Origins of submovements in movements of elderly adults

Neural Underpinnings of Learning in Dementia Populations: A Review of Motor Learning Studies Combined with Neuroimaging

The intent of this review article is to serve as an overview of current research regarding the neural characteristics of motor learning in Alzheimer disease (AD) as well as prodromal phases of AD: at-risk populations, and mild cognitive impairment. This review seeks to provide a cognitive framework to compare various motor tasks. We will highlight the neural characteristics related to cognitive domains that, through imaging, display functional or structural changes because of AD progression. In turn, this motivates the use of motor learning paradigms as possible screening techniques for AD and will build upon our current understanding of learning abilities in AD populations.

Role of the Cerebellum in the Construction of Functional and Geometrical Spaces

The perceptual and motor systems appear to have a set of movement primitives that exhibit certain geometric and kinematic invariances. Complex patterns and mental representations can be produced by (re)combining some simple motor elements in various ways using basic operations, transformations, and respecting a set of laws referred to as kinematic laws of motion. For example, point-to-point hand movements are characterized by straight hand paths with single-peaked-bell-shaped velocity profiles, whereas hand speed profiles for curved trajectories are often irregular and more variable, with speed valleys and inflections extrema occurring at the peak curvature. Curvature and speed are generically related by the 2/3 power law. Mathematically, such laws can be deduced from a combination of Euclidean, affine, and equi-affine geometries, whose neural correlates have been partially detected in various brain areas including the cerebellum and the basal ganglia. The cerebellum has been found to play an important role in the control of coordination, balance, posture, and timing over the past years. It is also assumed that the cerebellum computes forward internal models in relationship with specific cortical and subcortical brain regions but its motor relationship with the perceptual space is unclear. A renewed interest in the geometrical and spatial role of the cerebellum may enable a better understanding of its specific contribution to the action-perception loop and behavior's adaptation. In this sense, we complete this overview with an innovative theoretical framework that describes a possible implementation and selection by the cerebellum of geometries adhering to different mathematical laws.

The type 1 submovement conundrum: an investigation into the function of velocity zero-crossings within two-component aiming movements

In rapid manual aiming, traditional wisdom would have it that two components manifest from feedback-based processes, where error accumulated within the primary submovement can be corrected within the secondary submovement courtesy of online sensory feedback. In some aiming contexts, there are more type 1 submovements (overshooting) compared to types 2 and 3 submovements (undershooting), particularly for more rapid movements. These particular submovements have also been attributed to a mechanical artefact involving movement termination and stabilisation. Hence, the goal of our study was to more closely examine the function of type 1 submovements by revisiting some of our previous datasets. We categorised these submovements according to whether the secondary submovement moved the limb closer (functional), or not (non-functional), to the target. Overall, there were both functional and non-functional submovements with a significantly higher proportion for the former. The displacement at the primary and secondary submovements, and negative velocity peak were significantly greater in the functional compared to non-functional. The influence of submovement type on other movement characteristics, including movement time, was somewhat less clear. These findings indicate that the majority of type 1 submovements are related to intended feedforward- and/or feedback-based processes, although there are a portion that can be attributed an indirect manifestation of a mechanical artefact. As a result, we suggest that submovements should be further categorised by their error-reducing function.

Optimization in Manual Aiming: Relating Inherent Variability and Target Size, and Its Influence on Tendency

For manual aiming, the optimized submovement model predicts a tendency toward target-center of primary movement endpoints (probabilistic strategy), while the minimization model predicts target undershooting ("play-it-safe" strategy). The spatial variability of primary movement endpoints directed toward a cross-hair (400-500 ms) (Session 1) were scaled by a multiplicative factor (x1 - 4) to form circular targets of different sizes (Session 2). In recognition of both models, it was predicted that the more that inherent variability exceeded the target size, the greater the tendency to shift from target-center aiming to target undershooting. The central tendency of primary movement endpoints was not influenced by the targets, while it neared target-center. These findings concur with a probabilistic strategy, although we speculate on factors that might otherwise foster a "play-it-safe" strategy.

