Somatosensory Contribution to the Initial Stages of Human Motor Learning

Double dissociation of visuomotor interaction mediated by visual feedback during continuous de novo motor learning

While the sensorimotor cortices are central neural substrates for motor control and learning, how the interaction between their subregions with visual cortices contributes to acquiring de novo visuomotor skills is poorly understood. We design a continuous visuomotor task in fMRI where participants control a cursor using their fingers while learning an arbitrary finger-to-cursor mapping. To investigate visuomotor interaction in the de novo motor task, we manipulate visual feedback of a cursor such that they learn to control using fingers under two alternating conditions: online cursor feedback is available or unavailable except when a target is reached. As a result, we find double dissociation of fMRI activity in subregions of the sensorimotor and visual cortices. Specifically, motor and late visual cortices are more active with online cursor feedback, and somatosensory and early visual cortices are more active without online cursor feedback. We also find a significant reduction in functional connectivity between somatosensory cortices and early visual cortices, which is highly correlated with performance improvement. These findings support the distinct interaction between subregions of sensorimotor cortices and visual cortices, while the connectivity analysis highlights the critical role of somatosensory cortices during de novo motor learning.

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.

Non-invasive stimulation of the human striatum disrupts reinforcement learning of motor skills

Reinforcement feedback can improve motor learning, but the underlying brain mechanisms remain underexplored. In particular, the causal contribution of specific patterns of oscillatory activity within the human striatum is unknown. To address this question, we exploited a recently developed non-invasive deep brain stimulation technique called transcranial temporal interference stimulation (tTIS) during reinforcement motor learning with concurrent neuroimaging, in a randomized, sham-controlled, double-blind study. Striatal tTIS applied at 80 Hz, but not at 20 Hz, abolished the benefits of reinforcement on motor learning. This effect was related to a selective modulation of neural activity within the striatum. Moreover, 80 Hz, but not 20 Hz, tTIS increased the neuromodulatory influence of the striatum on frontal areas involved in reinforcement motor learning. These results show that tTIS can non-invasively and selectively modulate a striatal mechanism involved in reinforcement learning, expanding our tools for the study of causal relationships between deep brain structures and human behaviour.

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.

Short-Term Reproduction of Active Movement with Visual Feedback and Passive Movement with a Therapist's Hands

Reproducing instructed movements is crucial for practice in motor learning. In this study, we compared the short-term reproduction of active pelvis movements with visual feedback and passive movement with the therapist's hands in an upright stance. Sixteen healthy males (M age = 34.1; SD = 10.2 years) participated in this study. In one condition, healthy males maintained an upright stance while a physical therapist moved the participant's pelvis (passive movement instruction), and in a second condition, the participant actively moved their pelvis with visual feedback of the target and the online trajectory of the center of pressure (active movement instruction). Reproduction errors (displacement of the center of pressure in the medial-lateral axis) 10 s after the passive movement instruction were significantly greater than after the active movement instruction (p < 0.001), but this difference disappeared 30 s after the instruction (p = 0.118). Error of movement reproduction in the anterior-posterior axis after the passive movement instruction was significantly greater than after the active movement instruction, no matter how long the retention interval was between the instruction and reproduction phases (p = 0.025). Taken together, active pelvis movements with visual feedback, rather than passive movement with the therapist's hand, is better to be used for instructing pelvis movements.

The human somatosensory cortex contributes to the encoding of newly learned movements

Recent studies have indicated somatosensory cortex involvement in motor learning and retention. However, the nature of its contribution is unknown. One possibility is that the somatosensory cortex is transiently engaged during movement. Alternatively, there may be durable learning-related changes which would indicate sensory participation in the encoding of learned movements. These possibilities are dissociated by disrupting the somatosensory cortex following learning, thus targeting learning-related changes which may have occurred. If changes to the somatosensory cortex contribute to retention, which, in effect, means aspects of newly learned movements are encoded there, disruption of this area once learning is complete should lead to an impairment. Participants were trained to make movements while receiving rotated visual feedback. The primary motor cortex (M1) and the primary somatosensory cortex (S1) were targeted for continuous theta-burst stimulation, while stimulation over the occipital cortex served as a control. Retention was assessed using active movement reproduction, or recognition testing, which involved passive movements produced by a robot. Disruption of the somatosensory cortex resulted in impaired motor memory in both tests. Suppression of the motor cortex had no impact on retention as indicated by comparable retention levels in control and motor cortex conditions. The effects were learning specific. When stimulation was applied to S1 following training with unrotated feedback, movement direction, the main dependent variable, was unaltered. Thus, the somatosensory cortex is part of a circuit that contributes to retention, consistent with the idea that aspects of newly learned movements, possibly learning-updated sensory states (new sensory targets) which serve to guide movement, may be encoded there.

Comparing Taste Perception Across Modalities in Healthy Adults: Liquids Versus Dissolvable Taste Strips

Taste stimulation has rehabilitative value in dysphagia management, as it activates salient underlying afferent pathways to swallowing which may evoke feedforward effects on swallow biomechanics. Despite its potential beneficial effects on swallow physiology, taste stimulation's clinical application is limited for persons unsafe to orally consume food/liquid. This study aimed to create edible, dissolvable taste strips matched to flavor profiles previously used in research assessing taste's effects on swallowing physiology and brain activity, and to evaluate how similar their perceived intensity and hedonic, or palatability, ratings were between their liquid counterparts. Plain, sour, sweet-sour, lemon, and orange flavor profiles were custom-made in taste strips and liquid modalities. The generalized Labeled Magnitude Scale and hedonic generalized Labeled Magnitude Scale were used to assess intensity and palatability ratings for flavor profiles in each modality. Healthy participants were recruited and stratified across age and sex. Liquids were rated as more intense than taste strips; however, there was no difference in palatability ratings between the modalities. There were significant differences across flavor profiles in intensity and palatability ratings. Collapsed across liquid and taste strip modalities, pairwise comparisons revealed all flavored stimuli were rated as more intense than the plain profile, sour was perceived as more intense and less palatable than all other profiles, and orange was rated as more palatable than sour, lemon, and plain tastants. Taste strips have useful implications for dysphagia management, as they could offer safe and patient-preferred flavor profiles to potentially provide advantageous swallowing and neural hemodynamic responses.

Dissociable Codes in Motor Working Memory

Working memory has been comprehensively studied in sensory domains, like vision, but little attention has been paid to how motor information (e.g., kinematics of recent movements) is maintained and manipulated in working memory. "Motor working memory" (MWM) is important for short-term behavioral control and skill learning. Here, we employed tasks that required participants to encode and recall reaching movements over short timescales. We conducted three experiments (N = 65 undergraduates) to examine MWM under varying cognitive loads, delays, and degrees of interference. The results support a model of MWM that includes an abstract code that flexibly transfers across effectors, and an effector-specific code vulnerable to interfering movements, even when interfering movements are irrelevant to the task. Neither code was disrupted by increasing visuospatial working memory load. These results echo distinctions between representational formats in other domains, suggesting that MWM shares a basic computational structure with other working memory subsystems.

