand function and severe symptoms. Screening kinesthetic sense in patients with idiopathic CTS prior to decompression surgery or postoperative hand therapy is helpful to set realistic goals and achieve superior clinical outcomes.

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

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

The relationship between response dynamics and the formation of confidence varies across the lifespan

Accurate metacognitive judgments, such as forming a confidence judgment, are crucial for goal-directed behavior but decline with older age. Besides changes in the sensory processing of stimulus features, there might also be changes in the motoric aspects of giving responses that account for age-related changes in confidence. In order to assess the association between confidence and response parameters across the adult lifespan, we measured response times and peak forces in a four-choice flanker task with subsequent confidence judgments. In 65 healthy adults from 20 to 76 years of age, we showed divergent associations of each measure with confidence, depending on decision accuracy. Participants indicated higher confidence after faster responses in correct but not incorrect trials. They also indicated higher confidence after less forceful responses in errors but not in correct trials. Notably, these associations were age-dependent as the relationship between confidence and response time was more pronounced in older participants, while the relationship between confidence and response force decayed with age. Our results add to the notion that confidence is related to response parameters and demonstrate noteworthy changes in the observed associations across the adult lifespan. These changes potentially constitute an expression of general age-related deficits in performance monitoring or, alternatively, index a failing mechanism in the computation of confidence in older adults.

Error-related brain state analysis using electroencephalography in conjunction with functional near-infrared spectroscopy during a complex surgical motor task

Error-based learning is one of the basic skill acquisition mechanisms that can be modeled as a perception-action system and investigated based on brain-behavior analysis during skill training. Here, the error-related chain of mental processes is postulated to depend on the skill level leading to a difference in the contextual switching of the brain states on error commission. Therefore, the objective of this paper was to compare error-related brain states, measured with multi-modal portable brain imaging, between experts and novices during the Fundamentals of Laparoscopic Surgery (FLS) "suturing and intracorporeal knot-tying" task (FLS complex task)-the most difficult among the five psychomotor FLS tasks. The multi-modal portable brain imaging combined functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) for brain-behavior analysis in thirteen right-handed novice medical students and nine expert surgeons. The brain state changes were defined by quasi-stable EEG scalp topography (called microstates) changes using 32-channel EEG data acquired at 250 Hz. Six microstate prototypes were identified from the combined EEG data from experts and novices during the FLS complex task that explained 77.14% of the global variance. Analysis of variance (ANOVA) found that the proportion of the total time spent in different microstates during the 10-s error epoch was significantly affected by the skill level (p < 0.01), the microstate type (p < 0.01), and the interaction between the skill level and the microstate type (p < 0.01). Brain activation based on the slower oxyhemoglobin (HbO) changes corresponding to the EEG band power (1-40 Hz) changes were found using the regularized temporally embedded Canonical Correlation Analysis of the simultaneously acquired fNIRS-EEG signals. The HbO signal from the overlying the left inferior frontal gyrus-opercular part, left superior frontal gyrus-medial orbital, left postcentral gyrus, left superior temporal gyrus, right superior frontal gyrus-medial orbital cortical areas showed significant (p < 0.05) difference between experts and novices in the 10-s error epoch. We conclude that the difference in the error-related chain of mental processes was the activation of cognitive top-down attention-related brain areas, including left dorsolateral prefrontal/frontal eye field and left frontopolar brain regions, along with a 'focusing' effect of global suppression of hemodynamic activation in the experts, while the novices had a widespread stimulus(error)-driven hemodynamic activation without the 'focusing' effect.

Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology

Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R² = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η² = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R² = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.

Understanding implicit sensorimotor adaptation as a process of proprioceptive re-alignment

Multiple learning processes contribute to successful goal-directed actions in the face of changing physiological states, biomechanical constraints, and environmental contexts. Amongst these processes, implicit sensorimotor adaptation is of primary importance, ensuring that movements remain well-calibrated and accurate. A large body of work on reaching movements has emphasized how adaptation centers on an iterative process designed to minimize visual errors. The role of proprioception has been largely neglected, thought to play a passive role in which proprioception is affected by the visual error but does not directly contribute to adaptation. Here, we present an alternative to this visuo-centric framework, outlining a model in which implicit adaptation acts to minimize a proprioceptive error, the distance between the perceived hand position and its intended goal. This proprioceptive re-alignment model (PReMo) is consistent with many phenomena that have previously been interpreted in terms of learning from visual errors, and offers a parsimonious account of numerous unexplained phenomena. Cognizant that the evidence for PReMo rests on correlational studies, we highlight core predictions to be tested in future experiments, as well as note potential challenges for a proprioceptive-based perspective on implicit adaptation.

The influence of the motor command accuracy on the prediction error and the automatic corrective response

The online control system allows for automatic corrective response to unexpected perturbation. This corrective response may involve a prediction error between the sensory prediction by the motor command and the actual feedback signal. Therefore, we attempted to investigate the effect of motor command accuracy on the automatic corrective response. Participants were asked to move a cursor displayed on a monitor and required to reach the center of a Gaussian blob target as accurately as possible for small and large Gaussian blob conditions. The accuracy of the motor command was manipulated by the size of the Gaussian blob. In half of the trials, a perturbation occurred in which the cursor position jumped 10 mm to either the left or right from the actual position, which induced an automatic corrective response. This corrective response was detected by the acceleration signal on the lateral axis. In addition, the prediction error was estimated by the amplitude of the N1 event-related potential (ERP) of the EEG signal. We found that the automatic response and N1 ERP were significantly larger in the small Gaussian blob conditions than in the large one. This result indicates that the automatic corrective response is affected by the certainty of the motor command manipulated by the Gaussian blob. Furthermore, the linear mixed-effect model (LME) indicated that the response is associated with the N1 ERP. Therefore, we suggest that the motor command accuracy affects the prediction error, which in turn modulates the automatic corrective response.

