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A Pilot Investigation of Visual Pathways in Patients with Mild Traumatic Brain Injury. Neurol Int 2023; 15:534-548. [PMID: 36976675 PMCID: PMC10054811 DOI: 10.3390/neurolint15010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/22/2023] Open
Abstract
In this study, we examined visual processing within primary visual areas (V1) in normal and visually impaired individuals who exhibit significant visual symptomology due to sports-related mild traumatic brain injury (mTBI). Five spatial frequency stimuli were applied to the right, left and both eyes in order to assess the visual processing of patients with sports-related mild traumatic brain injuries who exhibited visual abnormalities, i.e., photophobia, blurriness, etc., and controls. The measurement of the left/right eye and binocular integration was accomplished via the quantification of the spectral power and visual event-related potentials. The principal results have shown that the power spectral density (PSD) measurements display a distinct loss in the alpha band-width range, which corresponded to more instances of medium-sized receptive field loss. Medium-size receptive field loss may correspond to parvocellular (p-cell) processing deprecation. Our major conclusion provides a new measurement, using PSD analysis to assess mTBI conditions from primary V1 areas. The statistical analysis demonstrated significant differences between the mTBI and control cohort in the Visual Evoked Potentials (VEP) amplitude responses and PSD measurements. Additionally, the PSD measurements were able to assess the improvement in the mTBI primary visual areas over time through rehabilitation.
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Bayani KY, Lawson RR, Levinson L, Mitchell S, Atawala N, Otwell M, Rickerson B, Wheaton LA. Implicit development of gaze strategies support motor improvements during action encoding training of prosthesis use. Neuropsychologia 2019; 127:75-83. [PMID: 30807755 DOI: 10.1016/j.neuropsychologia.2019.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/06/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Action observation training has been suggested to facilitate motor improvements in the lives of persons with neural injury. Previous studies have shown that for persons with upper limb amputation, matched limb training, where prosthesis users emulate each other, has shown promise above mismatched training where a prosthesis user emulates actions of a person with sound limbs (most commonly that of a therapist). OBJECTIVE The mechanism underlying the matched limb training benefit is unclear. Gaze strategies may reveal unique patterns between matched and mismatched training which could explain improvements in motor function in matched limb training. METHODS Twenty persons with sound limbs were trained on how to use a prosthesis simulator using matched or mismatched limb training in a single session. Eye movements were recorded during the training phase. Kinematics were recorded as persons performed the task. RESULTS Gaze patterns showed differences between the training groups. The mismatched group demonstrated a higher probability of gaze on the path between the start and end of the action, while the matched group demonstrated a significantly higher probability of focusing on the elements of the path of the action and a trend of focusing on the shoulders. Kinematics also revealed overall improvements in motor control for the matched group. CONCLUSIONS This study proposes a putative mechanism that may explain improvements in matched limb training through shifting gaze strategies. Further work is needed to understand whether implicit visual strategies seen during matched limb training might encourage motor learning during functional training with prostheses.
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Affiliation(s)
- Kristel Y Bayani
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Regan R Lawson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Lauren Levinson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Sarah Mitchell
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Neel Atawala
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Malone Otwell
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Beth Rickerson
- School of Biological Sciences Georgia Institute of Technology, United States
| | - Lewis A Wheaton
- School of Biological Sciences Georgia Institute of Technology, United States.
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Proud K, Heald JB, Ingram JN, Gallivan JP, Wolpert DM, Flanagan JR. Separate motor memories are formed when controlling different implicitly specified locations on a tool. J Neurophysiol 2019; 121:1342-1351. [PMID: 30625003 DOI: 10.1152/jn.00526.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Skillful manipulation requires forming and recalling memories of the dynamics of objects linking applied force to motion. It has been assumed that such memories are associated with entire objects. However, we often control different locations on an object, and these locations may be associated with different dynamics. We have previously demonstrated that multiple memories can be formed when participants are explicitly instructed to control different visual points marked on an object. A key question is whether this novel finding generalizes to more natural situations in which control points are implicitly defined by the task. To answer this question, we used objects with no explicit control points and tasks designed to encourage the use of distinct implicit control points. Participants moved a handle, attached to a robotic interface, to control the position of a rectangular object ("eraser") in the horizontal plane. Participants were required to move the eraser straight ahead to wipe away a column of dots ("dust"), located to either the left or right. We found that participants adapted to opposing dynamics when linked to the left and right dust locations, even though the movements required for these two contexts were the same. Control conditions showed this learning could not be accounted for by contextual cues or the fact that the task goal required moving in a straight line. These results suggest that people naturally control different locations on manipulated objects depending on the task context and that doing so affords the formation of separate motor memories. NEW & NOTEWORTHY Skilled manipulation requires forming motor memories of object dynamics, which have been assumed to be associated with entire objects. However, we recently demonstrated that people can form multiple memories when explicitly instructed to control different visual points on an object. In this article we show that this novel finding generalizes to more natural situations in which control points are implicitly defined by the task.