Endocannabinoid-mediated rescue of somatosensory cortex activity, plasticity and related behaviors following an early in life concussion

Due to the assumed plasticity of immature brain, early in life brain alterations are thought to lead to better recoveries in comparison to the mature brain. Despite clinical needs, how neuronal networks and associated behaviors are affected by early in life brain stresses, such as pediatric concussions, have been overlooked. Here we provide first evidence in mice that a single early in life concussion durably increases neuronal activity in the somatosensory cortex into adulthood, disrupting neuronal integration while the animal is performing sensory-related tasks. This represents a previously unappreciated clinically relevant mechanism for the impairment of sensory-related behavior performance. Furthermore, we demonstrate that pharmacological modulation of the endocannabinoid system a year post-concussion is well-suited to rescue neuronal activity and plasticity, and to normalize sensory-related behavioral performance, addressing the fundamental question of whether a treatment is still possible once post-concussive symptoms have developed, a time-window compatible with clinical treatment.

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.

Reoptimization of single-joint motor patterns to non-Earth gravity torques induced by a robotic exoskeleton

Gravity is a ubiquitous component of our environment that we have learned to optimally integrate in movement control. Yet, altered gravity conditions arise in numerous applications from space exploration to rehabilitation, thereby pressing the sensorimotor system to adapt. Here, we used a robotic exoskeleton to reproduce the elbow joint-level effects of arbitrary gravity fields ranging from 1g to -1g, passing through Mars- and Moon-like gravities, and tested whether humans can reoptimize their motor patterns accordingly. By comparing the motor patterns of actual arm movements with those predicted by an optimal control model, we show that our participants (N = 61 ) adapted optimally to each gravity-like torque. These findings suggest that the joint-level effects of a large range of gravities can be efficiently apprehended by humans, thus opening new perspectives in arm weight support training in manipulation tasks, whether it be for patients or astronauts.

Dynamic alterations in the amplitude of low-frequency fluctuation in patients with cerebral small vessel disease

Background and purpose

Previous studies have focused on the changes of dynamic and static functional connections in cerebral small vessel disease (CSVD). However, the dynamic characteristics of local brain activity are poorly understood. The purpose of this study was to investigate the dynamic cerebral activity changes in patients with CSVD using the dynamic amplitude of low-frequency fluctuation (d-ALFF).

Methods

A total of 104 CSVD patients with cognitive impairment (CSVD-CI, n = 52) or normal cognition (CSVD-NC, n = 52) and 63 matched healthy controls (HCs) were included in this study. Every participant underwent magnetic resonance imaging scans and a battery of neuropsychological examinations. The dynamics of spontaneous brain activity were assessed using dynamic changes in the amplitude of low-frequency fluctuation (ALFF) with the sliding-window method. We used voxel-wise one-way analysis of variance (ANOVA) to compare dynamic ALFF variability among the three groups. Post-hoc t-tests were used to evaluate differences between each group pair. Finally, the brain regions with d-ALFF values with differences between CSVD subgroups were taken as regions of interest (ROI), and the d-ALFF values corresponding to the ROI were extracted for partial correlation analysis with memory.

Results

(1) There was no significant difference in age (p = 0.120), sex (p = 0.673) and education (p = 0.067) among CSVD-CI, CSVD-NC and HC groups, but there were significant differences Prevalence of hypertension and diabetes mellitus among the three groups (p < 10-3). There were significant differences in scores of several neuropsychological scales among the three groups (p < 10-3). (2) ANOVA and post-hoc t-test showed that there were dynamic abnormalities of spontaneous activity in several brain regions in three groups, mainly located in bilateral parahippocampal gyrus and bilateral hippocampus, bilateral insular and frontal lobes, and the static activity abnormalities in bilateral parahippocampal gyrus and bilateral hippocampal regions were observed at the same time, suggesting that bilateral parahippocampal gyrus and bilateral hippocampus may be the key brain regions for cognitive impairment caused by CSVD. (3) The correlation showed that d-ALFF in the bilateral insular was slightly correlated with the Mini-Mental State Examination (MMSE) score and disease progression rate. The d-ALFF value of the left postcentral gyrus was negatively correlated with the Clock Drawing Test (CDT) score (r = -0.416, p = 0.004), and the d-ALFF value of the right postcentral gyrus was negatively correlated with the Rey's Auditory Verbal Learning Test (RAVLT) word recognition (r = -0.320, p = 0.028).

Conclusion

There is a wide range of dynamic abnormalities of spontaneous brain activity in patients with CSVD, in which the abnormalities of this activity in specific brain regions are related to memory and execution or emotion.

Ayres Sensory Integration Therapy for a Child With Rett Syndrome: A Case Report

Rett syndrome (RTT) is a neurodevelopmental disorder characterized by severe dyspraxia, hand stereotypies, and sensory processing issues for which there is no known treatment. This case describes a child with classic RTT and the child's responses to an Ayres Sensory Integration (ASI) treatment intervention (36 one-hour sessions, 3 per week). We coded and analyzed 36 detailed treatment notes to answer the following questions: What strategies and factors facilitated or interfered with participation in the intervention? What critical elements of treatment documentation might detect small changes in praxis and participation? How do patterns of motor or praxis milestones that emerge over time relate to this child's level of participation? We observed an increase in participation when the therapist incorporated elements of neurodevelopmental treatment (NDT) and motor learning theory- treatment strategies commonly used with children who have neuromotor conditions. This increase in participation in the ASI intervention emerged at approximately the same time that the therapist documented acquisition of new motor and praxis skills. We observed the importance of using: lateral movement activities to develop weight-shifting and bilateral coordination, rotary play to increase trunk rotation and improve postural transitions, and rhythm to promote continuing or initiating actions. The documentation of the specific amounts of assistance and prompting needed during treatment sessions was an important tool for tracking small yet meaningful responses to treatment. This case illustrates a novel use of ASI intervention supplemented with strategies that developed foundational skills, and the emergence of praxis and participation in the therapeutic intervention. We suggest further research is needed to determine efficacy of ASI for other children with this rare disorder.

Modulation of somatosensation by transcranial magnetic stimulation over somatosensory cortex: a systematic review

Over the last three decades, transcranial magnetic stimulation (TMS) has gained popularity as a tool to modulate human somatosensation. However, the effects of different stimulation types on the multiple distinct subdomains of somatosensation (e.g., tactile perception, proprioception and pain) have not been systematically compared. This is especially notable in the case of newer theta-burst stimulation protocols now in widespread use. Here, we aimed to systematically and critically review the existing TMS literature and provide a complete picture of current knowledge regarding the role of TMS in modulating human somatosensation across stimulation protocols and somatosensory domains. Following the PRISMA guidelines, fifty-four studies were included in the current review and were compared based on their methodologies and results. Overall, findings from these studies provide evidence that different types of somatosensation can be both disrupted and enhanced by targeted stimulation of specific somatosensory areas. Some mixed results, however, were reported in the literature. We discussed possible reasons for these mixed results, methodological limitations of existing investigations, and potential avenues for future research.