Age and Not the Preferred Limb Influences the Kinematic Structure of Pointing Movements

In goal-directed movements, effective open-loop control reduces the need for feedback-based corrective submovements. The purpose of this study was to determine the influence of hand preference and aging on submovements during single- and two-joint pointing movements. A total of 12 young and 12 older right-handed participants performed pointing movements that involved either elbow extension or a combination of elbow extension and horizontal shoulder flexion with their right and left arms to a target. Kinematics were used to separate the movements into their primary and secondary submovements. The older adults exhibited slower movements, used secondary submovements more often, and produced relatively shorter primary submovements. However, there were no interlimb differences for either age group or for the single- and two-joint movements. These findings indicate that open-loop control is similar between arms but compromised in older compared to younger adults.

Acceleration Gait Measures as Proxies for Motor Skill of Walking: A Narrative Review

In adults 65 years or older, falls or other neuromotor dysfunctions are often framed as walking-related declines in motor skill; the frequent occurrence of such decline in walking-related motor skill motivates the need for an improved understanding of the motor skill of walking. Simple gait measurements, such as speed, do not provide adequate information about the quality of the body motion's translation during walking. Gait measures from accelerometers can enrich measurements of walking and motor performance. This review article will categorize the aspects of the motor skill of walking and review how trunk-acceleration gait measures during walking can be mapped to motor skill aspects, satisfying a clinical need to understand how well accelerometer measures assess gait. We will clarify how to leverage more complicated acceleration measures to make accurate motor skill decline predictions, thus furthering fall research in older adults.

Comparison of upper limb kinematics in two activities of daily living with different handling requirements

INTRODUCTION

Recently, kinematic analysis of the drinking task (DRINK) has been recommended to assess the quality of upper limb (UL) movement after stroke, but the accomplishment of this task may become difficult for poststroke patients with hand impairment. Therefore, it is necessary to study ADLs that involve a simpler interaction with a daily life target, such as the turning on a light task (LIGHT). As the knowledge of movement performed by healthy adults becomes essential to assess the quality of movement of poststroke patients, the main goal of this article was to compare the kinematic strategies used by healthy adults in LIGHT with those that are used in DRINK.

METHODS

63 adults, aged 30 to 69 years old, drank water and turned on a light, using both ULs separately, while seated. The movements of both tasks were captured by a 3D motion capture system. End-point and joint kinematics of reaching and returning phases were analysed. A multifactorial analysis of variance with repeated measures was applied to the kinematic metrics, using age, sex, body mass index and dominance as main factors.

RESULTS

Mean and peak velocities, index of curvature, shoulder flexion and elbow extension were lower in LIGHT, which suggests that the real hand trajectory was smaller in this task. In LIGHT, reaching was less smooth and returning was smoother than DRINK. The instant of peak velocity was similar in both tasks. There was a minimal anterior trunk displacement in LIGHT, and a greater anterior trunk displacement in DRINK. Age and sex were the main factors which exerted effect on some of the kinematics, especially in LIGHT.

CONCLUSION

The different target formats and hand contact in DRINK and LIGHT seem to be responsible for differences in velocity profile, efficiency, smoothness, joint angles and trunk displacement. Results suggest that the real hand trajectory was smaller in LIGHT and that interaction with the switch seems to be less demanding than with the glass. Accordingly, LIGHT could be a good option for the assessment of poststroke patients without grasping ability. Age and sex seem to be the main factors to be considered in future studies for a better match between healthy and poststroke adults.

Methodological considerations for kinematic analysis of upper limbs in healthy and poststroke adults. Part I: A systematic review of sampling and motor tasks

BACKGROUND AND PURPOSE

The purpose of this study was to review the methods used to analyze the kinematics of upper limbs (ULs) of healthy and poststroke adults, namely specificities of sampling and motor tasks.

SUMMARY OF REVIEW

A database of articles published in the last decade was compiled using the following search terms combinations: ("upper extremity" OR "upper limb" OR arm) AND (kinematics OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review (1) had the purpose to analyze objectively a three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living (ADL) involving uppers limbs, and (3) studied healthy and/or poststroke adults. Fourteen articles were included (four studied a healthy sample, three analyzed poststroke patients, and seven examined both poststroke and healthy participants).

CONCLUSION

Most of the recommended demographic and stroke information, such as some preexisting conditions to stroke, initial stroke severity, and stroke location, were not collected by all or most of the articles. Time poststroke onset was presented in all articles but showed great variability. Few articles identified anthropometric characteristics and adjusted task environment to them. Most of the samples were composed mainly by males and had a low mean age, which does not represent poststroke population. Most articles analyzed "functional movements", namely simulations of ADL. Implication of key findings: Future research should identify the recommended information to allow an adequate stratification. Acute phase after stroke, real ADL with different complexities, and ipsilesional UL should be studied.