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Affiliation(s)
- Keaton Proud
- Department of Psychology, Queen's University , Kingston, Ontario , Canada
| | - James B Heald
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge , Cambridge , United Kingdom
| | - James N Ingram
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge , Cambridge , United Kingdom
| | - Jason P Gallivan
- Department of Psychology, Queen's University , Kingston, Ontario , Canada.,Centre for Neuroscience Studies, Queen's University , Kingston, Ontario , Canada.,Department of Biomedical and Molecular Sciences, Queen's University , Kingston, Ontario , Canada
| | - Daniel M Wolpert
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge , Cambridge , United Kingdom.,Zuckerman Mind Brain Behavior Institute, Department of Neuroscience, Columbia University , New York
| | - J Randall Flanagan
- Department of Psychology, Queen's University , Kingston, Ontario , Canada.,Centre for Neuroscience Studies, Queen's University , Kingston, Ontario , Canada
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Padula WV, Capo-Aponte JE, Padula WV, Singman EL, Jenness J. The consequence of spatial visual processing dysfunction caused by traumatic brain injury (TBI). Brain Inj 2017; 31:589-600. [PMID: 28440687 DOI: 10.1080/02699052.2017.1291991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A bi-modal visual processing model is supported by research to affect dysfunction following a traumatic brain injury (TBI). TBI causes dysfunction of visual processing affecting binocularity, spatial orientation, posture and balance. Research demonstrates that prescription of prisms influence the plasticity between spatial visual processing and motor-sensory systems improving visual processing and reducing symptoms following a TBI. RATIONALE The rationale demonstrates that visual processing underlies the functional aspects of binocularity, balance and posture. The bi-modal visual process maintains plasticity for efficiency. Compromise causes Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS). Rehabilitation through use of lenses, prisms and sectoral occlusion has inter-professional implications in rehabilitation affecting the plasticity of the bi-modal visual process, thereby improving binocularity, spatial orientation, posture and balance Main outcomes: This review provides an opportunity to create a new perspective of the consequences of TBI on visual processing and the symptoms that are often caused by trauma. It also serves to provide a perspective of visual processing dysfunction that has potential for developing new approaches of rehabilitation. CONCLUSIONS Understanding vision as a bi-modal process facilitates a new perspective of visual processing and the potentials for rehabilitation following a concussion, brain injury or other neurological events.
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Affiliation(s)
- William V Padula
- a Salus University College of Optometry , Philadelphia , PA , USA.,b Padula Institute of Vision Rehabilitation , Guilford , CT , USA
| | - Jose E Capo-Aponte
- c Department of Optometry Womack Army Medical Center , Fort Bragg , NC , USA
| | - William V Padula
- d Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Eric L Singman
- e Department of Ophthalmology , Wilmer Eye Institute, Johns Hopkins Medicine , Baltimore , MD , USA
| | - Jonathan Jenness
- b Padula Institute of Vision Rehabilitation , Guilford , CT , USA
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Abstract
As part of an investigation into real-world drawing, eye movements and eye – hand interactions have been recorded for twenty subjects of varying drawing experience drawing simple straight and curved lines and a square. Two modes of eye — hand behaviour were observed. In the first, named ‘close pursuit’, fixations closely followed the pencil with a sequence of small saccades. In the second, named ‘target locking’, a stable fixation was made on the end-point of the line throughout the entire drawing action. Depending on subject and type of line, close pursuit, target locking, or a combination of these modes was used regardless of previous drawing experience. The results are discussed in terms of the role of the eye in the control of the movement trajectory of the hand.
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Affiliation(s)
- John Tchalenko
- Drawing and Cognition, Camberwell College of Arts, London SE5 8UF, UK
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7
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The role of eye movements in motor sequence learning. Hum Mov Sci 2015; 40:220-36. [DOI: 10.1016/j.humov.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 12/16/2014] [Accepted: 01/03/2015] [Indexed: 11/22/2022]
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Cicerale A, Ambron E, Lingnau A, Rumiati RI. A kinematic analysis of age-related changes in grasping to use and grasping to move common objects. Acta Psychol (Amst) 2014; 151:134-42. [PMID: 24977936 DOI: 10.1016/j.actpsy.2014.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/08/2014] [Accepted: 06/03/2014] [Indexed: 11/15/2022] Open
Abstract
Grasping is a complex action which requires high-level motor control. Although the impact of aging on grasping has been investigated in some studies, to date little is known as to how the aging process interacts with the purpose of the movement. The aims of the present study were (i) to investigate the effect of aging on grasping movements, and to explore on how this effect is modulated by (ii) the goal of the task, and by (iii) the characteristics of the target such as its location in the visual field, its orientation and its size. Young and elderly adults were asked to grasp to move or to grasp to use objects of different sizes and orientations, presented either in the central or the peripheral visual field. Movement duration did not differ between the two groups. However, elderly participants required a longer approach phase and showed a different grasping strategy, characterized by larger grip aperture and smaller percentage of wrist rotation in comparison to young adults. Elderly adults showed a decrease in accuracy when grasping objects presented in the peripheral, but not in the central visual field. A similar modulation of the kinematic parameters consisting in longer planning and execution phases in the grasp to use in comparison to the grasp to move condition was observed in both groups, suggesting that the effect of aging might be minimized and compensated in more goal-directed tasks.