Passive somatosensory training enhances piano skill in adolescent and adult pianists: A preliminary study

Sensory afferent information, such as auditory and somatosensory feedback while moving, plays a crucial role in both control and learning of motor performance across the lifespan. Music performance requires skillful integration of multimodal sensory information for the production of dexterous movements. However, it has not been understood what roles somatosensory afferent information plays in the acquisition and sophistication of specialized motor skills of musicians across different stages of development. In the present preliminary study, we addressed this issue by using a novel technique with a hand exoskeleton robot that can externally move the fingers of pianists. Short-term exposure to fast and complex finger movements generated by the exoskeleton (i.e., passive movements) increased the maximum rate of repetitive piano keystrokes by the pianists. This indicates that somatosensory inputs derived from the externally generated motions enhanced the quickness of the sequential finger movements in piano performance, even though the pianists did not voluntarily move the fingers. The enhancement of motor skill through passive somatosensory training using the exoskeleton was more pronounced in adolescent pianists than adult pianists. These preliminary results implicate a sensitive period of neuroplasticity of the somatosensory-motor system of trained pianists, which emphasizes the importance of somatosensory-motor training in professional music education during adolescence.

Memory decay and generalization following distinct motor learning mechanisms

Motor skill learning is considered to arise out of contributions from multiple learning mechanisms, including error-based learning (EBL), use-dependent learning (UDL), and reinforcement learning (RL). These learning mechanisms exhibit dissociable roles and engage different neural circuits during skill acquisition. However, it remains largely unknown how a newly formed motor memory acquired through each learning mechanism decays over time and whether distinct learning mechanisms produce different generalization patterns. Here, we used variants of reaching paradigms that dissociated these learning mechanisms to examine the time course of memory decay following each learning and the generalization patterns of each learning. We found that motor memories acquired through these learning mechanisms decayed as a function of time. Notably, 15 min, 6 h, and 24 h after acquisition, the memory of EBL decayed much greater than that of RL. The memory acquired through UDL faded away within a few minutes. Motor memories formed through EBL and RL for given movement directions generalized to untrained movement directions, with the generalization of EBL being greater than that of RL. In contrast, motor memory of UDL could not generalize to untrained movement directions. These results suggest that distinct learning mechanisms exhibit different patterns of memory decay and generalization.NEW & NOTEWORTHY Motor skill learning is likely to involve error-based learning, use-dependent plasticity, and operant reinforcement. Here, we showed that these dissociable learning mechanisms exhibited distinct patterns of memory decay and generalization. With a better understanding of the characteristics of these learning mechanisms, it becomes possible to regulate each learning process separately to improve neurological rehabilitation.

Effects of guided exploration on reaching measures of auditory peripersonal space

Despite the recognized importance of bodily movements in spatial audition, few studies have integrated action-based protocols with spatial hearing in the peripersonal space. Recent work shows that tactile feedback and active exploration allow participants to improve performance in auditory distance perception tasks. However, the role of the different aspects involved in the learning phase, such as voluntary control of movement, proprioceptive cues, and the possibility of self-correcting errors, is still unclear. We study the effect of guided reaching exploration on perceptual learning of auditory distance in peripersonal space. We implemented a pretest-posttest experimental design in which blindfolded participants must reach for a sound source located in this region. They were divided into three groups that were differentiated by the intermediate training phase: Guided, an experimenter guides the participant’s arm to contact the sound source; Active, the participant freely explores the space until contacting the source; and Control, without tactile feedback. The effects of exploration feedback on auditory distance perception in the peripersonal space are heterogeneous. Both the Guided and Active groups change their performance. However, participants in the Guided group tended to overestimate distances more than those in the Active group. The response error of the Guided group corresponds to a generalized calibration criterion over the entire range of reachable distances. Whereas the Active group made different adjustments for proximal and distal positions. The results suggest that guided exploration can induce changes on the boundary of the auditory reachable space. We postulate that aspects of agency such as initiation, control, and monitoring of movement, assume different degrees of involvement in both guided and active tasks, reinforcing a non-binary approach to the question of activity-passivity in perceptual learning and supporting a complex view of the phenomena involved in action-based learning.

Ventrolateral Prefrontal Cortex Contributes to Human Motor Learning

This study assesses the involvement in human motor learning, of the ventrolateral prefrontal cortex (BA 9/46v), a somatic region in the middle frontal gyrus. The potential involvement of this cortical area in motor learning is suggested by studies in nonhuman primates which have found anatomic connections between this area and sensorimotor regions in frontal and parietal cortex, and also with basal ganglia output zones. It is likewise suggested by electrophysiological studies which have shown that activity in this region is implicated in somatic sensory memory and is also influenced by reward. We directly tested the hypothesis that area 9/46v is involved in reinforcement-based motor learning in humans. Participants performed reaching movements to a hidden target and received positive feedback when successful. Before the learning task, we applied continuous theta burst stimulation (cTBS) to disrupt activity in 9/46v in the left or right hemisphere. A control group received sham cTBS. The data showed that cTBS to left 9/46v almost entirely eliminated motor learning, whereas learning was not different from sham stimulation when cTBS was applied to the same zone in the right hemisphere. Additional analyses showed that the basic reward-history-dependent pattern of movements was preserved but more variable following left hemisphere stimulation, which suggests an overall deficit in somatic memory for target location or target directed movement rather than reward processing per se. The results indicate that area 9/46v is part of the human motor learning circuit.

Changes in excitability and GABAergic neuronal activity of the primary somatosensory cortex after motor learning

Introduction

It is widely known that motor learning changes the excitability of the primary motor cortex. More recently, it has been shown that the primary somatosensory cortex (S1) also plays an important role in motor learning, but the details have not been fully examined. Therefore, we investigated how motor skill training affects somatosensory evoked potential (SEP) in 30 neurologically healthy subjects.

Methods

SEP N20/P25_component and N20/P25 SEP paired-pulse depression (SEP-PPD) were assessed before and immediately after complex or simple visuomotor tasks.

Results

Motor learning was induced more efficiently by the complex visuomotor task than by the simple visuomotor task. Both the N20/P25 SEP amplitude and N20/P25 SEP-PPD increased significantly immediately after the complex visuomotor task, but not after the simple visuomotor task. Furthermore, the altered N20/P25 SEP amplitude was associated with an increase in motor learning efficiency.

Conclusion

These results suggest that motor learning modulated primary somatosensory cortex excitability.

The relationships between motor behavior and sensory gating in the ball rotation task

During voluntary muscle contraction, sensory information induced by electrostimulation of the nerves supplying the contracting muscle is inhibited and the amplitude of the corresponding somatosensory evoked potential (SEP) decreases. This phenomenon is called "gating." The reduction of the SEP amplitude is reportedly significantly larger when task performance is high. However, the relationship between dexterous movement skills and gating remains unclear. In this study, we investigated through a ball rotation (BR) task how dexterous movement skills affect the SEP amplitudes. Thirty healthy subjects performed the BR task comprising the rotation of two wooden balls as quickly as possible. We estimated the median number of ball rotations for each participant and classified the participants into two (fast and slow) groups based on the results. Moreover, we recorded SEPs, while the subjects performed BR tasks or rested. SEP amplitude reduction (P45) was significantly larger in the fast than in the slow group. We also observed that the P45 amplitude during the BR task was attenuated even more so in the case of the participants with better dexterous movement skills. Our results suggest that the participants with better dexterous movement skills might display stronger somatosensory information suppression because of increasing the motor cortex activity and the afferent input during the BR task.