Quantitative evaluation of age-related decline in control of preprogramed movement

In this paper, we examined the age-related changes in control of preprogramed movement, with emphasis on its accuracy. Forty-nine healthy subjects participated in this study, and were divided into three groups depending on their ages: the young group (20–39 years) (n = 16), the middle-age group (40–59 years) (n = 16), and the elderly group (60–79 years) (n = 17). We asked the subjects to perform step-tracking movements of the wrist joint with a manipulandum, and recorded the movements. We evaluated the accuracy of control of preprogramed movement in the three groups in terms of the primary submovement, which was identified as the first segment of the step-tracking movement based on the bell-shaped velocity profile, and calculated the distance between the end position of the primary submovement and the target (i.e. error). The error in the young group was found to be significantly smaller than that in the middle-age and elderly groups, i.e., the error was larger for the higher age groups. These results suggest that young subjects have better control of preprogramed movement than middle-age or elderly subjects. Finally, we examined the temporal property of the primary submovement and its age-related changes. The duration of the primary submovement tended to be longer for the aged groups, although significance was reached only for the elderly group. In particular, the ratio of the duration of the primary submovement to total movement time tended to be lower for the aged groups, suggesting that the proportion of additional movements that are required to compensate for the incomplete control in the preprogramed movement, which are under feedback control, was higher for the aged groups. Consequently, our results indicate that the distance between the end point of the primary submovement and the target center (i.e. error) in the step-tracking movement is a useful parameter to evaluate the age-related changes in control of preprogramed movement.

The violation of Fitts' Law: an examination of displacement biases and corrective submovements

Fitts' Law holds that, to maintain accuracy, movement times of aiming movements must change as a result of varying degrees of movement difficulty. Recent evidence has emerged that aiming to a target located last in an array of placeholders results in a shorter movement time than would be expected by the Fitts' equation-a violation of Fitts' Law. It has been suggested that the violation emerges because the performer adopts an optimized movement strategy in which they partially pre-plan an action to the closest placeholder (undershoot the last placeholder) and rely on a secondary acceleration to propel the limb toward the last location when it is selected as the target (Glazebrook et al. in Hum Mov Sci 39:163-176, 2015). In the current study, we examine this proposal and further elucidate the processes underlying the violation by examining limb displacement and corrective submovements that occur when performers aim to different target locations. For our Main Study, participants executed discrete aiming movements in a five-placeholder array. We also reanalyzed data from a previously reported study in which participants aimed in placeholder and no-placeholder conditions (Blinch et al. in Exp Brain Res 223:505-515, 2012). The results showed the violation of Fitts' Law unfolded following peak velocity (online control). Further, the analysis showed that movements to the last target tended to overshoot and had a higher proportion of secondary submovements featuring a reversal than other categories of submovement (secondary accelerations, discontinuities). These findings indicate that the violation of Fitts' Law may, in fact, result from a strategic bias toward planning farther initial displacements of the limb which accommodates a shorter time in online control.

Sensori-motor strategic variations and sequential effects in young and older adults performing a Fitts' task

The present study aimed at investigating age-related changes in strategic variations and sequential effects in discrete Fitts' aiming task. Three sequential effects were investigated, namely trial sequential difficulty effects (TSDE), strategy sequential difficulty effects (SSDE), and strategy repetition effects (SRE). After generalizing previously observed aging effects on strategic variations, our results showed that movement times were longer when performed after harder ID level than when following easier ID level (TSDE). We also observed SSDE, such that is movement times were longer when participants executed a strategy of intermediate difficulty (i.e., the progressive-deceleration strategy) after having used a more difficult strategy (i.e., the undershoot strategy) on the previous trial than after an easier strategy (i.e., the one-shot strategy). These sequential difficulty effects related to both difficulty and strategy were similar in young and older adults. In addition, we found that across two successive trials, participants tended to repeat the one-shot strategy the most often and the undershoot strategy the least often, with repetition rates of the progressive-deceleration strategy being in-between (SRE). Finally, age-related differences in strategy repetition effects varied with strategies (e.g., they were largest for the one-shot strategy). These findings have important implications for deciphering processes responsible for sequential effects in sensori-motor tasks as well as in cognitive tasks in general, and for our understanding of processes underlying sensori-motor performance in young and older adults.