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Affiliation(s)
- Alessandro Cicerale
- Area of Neuroscience, SISSA, Trieste, Italy; LabNI, Department of Neurosciences, University of Turin, Italy
| | | | - Angelika Lingnau
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy; Department of Cognitive Sciences, University of Trento, Italy
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Reis PMR, Hebenstreit F, Gabsteiger F, von Tscharner V, Lochmann M. Methodological aspects of EEG and body dynamics measurements during motion. Front Hum Neurosci 2014; 8:156. [PMID: 24715858 PMCID: PMC3970018 DOI: 10.3389/fnhum.2014.00156] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/03/2014] [Indexed: 12/03/2022] Open
Abstract
EEG involves the recording, analysis, and interpretation of voltages recorded on the human scalp which originate from brain gray matter. EEG is one of the most popular methods of studying and understanding the processes that underlie behavior. This is so, because EEG is relatively cheap, easy to wear, light weight and has high temporal resolution. In terms of behavior, this encompasses actions, such as movements that are performed in response to the environment. However, there are methodological difficulties which can occur when recording EEG during movement such as movement artifacts. Thus, most studies about the human brain have examined activations during static conditions. This article attempts to compile and describe relevant methodological solutions that emerged in order to measure body and brain dynamics during motion. These descriptions cover suggestions on how to avoid and reduce motion artifacts, hardware, software and techniques for synchronously recording EEG, EMG, kinematics, kinetics, and eye movements during motion. Additionally, we present various recording systems, EEG electrodes, caps and methods for determinating real/custom electrode positions. In the end we will conclude that it is possible to record and analyze synchronized brain and body dynamics related to movement or exercise tasks.
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Affiliation(s)
- Pedro M. R. Reis
- Department of Sports and Exercise Medicine, Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Felix Hebenstreit
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Florian Gabsteiger
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Vinzenz von Tscharner
- Human Performance Laboratory, Faculty of Kinesiology, University of CalgaryCalgary, AB, Canada
| | - Matthias Lochmann
- Department of Sports and Exercise Medicine, Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
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Kinematic property of target motion conditions gaze behavior and eye-hand synergy during manual tracking. Hum Mov Sci 2013; 32:1253-69. [PMID: 24054436 DOI: 10.1016/j.humov.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/17/2012] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
Abstract
This study investigated how frequency demand and motion feedback influenced composite ocular movements and eye-hand synergy during manual tracking. Fourteen volunteers conducted slow and fast force-tracking in which targets were displayed in either line-mode or wave-mode to guide manual tracking with target movement of direct position or velocity nature. The results showed that eye-hand synergy was a selective response of spatiotemporal coupling conditional on target rate and feedback mode. Slow and line-mode tracking exhibited stronger eye-hand coupling than fast and wave-mode tracking. Both eye movement and manual action led the target signal during fast-tracking, while the latency of ocular navigation during slow-tracking depended on the feedback mode. Slow-tracking resulted in more saccadic responses and larger pursuit gains than fast-tracking. Line-mode tracking led to larger pursuit gains but fewer and shorter gaze fixations than wave-mode tracking. During slow-tracking, incidences of saccade and gaze fixation fluctuated across a target cycle, peaking at velocity maximum and the maximal curvature of target displacement, respectively. For line-mode tracking, the incidence of smooth pursuit was phase-dependent, peaking at velocity maximum as well. Manual behavior of slow or line-mode tracking was better predicted by composite eye movements than that of fast or wave-mode tracking. In conclusion, manual tracking relied on versatile visual strategies to perceive target movements of different kinematic properties, which suggested a flexible coordinative control for the ocular and manual sensorimotor systems.