The dissociable effects of reward on sequential motor behavior

Reward has consistently been shown to enhance motor behavior; however, its beneficial effects appear to be largely unspecific. For example, reward is associated with both rapid and training-dependent improvements in performance, with a mechanistic account of these effects currently lacking. Here we tested the hypothesis that these distinct reward-based improvements are driven by dissociable reward types: monetary incentive and performance feedback. Whereas performance feedback provides information on how well a motor task has been completed (knowledge of performance), monetary incentive increases the motivation to perform optimally without providing a performance-based learning signal. Experiment 1 showed that groups who received monetary incentive rapidly improved movement times (MTs), using a novel sequential reaching task. In contrast, only groups with correct performance-based feedback showed learning-related improvements. Importantly, pairing both maximized MT performance gains and accelerated movement fusion. Fusion describes an optimization process during which neighboring sequential movements blend together to form singular actions. Results from experiment 2 served as a replication and showed that fusion led to enhanced performance speed while also improving movement efficiency through increased smoothness. Finally, experiment 3 showed that these improvements in performance persist for 24 h even without reward availability. This highlights the dissociable impact of monetary incentive and performance feedback, with their combination maximizing performance gains and leading to stable improvements in the speed and efficiency of sequential actions.NEW & NOTEWORTHY Our work provides a mechanistic framework for how reward influences motor behavior. Specifically, we show that rapid improvements in speed and accuracy are driven by reward presented in the form of money, whereas knowledge of performance through performance feedback leads to training-based improvements. Importantly, combining both maximized performance gains and led to improvements in movement quality through fusion, which describes an optimization process during which sequential movements blend into a single action.

Reward timing matters in motor learning

Reward timing, that is, the delay after which reward is delivered following an action is known to strongly influence reinforcement learning. Here, we asked if reward timing could also modulate how people learn and consolidate new motor skills. In 60 healthy participants, we found that delaying reward delivery by a few seconds influenced motor learning. Indeed, training with a short reward delay (1 s) induced continuous improvements in performance, whereas a long reward delay (6 s) led to initially high learning rates that were followed by an early plateau in the learning curve and a lower performance at the end of training. Participants who learned the skill with a long reward delay also exhibited reduced overnight memory consolidation. Overall, our data show that reward timing affects the dynamics and consolidation of motor learning, a finding that could be exploited in future rehabilitation programs.

Enhancing Locomotor Learning With Transcutaneous Spinal Electrical Stimulation and Somatosensory Augmentation: A Pilot Randomized Controlled Trial in Older Adults

This study investigated locomotor learning of a complex terrain walking task in older adults, when combined with two adjuvant interventions: transcutaneous spinal direct current stimulation (tsDCS) to increase lumbar spinal cord excitability, and textured shoe insoles to increase somatosensory feedback to the spinal cord. The spinal cord has a crucial contribution to control of walking, and is a novel therapeutic target for rehabilitation of older adults. The complex terrain task involved walking a 10-meter course consisting of nine obstacles and three sections of compliant (soft) walking surface. Twenty-three participants were randomly assigned to one of the following groups: sham tsDCS and smooth insoles (sham/smooth; control group), sham tsDCS and textured insoles (sham/textured), active tsDCS and smooth insoles (active/smooth), and active tsDCS and textured insoles (active/textured). The first objective was to assess the feasibility, tolerability, and safety of the interventions. The second objective was to assess preliminary efficacy for increasing locomotor learning, as defined by retention of gains in walking speed between a baseline visit of task practice, and a subsequent follow-up visit. Variability of the center of mass while walking over the course was also evaluated. The change in executive control of walking (prefrontal cortical activity) between the baseline and follow-up visits was measured with functional near infrared spectroscopy. The study results demonstrated feasibility based on enrollment and retention of participants, tolerability based on self-report, and safety based on absence of adverse events. Preliminary efficacy was supported based on trends showing larger gains in walking speed and more pronounced reductions in mediolateral center of mass variability at the follow-up visit in the groups randomized to active tsDCS or textured insoles. These data justify future larger studies to further assess dosing and efficacy of these intervention approaches. In conclusion, rehabilitation interventions that target spinal control of walking present a potential opportunity for enhancing walking function in older adults.

Altered Spontaneous Brain Activity Related to Neurologic Dysfunction in Patients With Cerebral Small Vessel Disease

Cerebral small vessel disease (CSVD) encompasses several diseases affecting the small arteries, arterioles, venules, and capillaries of the brain and refers to several pathological processes and etiologies. Neuroimaging is considered the gold standard for detecting CSVD, which can present diverse features on MRI. Cerebral microbleeds (CMBs) in CSVD have been demonstrated to play a synergistic role in both cerebrovascular and neurodegenerative pathology. Considering previous studies on brain structural abnormalities in CSVD, in the present study, we aimed to explore altered spontaneous brain activity among CSVD patients using amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo) methods based on resting-state functional MRI. In this study, we recruited 24 CSVD patients with CMBs (CSVD-c), 42 CSVD patients without CMBs (CSVD-n) and 36 healthy controls from outpatient clinics in Shandong Provincial Hospital affiliated to Shandong First Medical University between September 2018 and June 2019. All subjects underwent 3-T MRI, including blood oxygen level-dependent (BOLD) and susceptibility-weighted imaging (SWI). Anatomic structures were segmented, ALFF/fALFF values were calculated, and ReHo maps were generated. Further statistical analysis was applied to study the difference in ALFF/fALFF/ReHo among the three groups and the association between ALFF/fALFF/ReHo changes in different brain regions and clinical characteristics. Twenty-four CSVD-c patients (age: 67.54 ± 6.00 years, 10 females), 42 CSVD-n patients (age: 66.33 ± 5.25 years, 22 females) and 36 healthy subjects (age: 64.14 ± 8.57 years, 19 females) were evaluated. Compared with controls, the CSVD-c group showed significantly increased ALFF values in the right insula, putamen and left precuneus; decreased fALFF values in the right precentral gyrus and postcentral gyrus; and increased ReHo values in the left precuneus, fusiform gyrus, right supplementary motor area (SMA), and superior frontal gyrus. Notably, the mean ALFF values of the right insula and putamen were not only significantly related to all clinical parameters but also demonstrated the best performance in Receiver Operating Characteristic (ROC) curve analysis. These findings reveal CSVD-c patients have dysfunctions in the default mode network, sensorimotor network and frontoparietal network, which may implicate the underlying neurophysiological mechanisms of intrinsic brain activity. The correlation between altered spontaneous neuronal activity and clinical parameters provides early useful diagnostic biomarkers for CSVD.

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.

Clustering analysis of movement kinematics in reinforcement learning

Reinforcement learning has been used as an experimental model of motor skill acquisition, where at times movements are successful and thus reinforced. One fundamental problem is to understand how humans select exploration over exploitation during learning. The decision could be influenced by factors such as task demands and reward availability. In this study, we applied a clustering algorithm to examine how a change in the accuracy requirements of a task affected the choice of exploration over exploitation. Participants made reaching movements to an unseen target using a planar robot arm and received reward after each successful movement. For one group of participants, the width of the hidden target decreased after every other training block. For a second group, it remained constant. The clustering algorithm was applied to the kinematic data to characterize motor learning on a trial-to-trial basis as a sequence of movements, each belonging to one of the identified clusters. By the end of learning, movement trajectories across all participants converged primarily to a single cluster with the greatest number of successful trials. Within this analysis framework, we defined exploration and exploitation as types of behavior in which two successive trajectories belong to different or similar clusters, respectively. The frequency of each mode of behavior was evaluated over the course of learning. It was found that by reducing the target width, participants used a greater variety of different clusters and displayed more exploration than exploitation. Excessive exploration relative to exploitation was found to be detrimental to subsequent motor learning.