Submovements during reaching movements after stroke

Neurological deficits after cerebrovascular accidents very frequently disrupt the kinematics of voluntary movements with the consequent impact in daily life activities. Robotic methodologies enable the quantitative characterization of specific control deficits needed to understand the basis of functional impairments and to design effective rehabilitation therapies. In a group of right handed chronic stroke survivors (SS) with right side hemiparesis, intact proprioception, and differing levels of motor impairment, we used a robotic manipulandum to study right arm function during discrete point-to-point reaching movements and reciprocal out-and-back movements to visual targets. We compared these movements with those of neurologically intact individuals (NI). We analyzed the presence of secondary submovements in the initial (i.e. outward) trajectory portion of the two tasks and found that the SS with severe impairment (FM < 30) presented arm submovements that differed notably not only from NI but also from those of SS with moderate arm impairment (FM 30-50). Therefore the results of this pilot study suggest that in SS arm kinematics vary significantly across differing levels of motor impairment. Our results support the development of rehabilitation therapies carefully tailored to each individual stroke survivor.

Primary and submovement control of aiming in C6 tetraplegics following posterior deltoid transfer

BACKGROUND

Upper limb motor control in fast, goal-directed aiming is altered in tetraplegics following posterior-deltoid musculotendinous transfer. Specifically, movements have similar end-point accuracy but longer duration and lower peak velocity than those of age-matched, neurotypical controls. Here, we examine in detail the interplay between primary movement and submovement phases in five C6 tetraplegic and five control participants.

METHODS

Aiming movements were performed in two directions (20 cm away or toward), with or without vision. Trials that contained a submovement phase (i.e., discontinuity in velocity, acceleration or jerk) were identified. Discrete kinematic variables were then extracted on the primary and submovements phases.

RESULTS

The presence of submovements did not differ between the tetraplegic (68%) and control (57%) groups, and almost all submovements resulted from acceleration and jerk discontinuities. Tetraplegics tended to make a smaller amplitude primary movement, which had lower peak velocity and greater spatial variability at peak velocity. This was followed by a larger amplitude and longer duration secondary submovement. Peak velocity of primary movement was not related to submovement incidence. Together, the primary and submovement phases of both groups were equally effective in reducing end-point error.

CONCLUSIONS

C6 tetraplegic participants exhibit some subtle differences in measures of motor behaviour compared to control participants, but importantly feedforward and feedback processes work effectively in combination to achieve accurate goal-directed aiming.

Spectral analyses of wrist motion in individuals poststroke: the development of a performance measure with promise for unsupervised settings

BACKGROUND

Upper extremity use in daily life is a critical ingredient of continued functional recovery after cerebral stroke. However, time-evolutions of use-dependent motion quality are poorly understood due to limitations of existing measurement tools.

OBJECTIVE

Proof-of-concept study to determine if spectral analyses explain the variability of known temporal kinematic movement quality (ie, movement duration, number of peaks, jerk) for uncontrolled reach-to-grasp tasks.

METHODS

Ten individuals with chronic stroke performed unimanual goal-directed movements using both hands, with and without task object present, wearing accelerometers on each wrist. Temporal and spectral measures were extracted for each gesture. The effects of performance condition on outcome measures were determined using 2-way, within subject, hand (nonparetic vs paretic) × object (present vs absent) analysis of variance. Regression analyses determined if spectral measures explained the variability of the temporal measures.

RESULTS

There were main effects of hand on all 3 temporal measures and main effects of object on movement duration and peaks. For the paretic limb, spectral measures explain 41.2% and 51.1% of the variability in movement duration and peaks, respectively. For the nonparetic limb, spectral measures explain 40.1%, 42.5%, and 27.8% of the variability of movement duration, peaks, and jerk, respectively.

CONCLUSIONS

Spectral measures explain the variability of motion efficiency and control in individuals with stroke. Signal power from 1.0 to 2.0 Hz is sensitive to changes in hand and object. Analyzing the evolution of this measure in ambient environments may provide as yet uncharted information useful for evaluating long-term recovery.