Tactile perception of right middle fingertip suppresses excitability of motor cortex supplying right first dorsal interosseous muscle

The present study examined whether tactile perception of the fingertip modulates excitability of the motor cortex supplying the intrinsic hand muscle and whether this modulation is specific to the fingertip stimulated and the muscle and hand tested. Tactile stimulation was given to one of the five fingertips in the left or right hand, and transcranial magnetic stimulation eliciting motor evoked potential in the first dorsal interosseous muscle (FDI) or abductor digiti minimi was given 200 ms after the onset of tactile stimulation. The corticospinal excitability of the FDI at rest was suppressed by the tactile stimulation of the right middle fingertip, but such suppression was absent for the other fingers stimulated and for the other muscle or hand tested. The persistence and amplitude of the F-wave was not significantly influenced by tactile stimulation of the fingertip in the right hand. These findings indicate that tactile perception of the right middle fingertip suppresses excitability of the motor cortex supplying the right FDI at rest. The suppression of corticospinal excitability was absent during tonic contraction of the right FDI, indicating that the motor execution process interrupts the tactile perception-induced suppression of motor cortical excitability supplying the right FDI. These findings are in line with a view that the tactile perception of the right middle finger induces surround inhibition of the motor cortex supplying the prime mover of the finger neighboring the stimulated finger.

Understanding and Synergy: A Single Concept at Different Levels of Analysis?

Biological systems differ from the inanimate world in their behaviors ranging from simple movements to coordinated purposeful actions by large groups of muscles, to perception of the world based on signals of different modalities, to cognitive acts, and to the role of self-imposed constraints such as laws of ethics. Respectively, depending on the behavior of interest, studies of biological objects based on laws of nature (physics) have to deal with different salient sets of variables and parameters. Understanding is a high-level concept, and its analysis has been linked to other high-level concepts such as "mental model" and "meaning". Attempts to analyze understanding based on laws of nature are an example of the top-down approach. Studies of the neural control of movements represent an opposite, bottom-up approach, which starts at the interface with classical physics of the inanimate world and operates with traditional concepts such as forces, coordinates, etc. There are common features shared by the two approaches. In particular, both assume organizations of large groups of elements into task-specific groups, which can be described with only a handful of salient variables. Both assume optimality criteria that allow the emergence of families of solutions to typical tasks. Both assume predictive processes reflected in anticipatory adjustments to actions (motor and non-motor). Both recognize the importance of generating dynamically stable solutions. The recent progress in studies of the neural control of movements has led to a theory of hierarchical control with spatial referent coordinates for the effectors. This theory, in combination with the uncontrolled manifold hypothesis, allows quantifying the stability of actions with respect to salient variables. This approach has been used in the analysis of motor learning, changes in movements with typical and atypical development and with aging, and impaired actions by patients with various neurological disorders. It has been developed to address issues of kinesthetic perception. There seems to be hope that the two counter-directional approaches will meet and result in a single theoretical scheme encompassing biological phenomena from figuring out the best next move in a chess position to activating motor units appropriate for implementing that move on the chessboard.

Unintentional Force Drifts as Consequences of Indirect Force Control with Spatial Referent Coordinates

We explored the phenomenon of unintentional force drifts in the absence of visual feedback. Based on the idea of direct force control with internal models and on the idea of indirect force control with referent coordinates to the involved muscle groups, contrasting predictions were drawn for changes in the drift magnitude when acting against external spring loads. Fifteen young subjects performed typical accurate force production tasks by pressing with the Index finger at 20% of maximal voluntary contraction (MVC) in isometric conditions and while acting against one of the three external springs with different stiffness. The visual feedback on the force was turned off after 5 s. At the end of each 20-s trial, the subjects relaxed and then tried to reproduce the final force level. The force drifts were significantly smaller in the spring conditions, particularly when acting against more compliant springs. The subjects were unaware of the force drifts and, during force matching, produced forces close to the initial force magnitude, which were not different across the conditions. There was a trend toward larger drifts during performance by the dominant hand. We view these observations as strong arguments in favor of the theory of control with spatial referent coordinates. In particular, force drifts were likely consequences of drifts of referent coordinates to both agonist and antagonist muscles. The lack of drift effects on both perception-to-report and perception-to-act fit the scheme of kinesthetic perception based on the interaction of efferent (referent coordinate) and afferent processes.

Echo State Networks for Estimating Exteroceptive Conditions From Proprioceptive States in Quadruped Robots

We propose a methodology based on reservoir computing for mapping local proprioceptive information acquired at the level of the leg joints of a simulated quadruped robot into exteroceptive and global information, including both the ground reaction forces at the level of the different legs and information about the type of terrain traversed by the robot. Both dynamic estimation and terrain classification can be achieved concurrently with the same reservoir computing structure, which serves as a soft sensor device. Simulation results are presented together with preliminary experiments on a real quadruped robot. They demonstrate the suitability of the proposed approach for various terrains and sensory system fault conditions. The strategy, which belongs to the class of data-driven models, is independent of the robotic mechanical design and can easily be generalized to different robotic structures.