NEW & NOTEWORTHY The choice of exploration versus exploitation is a fundamental problem in learning new motor skills through reinforcement. In this study, we employed a data-driven approach to characterize movements on a trial-by-trial basis with an unsupervised clustering algorithm. Using this technique, we found that changes in task demands and, in particular, in the required accuracy of movements, influenced the ratio of exploration to exploitation. This analysis framework provides an attractive tool to investigate mechanisms of explorative and exploitative behavior while studying motor learning.

Functional Connectivity and Networks Underlying Complex Tool-Use Movement in Assembly Workers: An fMRI Study

The aim of this study was to identify the functional connectivity and networks utilized during tool-use in real assembly workers. These brain networks have not been elucidated because the use of tools in real-life settings is more complex than that in experimental environments. We evaluated task-related functional magnetic resonance imaging in 13 assembly workers (trained workers, TW) and 27 age-matched volunteers (untrained workers, UTW) during a tool-use pantomiming task, and resting-state functional connectivity was also analyzed. Two-way repeated-measures analysis of covariance was conducted with the group as a between-subject factor (TW > UTW) and condition (task > resting) as a repeated measure, controlling for assembly time and accuracy as covariates. We identified two patterns of functional connectivity in the whole brain within three networks that distinguished TW from UTW. TW had higher connectivity than UTW between the left middle temporal gyrus and right cerebellum Crus II (false discovery rate corrected p-value, p-FDR = 0.002) as well as between the left supplementary motor area and the pars triangularis of the right inferior frontal gyrus (p-FDR = 0.010). These network integrities may allow for TW to perform rapid tool-use. In contrast, UTW showed a stronger integrity compared to TW between the left paracentral lobule and right angular gyrus (p-FDR = 0.004), which may reflect a greater reliance on sensorimotor input to acquire complex tool-use ability than that of TW. Additionally, the fronto-parietal network was identified as a common network between groups. These findings support our hypothesis that assembly workers have stronger connectivity in tool-specific motor regions and the cerebellum, whereas UTW have greater involvement of sensorimotor networks during a tool-use task.

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.

Reward boosts reinforcement-based motor learning

Besides relying heavily on sensory and reinforcement feedback, motor skill learning may also depend on the level of motivation experienced during training. Yet, how motivation by reward modulates motor learning remains unclear. In 90 healthy subjects, we investigated the net effect of motivation by reward on motor learning while controlling for the sensory and reinforcement feedback received by the participants. Reward improved motor skill learning beyond performance-based reinforcement feedback. Importantly, the beneficial effect of reward involved a specific potentiation of reinforcement-related adjustments in motor commands, which concerned primarily the most relevant motor component for task success and persisted on the following day in the absence of reward. We propose that the long-lasting effects of motivation on motor learning may entail a form of associative learning resulting from the repetitive pairing of the reinforcement feedback and reward during training, a mechanism that may be exploited in future rehabilitation protocols.

Acoustic stimulation increases implicit adaptation in sensorimotor adaptation

Sensorimotor adaptation is an important part of our ability to perform novel motor tasks (i.e., learning of motor skills). Efforts to improve adaptation in healthy and clinical patients using non-invasive brain stimulation methods have been hindered by inter-individual and intra-individual variability in brain susceptibility to stimulation. Here, we explore unpredictable loud acoustic stimulation as an alternative method of modulating brain excitability to improve sensorimotor adaptation. In two experiments, participants moved a cursor towards targets, and adapted to a 30º rotation of cursor feedback, either with or without unpredictable acoustic stimulation. Acoustic stimulation improved initial adaptation to sensory prediction errors in Study 1, and improved overnight retention of adaptation in Study 2. Unpredictable loud acoustic stimulation might thus be a potent method of modulating sensorimotor adaptation in healthy adults.

Null effects of levodopa on reward- and error-based motor adaptation, savings, and anterograde interference

Dopamine signaling is thought to mediate reward-based learning. We tested for a role of dopamine in motor adaptation by administering the dopamine precursor levodopa to healthy participants in two experiments involving reaching movements. Levodopa has been shown to impair reward-based learning in cognitive tasks. Thus, we hypothesized that levodopa would selectively impair aspects of motor adaptation that depend on the reinforcement of rewarding actions. In the first experiment, participants performed two separate tasks in which adaptation was driven either by visual error-based feedback of the hand position or binary reward feedback. We used EEG to measure event-related potentials evoked by task feedback. We hypothesized that levodopa would specifically diminish adaptation and the neural responses to feedback in the reward learning task. However, levodopa did not affect motor adaptation in either task nor did it diminish event-related potentials elicited by reward outcomes. In the second experiment, participants learned to compensate for mechanical force field perturbations applied to the hand during reaching. Previous exposure to a particular force field can result in savings during subsequent adaptation to the same force field or interference during adaptation to an opposite force field. We hypothesized that levodopa would diminish savings and anterograde interference, as previous work suggests that these phenomena result from a reinforcement learning process. However, we found no reliable effects of levodopa. These results suggest that reward-based motor adaptation, savings, and interference may not depend on the same dopaminergic mechanisms that have been shown to be disrupted by levodopa during various cognitive tasks.NEW & NOTEWORTHY Motor adaptation relies on multiple processes including reinforcement of successful actions. Cognitive reinforcement learning is impaired by levodopa-induced disruption of dopamine function. We administered levodopa to healthy adults who participated in multiple motor adaptation tasks. We found no effects of levodopa on any component of motor adaptation. This suggests that motor adaptation may not depend on the same dopaminergic mechanisms as cognitive forms or reinforcement learning that have been shown to be impaired by levodopa.

A Framework for Optimizing Co-adaptation in Body-Machine Interfaces

The operation of a human-machine interface is increasingly often referred to as a two-learners problem, where both the human and the interface independently adapt their behavior based on shared information to improve joint performance over a specific task. Drawing inspiration from the field of body-machine interfaces, we take a different perspective and propose a framework for studying co-adaptation in scenarios where the evolution of the interface is dependent on the users' behavior and that do not require task goals to be explicitly defined. Our mathematical description of co-adaptation is built upon the assumption that the interface and the user agents co-adapt toward maximizing the interaction efficiency rather than optimizing task performance. This work describes a mathematical framework for body-machine interfaces where a naïve user interacts with an adaptive interface. The interface, modeled as a linear map from a space with high dimension (the user input) to a lower dimensional feedback, acts as an adaptive “tool” whose goal is to minimize transmission loss following an unsupervised learning procedure and has no knowledge of the task being performed by the user. The user is modeled as a non-stationary multivariate Gaussian generative process that produces a sequence of actions that is either statistically independent or correlated. Dependent data is used to model the output of an action selection module concerned with achieving some unknown goal dictated by the task. The framework assumes that in parallel to this explicit objective, the user is implicitly learning a suitable but not necessarily optimal way to interact with the interface. Implicit learning is modeled as use-dependent learning modulated by a reward-based mechanism acting on the generative distribution. Through simulation, the work quantifies how the system evolves as a function of the learning time scales when a user learns to operate a static vs. an adaptive interface. We show that this novel framework can be directly exploited to readily simulate a variety of interaction scenarios, to facilitate the exploration of the parameters that lead to optimal learning dynamics of the joint system, and to provide an empirical proof for the superiority of human-machine co-adaptation over user adaptation.