Use of a tracing task to assess visuomotor performance: effects of age, sex, and handedness

BACKGROUND

Visuomotor abnormalities are common in aging and age-related disease, yet difficult to quantify. This study investigated the effects of healthy aging, sex, and handedness on the performance of a tracing task. Participants (n = 150, aged 21-95 years, 75 females) used a stylus to follow a moving target around a circle on a tablet computer with their dominant and nondominant hands. Participants also performed the Trail Making Test (a measure of executive function).

METHODS

Deviations from the circular path were computed to derive an "error" time series. For each time series, absolute mean, variance, and complexity index (a proposed measure of system functionality and adaptability) were calculated. Using the moving target and stylus coordinates, the percentage of task time within the target region and the cumulative micropause duration (a measure of motion continuity) were computed.

RESULTS

All measures showed significant effects of aging (p < .0005). Post hoc age group comparisons showed that with increasing age, the absolute mean and variance of the error increased, complexity index decreased, percentage of time within the target region decreased, and cumulative micropause duration increased. Only complexity index showed a significant difference between dominant versus nondominant hands within each age group (p < .0005). All measures showed relationships to the Trail Making Test (p < .05).

CONCLUSIONS

Measures derived from a tracing task identified performance differences in healthy individuals as a function of age, sex, and handedness. Studies in populations with specific neuromotor syndromes are warranted to test the utility of measures based on the dynamics of tracking a target as a clinical assessment tool.

Impairment of gradual muscle adjustment during wrist circumduction in Parkinson's disease

Purposeful movements are attained by gradually adjusted activity of opposite muscles, or synergists. This requires a motor system that adequately modulates initiation and inhibition of movement and selectively activates the appropriate muscles. In patients with Parkinson's disease (PD) initiation and inhibition of movements are impaired which may manifest itself in e.g. difficulty to start and stop walking. At single-joint level, impaired movement initiation is further accompanied by insufficient inhibition of antagonist muscle activity. As the motor symptoms in PD primarily result from cerebral dysfunction, quantitative investigation of gradually adjusted muscle activity during execution of purposeful movement is a first step to gain more insight in the link between impaired modulation of initiation and inhibition at the levels of (i) cerebrally coded task performance and (ii) final execution by the musculoskeletal system. To that end, the present study investigated changes in gradual adjustment of muscle synergists using a manipulandum that enabled standardized smooth movement by continuous wrist circumduction. Differences between PD patients (N = 15, off-medication) and healthy subjects (N = 16) concerning the relation between muscle activity and movement performance in these groups were assessed using kinematic and electromyographic (EMG) recordings. The variability in the extent to which a particular muscle was active during wrist circumduction--defined as muscle activity differentiation--was quantified by EMG. We demonstrated that more differentiated muscle activity indeed correlated positively with improved movement performance, i.e. higher movement speed and increased smoothness of movement. Additionally, patients employed a less differentiated muscle activity pattern than healthy subjects. These specific changes during wrist circumduction imply that patients have a decreased ability to gradually adjust muscles causing a decline in movement performance. We propose that less differentiated muscle use in PD patients reflects impaired control of modulated initiation and inhibition due to decreased ability to selectively and jointly activate muscles.

Manipulation of a fragile object by elderly individuals

We investigated strategies of healthy elderly participants (74-84 years old) during prehension and transport of an object with varying degrees of fragility. Fragility was specified as the maximal normal force that the object could withstand without collapsing. Specifically, kinetic and kinematic variables as well as and force covariation indices were quantified and compared to those shown by young healthy persons (19-28 years old). We tested three hypotheses related to age-related changes in two safety margins (slip safety margin and crush safety margin) and indices of force covariation. Compared to young controls, elderly individuals exhibited a decrease in object acceleration and an increase in movement time, an increase in grip force production, a decrease in the correlation between grip and load forces, an overall decrease in indices of multi-digit synergies, and lower safety margin indices computed with respect to both dropping and crushing the object. Elderly participants preferred to be at a relatively lower risk of crushing the object even if this led to a higher risk of dropping it. Both groups showed an increase in the index of synergy stabilizing total normal force produced by the four fingers with increased fragility of the object. Age-related changes are viewed as a direct result of physiological changes due to aging, not adaptation to object fragility. Such changes in overall characteristics of prehension likely reflect diminished synergic control by the central nervous system of finger forces with aging. The findings corroborate an earlier hypothesis on an age-related shift from synergic to element-based control.