Recognition memory for human motor learning

Motor skill retention is typically measured by asking participants to reproduce previously learned movements from memory. The analog of this retention test (recall memory) in human verbal memory is known to underestimate how much learning is actually retained. Here we asked whether information about previously learned movements, which can no longer be reproduced, is also retained. Following visuomotor adaptation, we used tests of recall that involved reproduction of previously learned movements and tests of recognition in which participants were asked whether a candidate limb displacement, produced by a robot arm held by the subject, corresponded to a movement direction that was experienced during active training. The main finding was that 24 h after training, estimates of recognition memory were about twice as accurate as those of recall memory. Thus, there is information about previously learned movements that is not retrieved using recall testing but can be accessed in tests of recognition. We conducted additional tests to assess whether, 24 h after learning, recall for previously learned movements could be improved by presenting passive movements as retrieval cues. These tests were conducted immediately prior to recall testing and involved the passive playback of a small number of movements, which were spread across the workspace and included both adapted and baseline movements, without being marked as such. This technique restored recall memory for movements to levels close to those of recognition memory performance. Thus, somatic information may enable retrieval of otherwise inaccessible motor memories.

Multiple processes independently predict motor learning

Background

Our ability to acquire, refine and adapt skilled limb movements is a hallmark of human motor learning that allows us to successfully perform many daily activities. The capacity to acquire, refine and adapt other features of motor performance, such as visual search, eye-hand coordination and visuomotor decisions, may also contribute to motor learning. However, the extent to which refinements of multiple behavioral features and their underlying neural processes independently contribute to motor learning remains unknown. In the current study, we used an ethological approach to test the hypothesis that practice-related refinements of multiple behavioral features would be independently predictive of motor learning.

Methods

Eighteen healthy, young adults used an upper-limb robot with eye-tracking to practice six trials of a continuous, visuomotor task once a week for six consecutive weeks. Participants used virtual paddles to hit away 200 “Targets” and avoid hitting 100 “Distractors” that continuously moved towards them from the back of the workspace. Motor learning was inferred from trial-by-trial acquisition and week-by-week retention of improvements on two measures of task performance related to motor execution and motor inhibition. Adaptations involving underlying neural processes were inferred from trial-by-trial acquisition and week-by-week retention of refinements on measures of skilled limb movement, visual search, eye-hand coordination and visuomotor decisions. We tested our hypothesis by quantifying the extent to which refinements on measures of multiple behavioral features (predictors) were independently predictive of improvements on our two measures of task performance (outcomes) after removing all shared variance between predictors.

Results

We found that refinements on measures of skilled limb movement, visual search and eye-hand coordination were independently predictive of improvements on our measure of task performance related to motor execution. In contrast, only refinements of eye-hand coordination were independently predictive of improvements on our measure of task performance related to motor inhibition.

Conclusion

Our results provide indirect evidence that refinements involving multiple, neural processes may independently contribute to motor learning, and distinct neural processes may underlie improvements in task performance related to motor execution and motor inhibition. This also suggests that refinements involving multiple, neural processes may contribute to motor recovery after stroke, and rehabilitation interventions should be designed to produce refinements of all behavioral features that may contribute to motor recovery.

Feasibility Case Study for Treating a Patient with Sensory Ataxia Following a Stroke with Kinesthetic Illusion Induced by Visual Stimulation

Background: Sensory ataxia is a disorder of movement coordination caused by sensory deficits, especially in kinesthetic perception. Visual stimulus-induced kinesthetic illusion (KINVIS) is a method used to provide vivid kinesthetic perception without peripheral sensory input by using a video showing pre-recorded limb movements while the actual limb remains stationary. We examined the effects of KINVIS intervention in a patient with sensory ataxia. Case: The patient was a 59-year-old man with a severe proprioceptive deficit caused by left thalamic hemorrhage. During KINVIS intervention, a computer screen displayed a pre-recorded mirror image video of the patient’s unaffected hand performing flexion–extension movements as if it were attached to the patient’s affected forearm. Kinematics during the flexion–extension movements of the paretic hand were recorded before and after 20-min interventions. Transcranial magnetic stimulation was applied to the affected and non-affected hemispheres. The amplitude of the motor-evoked potential (MEP) at rest was recorded for the muscles of both hands. After the intervention, the total trajectory length and the rectangular area bounding the trajectory of the index fingertip decreased. The MEP amplitude of the paretic hand increased, whereas the MEP amplitude of the non-paretic hand was unchanged. Discussion: The changes in kinematics after the intervention suggested that KINVIS therapy may be a useful new intervention for sensory ataxia, a condition for which few effective treatments are currently available. Studies in larger numbers of patients are needed to clarify the mechanisms underlying this therapeutic effect.

Role of the somatosensory cortex in motor memory consolidation

Motor memories become resistant to interference by the process of consolidation, which leads to long-term retention. Studies have shown involvement of the somatosensory cortex in motor learning-related plasticity, but not directly in motor memory consolidation. This Neuro Forum article reviews evidence from a continuous theta-burst transcranial magnetic stimulation (cTBS) study by Kumar and colleagues (Kumar N, Manning TF, Ostry DJ. PLoS Biol 17: e3000469, 2019) that demonstrates the role of somatosensory, rather than motor, cortex in human motor memory consolidation during implicit motor learning.

Altered Brain Function in Cerebral Small Vessel Disease Patients With Gait Disorders: A Resting-State Functional MRI Study

Gait disturbances are important clinical features of cerebral small vessel disease (CSVD) that increase the risk of falls and disability. Brain structural alterations and gait disturbances in CSVD patients have been well demonstrated. However, intrinsic resting cerebral function patterns in CSVD patients with gait disorders remain largely unknown. Fifty-eight CSVD patients were enrolled in our studies and categorized into the gait disorder group (CSVD-GD, n = 29) and no-gait disorder group (CSVD-NGD, n = 29) based on a gait examination. Gait was quantitatively assessed with the Timed Up and Go test and the intelligent device for energy expenditure and activity (IDEEA). Functional MRI and fractional amplitude of low-frequency fluctuation (fALFF) analyses were employed to explore local intrinsic neural oscillation alterations. Functional connectivity based on fALFF results was calculated to detect the potential changes in remote connectivity. Compared with the CSVD-NGD group, the CSVD-GD group showed decreased fALFF in regions mainly located in the sensorimotor network and frontoparietal network, such as the left supplementary motor area (SMA.L) and the left superior parietal gyrus, and increased fALFF in the right inferior frontal gyrus (orbital part), the left caudate, and the left precuneus. Moreover, the CSVD-GD patients exhibited lower connectivity between the SMA.L and temporal lobe, which was related to gait speed. The fALFF value of the SMA.L was associated with cadence. This study highlights the regional and network interaction abnormalities of the SMA in CSVD patients with gait disturbances. These findings could provide further insight into the neural mechanisms of gait disturbances in CSVD.

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.

Aberrant Somatosensory-Motor Adaptation in Musicians' Dystonia

BACKGROUND

Some forms of movement disorders are characterized by task-specific manifestations of symptoms. However, its underlying mechanisms are poorly understood. Here we addressed this issue through a novel motor adaptation experimental paradigm.

METHODS

Pianists with and without focal task-specific dystonia learned to play the piano with a key whose weight can be modified by a novel robot system.

RESULTS

The result clearly demonstrated a significantly larger error between the target and produced keystroke velocities in the patients than the controls following a repetition of keystrokes of the weighted key. This adaptation failure was not correlated with the variability of timing and velocity of the keystroke when the patients were playing unloaded piano keys, which suggests distinct effects of focal task-specific dystonia on motor adaptation and fine motor control. Immediately after a repetition of the strikes of the heavy key with keeping the fingers adducted, the error of the keystroke velocity when striking the key with the fingers more abducted was maintained in both the patients and controls. This generalization of the adaptation across different hand postures suggests that motor memory of dynamics of the piano key is independent of biomechanical properties of the hand. Importantly, a lack of difference in the finger muscular strength between the groups indicated that the adaptation failure was not attributed to deficit of muscular strength in the patients.

CONCLUSIONS

These findings suggest that task-specific manifestation of dystonic movements in focal task-specific dystonia is associated with malfunctions of internal representation of mechanical properties of a well-trained tool. © 2020 International Parkinson and Movement Disorder Society.

Somatosensory cortex participates in the consolidation of human motor memory

Newly learned motor skills are initially labile and then consolidated to permit retention. The circuits that enable the consolidation of motor memories remain uncertain. Most work to date has focused on primary motor cortex, and although there is ample evidence of learning-related plasticity in motor cortex, direct evidence for its involvement in memory consolidation is limited. Learning-related plasticity is also observed in somatosensory cortex, and accordingly, it may also be involved in memory consolidation. Here, by using transcranial magnetic stimulation (TMS) to block consolidation, we report the first direct evidence that plasticity in somatosensory cortex participates in the consolidation of motor memory. Participants made movements to targets while a robot applied forces to the hand to alter somatosensory feedback. Immediately following adaptation, continuous theta-burst transcranial magnetic stimulation (cTBS) was delivered to block retention; then, following a 24-hour delay, which would normally permit consolidation, we assessed whether there was an impairment. It was found that when mechanical loads were introduced gradually to engage implicit learning processes, suppression of somatosensory cortex following training almost entirely eliminated retention. In contrast, cTBS to motor cortex following learning had little effect on retention at all; retention following cTBS to motor cortex was not different than following sham TMS stimulation. We confirmed that cTBS to somatosensory cortex interfered with normal sensory function and that it blocked motor memory consolidation and not the ability to retrieve a consolidated motor memory. In conclusion, the findings are consistent with the hypothesis that in adaptation learning, somatosensory cortex rather than motor cortex is involved in the consolidation of motor memory.

Early stages of sensorimotor map acquisition: learning with free exploration, without active movement or global structure

One of the puzzles of learning to talk or play a musical instrument is how we learn which movement produces a particular sound: an audiomotor map. The initial stages of map acquisition can be studied by having participants learn arm movements to auditory targets. The key question is what mechanism drives this early learning. Three learning processes from previous literature were tested: map learning may rely on active motor outflow (target), on error correction, and on the correspondence between sensory and motor distances (i.e., that similar movements map to similar sounds). Alternatively, we hypothesized that map learning can proceed without these. Participants made movements that were mapped to sounds in a number of different conditions that each precluded one of the potential learning processes. We tested whether map learning relies on assumptions about topological continuity by exposing participants to a permuted map that did not preserve distances in auditory and motor space. Further groups were tested who passively experienced the targets, kinematic trajectories produced by a robot arm, and auditory feedback as a yoked active participant (hence without active motor outflow). Another group made movements without receiving targets (thus without experiencing errors). In each case we observed substantial learning, therefore none of the three hypothesized processes is required for learning. Instead early map acquisition can occur with free exploration without target error correction, is based on sensory-to-sensory correspondences, and possible even for discontinuous maps. The findings are consistent with the idea that early sensorimotor map formation can involve instance-specific learning.NEW & NOTEWORTHY This study tested learning of novel sensorimotor maps in a variety of unusual circumstances, including learning a mapping that was permuted in such as way that it fragmented the sensorimotor workspace into discontinuous parts, thus not preserving sensory and motor topology. Participants could learn this mapping, and they could learn without motor outflow or targets. These results point to a robust learning mechanism building on individual instances, inspired from machine learning literature.

Use of an Errorless Learning Approach in a Person With Concomitant Traumatic Spinal Cord Injury and Brain Injury: A Case Report

: Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive deficits that may limit the ability to learn novel motor tasks necessary for functional independence. Errorless learning has been shown to improve cognitive task performance in persons with brain injury but little is known about its usefulness for improving novel motor task learning.

CASE DESCRIPTION

A 44-year-old man with traumatic spinal cord and brain injuries from a motor vehicle accident was admitted to an inpatient rehabilitation hospital. His spinal cord injury was classified as T4 American Spinal Injury Association Impairment Scale (AIS) A, and his cognitive status was level IV on the Ranchos Los Amigos Scale. Initially, the patient required maximal assistance from 2 clinicians to complete a slide board transfer, propelled his wheelchair 25 ft with minimal assistance, and scored 9/56 on the Function in Sitting Test.

INTERVENTION

The therapist applied traditional motor-learning approaches during the first 37 days of the patient's inpatient rehabilitation facility stay without meaningful gains in functional mobility. A subsequent change to errorless learning was made for the following 32 days until discharge.

OUTCOMES

After use of errorless learning, the patient performed novel mobility-related tasks of slide board transfers with minimal assistance and wheelchair propulsion without physical assistance up to 150 ft; the Function in Sitting Test score improved to 18/56. His sensorimotor system progressed to an AIS classification of AIS B, while his cognition emerged to a level V on the Ranchos Los Amigos Scale.

DISCUSSION

Errorless learning may have facilitated acquisition of novel transfer and mobility skills in this individual with dual diagnoses. This approach may have value for patients with neurologic conditions who have both motor and cognitive impairment.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A201).

Somatosensory cortical excitability changes precede those in motor cortex during human motor learning

Motor learning is associated with plasticity in both motor and somatosensory cortex. It is known from animal studies that tetanic stimulation to each of these areas individually induces long-term potentiation in its counterpart. In this context it is possible that changes in motor cortex contribute to somatosensory change and that changes in somatosensory cortex are involved in changes in motor areas of the brain. It is also possible that learning-related plasticity occurs in these areas independently. To better understand the relative contribution to human motor learning of motor cortical and somatosensory plasticity, we assessed the time course of changes in primary somatosensory and motor cortex excitability during motor skill learning. Learning was assessed using a force production task in which a target force profile varied from one trial to the next. The excitability of primary somatosensory cortex was measured using somatosensory evoked potentials in response to median nerve stimulation. The excitability of primary motor cortex was measured using motor evoked potentials elicited by single-pulse transcranial magnetic stimulation. These two measures were interleaved with blocks of motor learning trials. We found that the earliest changes in cortical excitability during learning occurred in somatosensory cortical responses, and these changes preceded changes in motor cortical excitability. Changes in somatosensory evoked potentials were correlated with behavioral measures of learning. Changes in motor evoked potentials were not. These findings indicate that plasticity in somatosensory cortex occurs as a part of the earliest stages of motor learning, before changes in motor cortex are observed.NEW & NOTEWORTHY We tracked somatosensory and motor cortical excitability during motor skill acquisition. Changes in both motor cortical and somatosensory excitability were observed during learning; however, the earliest changes were in somatosensory cortex, not motor cortex. Moreover, the earliest changes in somatosensory cortical excitability predict the extent of subsequent learning; those in motor cortex do not. This is consistent with the idea that plasticity in somatosensory cortex coincides with the earliest stages of human motor learning.

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.

Assessing lower limb position sense in stroke using the gradient discrimination test (GradDT™) and step-height discrimination test (StepDT™): a reliability and validity study

Purpose: To evaluate the psychometric properties of two novel tests of lower limb position sense.Methods: Our newly developed tests assess the discrimination thresholds of under-foot slope and step height perception using a two alternative forced choice approach. Stroke participants (n = 32) and age matched controls (n = 32) were tested. Inter- and intra-rater reliability and agreement, sensitivity and specificity, discriminant and convergent validity were evaluated.Results: Intra-rater reliability for both variants of the gradient discrimination test was excellent; intraclass correlation coefficients (ICC) =0.91 and 0.89. The step height discrimination test had excellent intra-rater reliability and agreement: ICC =0.95. Inter-rater reliability was also excellent in both tests (ICC= 0.85-0.93). Discriminant validity was demonstrated with significant differences in test performance between stroke and control participants (p < 0.001). Our novel tests did not significantly correlate with the proprioceptive component of the Erasmus modified Nottingham Sensory Assessment. Receiver Operating Characteristic curve analysis indicated both novel tests to have greater sensitivity and specificity than the proprioceptive component of the Erasmus modified Nottingham Sensory Assessment in predicting the presence of self-reported sensory impairments. Functional reach test, 10 meter walk test, centre of pressure measurement and reported falls showed significant and moderate to strong correlations with novel test performance (r = 0.40-0.60); the Erasmus modified Nottingham Sensory Assessment did not.Conclusions: Our novel, functionally oriented tests of lower limb position sense are reliable, valid and feasible for use in an ambulatory chronic stroke and elderly population.Implications for rehabilitationThe GradDT™ and StepDT are two novel tests of lower limb position sense which are reliable and valid in a chronic stroke sample.They offer clinicians and researchers sensitive, accurate and clinically usable measures of lower limb position sense.

Individual optimal attentional strategy during implicit motor learning boosts frontoparietal neural processing efficiency: A functional near-infrared spectroscopy study

INTRODUCTION

Optimal focus of attention is a crucial factor for improving motor learning. Most previous studies have shown that directing attention to movement outcome (external focus; EF) is more effective than directing attention to body movement itself (internal focus; IF). However, our recent studies demonstrated that the optimal attentional strategy in healthy and clinical populations varies depending on individual motor imagery ability. To explore the neurological basis underlying individual optimal attentional strategy during motor learning tasks, in the present study, we measured frontoparietal activities using functional near-infrared spectroscopy (fNIRS).

METHODS

Twenty-eight participants performed a visuomotor learning task requiring circular tracking. During the task, the participants were required to direct their attention internally or externally. The individual optimal attentional strategy was determined by comparing the after-effect sizes between the IF and EF conditions.

RESULTS

Fifteen participants showed larger after-effects under the EF condition (External-dominant), whereas the others showed larger after-effects under the IF condition (Internal-dominant). Based on the differences in neural activities between Internal- and External-dominant groups, we identified the right dorsolateral prefrontal cortex (Brodmann area 46) and right somatosensory association cortex (Brodmann area 7) as the neural bases associated with individual optimal attentional strategy during motor learning. Furthermore, we observed a significant negative correlation, that is, lower activity in these areas was associated with a larger after-effect size under the optimal attentional strategy.

CONCLUSION

Our findings demonstrated that more efficient neural processing in the frontoparietal area under the individual optimal attentional strategy can accelerate motor learning.

Parallel learning processes of a visuomotor adaptation task in a changing environment

During the control of reaching movements, a key contribution of the visual system is the localization of relevant environmental targets. In motor adaptation processes, the visual evaluation of effector motor behavior enables learning from errors, which demands continuous visual attentional focus. However, most current adaptation paradigms include static targets; therefore, when a learning situation develops in a highly variable environment and there is a double demand for visual resources (environment and motor performance), the evolution of learning processes is unknown. In order to understand how learning processes evolve in a variable environment, a video game task was designed in which subjects were asked to manage a 60° counterclockwise-rotated cursor to capture descending targets with initially unpredictable trajectories. During the task, the cursor and eye movements were recorded to dissect visuomotor coordination. We observed that the pursuit of the targets conditioned a predominant and continuous visual inspection of the environment instead of the rotated cursor. As learning progressed, subjects exhibited a linear reduction in directional error and selected a motor strategy based on the degree of reward, which improved the performance. These results suggest that when the environment demands high visual attention, error-based and reinforced motor learning processes are implemented simultaneously, thus enabling efficient predictive behavior.

Somatosensory working memory in human reinforcement-based motor learning

Recent studies using visuomotor adaptation and sequence learning tasks have assessed the involvement of working memory in the visuospatial domain. The capacity to maintain previously performed movements in working memory is perhaps even more important in reinforcement-based learning to repeat accurate movements and avoid mistakes. Using this kind of task in the present work, we tested the relationship between somatosensory working memory and motor learning. The first experiment involved separate memory and motor learning tasks. In the memory task, the participant's arm was displaced in different directions by a robotic arm, and the participant was asked to judge whether a subsequent test direction was one of the previously presented directions. In the motor learning task, participants made reaching movements to a hidden visual target and were provided with positive feedback as reinforcement when the movement ended in the target zone. It was found that participants that had better somatosensory working memory showed greater motor learning. In a second experiment, we designed a new task in which learning and working memory trials were interleaved, allowing us to study participants' memory for movements they performed as part of learning. As in the first experiment, we found that participants with better somatosensory working memory also learned more. Moreover, memory performance for successful movements was better than for movements that failed to reach the target. These results suggest that somatosensory working memory is involved in reinforcement motor learning and that this memory preferentially keeps track of reinforced movements. NEW & NOTEWORTHY The present work examined somatosensory working memory in reinforcement-based motor learning. Working memory performance was reliably correlated with the extent of learning. With the use of a paradigm in which learning and memory trials were interleaved, memory was assessed for movements performed during learning. Movements that received positive feedback were better remembered than movements that did not. Thus working memory does not track all movements equally but is biased to retain movements that were rewarded.