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Thibbotuwawa N, Goonetilleke RS, Hoffmann ER. Constrained path tracking at varying angles in a mouse tracking task. HUMAN FACTORS 2012; 54:138-150. [PMID: 22409108 DOI: 10.1177/0018720811424743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study was aimed to determine the effects of direction and path length on movement time when traversing a constrained path of width, W, in a mouse tracking task. BACKGROUND Tracking within constrained paths has been demonstrated to hold in many applications. Movement time and velocity of movement have shown very similar relationships, possibly because of the lack of extreme testing conditions. Most previous research evaluated conditions with only constant path length (A) of movement. METHOD A total of 15 participants performed a mouse steering task within a constrained path at various angles. The independent variables were track width (W), path length, and path angle. Movement time was the dependent variable. RESULTS Analyses showed a significant effect of movement direction on movement time, and the relationship was approximately sinusoidal and symmetrical about the horizontal axis. Path length had a significant effect on speed of movement, which was not that apparent on movement time. At low A/W values, movements appeared to be ballistic. CONCLUSION Tracking within constrained paths can be modeled to account for the effect of path angle. APPLICATION Vertical hand movements, especially within constrained paths, may not be ideal from a performance and biomechanical standpoint. The performance curve gradients are a good way to evaluate and standardize the testing of input devices and to define acceptable speeds for various tolerances in computer and industrial tasks that involve angular motions. The results of this experiment will help designers to optimize products and training programs.
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Affiliation(s)
- Namal Thibbotuwawa
- Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
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Bouquet CA, Shipley TF, Capa RL, Marshall PJ. Motor contagion: goal-directed actions are more contagious than non-goal-directed actions. Exp Psychol 2011; 58:71-8. [PMID: 20494864 DOI: 10.1027/1618-3169/a000069] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent theories posit a mirror-matching system mapping observed actions onto one's own motor system. Determining whether this system makes a distinction between goal-directed and non-goal-directed actions is crucial for the understanding of its function. The present study tested whether motor interference between observed and executed actions, which is thought to be an index of perceptual-motor matching, depends on the presence of goals in the observed action. Participants executed sinusoidal arm movements while observing a video of another person making similar or different movements. In certain conditions, elements representing goals for the observed movement were superimposed on the video displays. Overall, observing an incongruent movement interfered with movement execution. This interference was markedly increased when the observed incongruent movement was directed toward a visible goal, suggesting a greater perceptual-motor matching during observation of goal-directed versus non-goal-directed actions. This finding supports an action-reconstruction model of mirror system function rather than the traditional direct-matching model.
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Affiliation(s)
- Cédric A Bouquet
- Centre de Recherches sur la Cognition et l'Apprentissage - CNRS UMR 6234, University of Poitiers, France.
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Knaut LA, Subramanian SK, McFadyen BJ, Bourbonnais D, Levin MF. Kinematics of pointing movements made in a virtual versus a physical 3-dimensional environment in healthy and stroke subjects. Arch Phys Med Rehabil 2009; 90:793-802. [PMID: 19406299 DOI: 10.1016/j.apmr.2008.10.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 10/31/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare kinematics of 3-dimensional pointing movements performed in a virtual environment (VE) displayed through a head-mounted display with those made in a physical environment. DESIGN Observational study of movement in poststroke and healthy subjects. SETTING Motion analysis laboratory. PARTICIPANTS Adults (n=15; 4 women; 59+/-15.4y) with chronic poststroke hemiparesis were recruited. Participants had moderate upper-limb impairment with Chedoke-McMaster Arm Scores ranging from 3 to 6 out of 7. Twelve healthy subjects (6 women; 53.3+/-17.1y) were recruited from the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Arm and trunk kinematics were recorded in similar virtual and physical environments with an Optotrak System (6 markers; 100Hz; 5s). Subjects pointed as quickly and as accurately as possible to 6 targets (12 trials/target in a randomized sequence) placed in arm workspace areas requiring different arm movement patterns and levels of difficulty. Movements were analyzed in terms of performance outcome measures (endpoint precision, trajectory, peak velocity) and arm and trunk movement patterns (elbow and shoulder ranges of motion, elbow/shoulder coordination, trunk displacement, rotation). RESULTS For healthy subjects, precision and trajectory straightness were higher in VE when pointing to contralateral targets, and movements were slower for all targets in VE. Stroke participants made less accurate and more curved movements in VE and used less trunk displacement. Elbow/shoulder coordination differed when pointing to the lower ipsilateral target. There were no group-by-environment interactions. CONCLUSIONS Movements in both environments were sufficiently similar to consider VE a valid environment for clinical interventions and motor control studies.
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Affiliation(s)
- Luiz A Knaut
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
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Abstract
PURPOSE A new method was developed using the scanning laser ophthalmoscope (SLO) to investigate the effects of central visual loss on eye-hand coordination in manual tasks. Using the SLO, the retinal positions of the hand, fingers, and objects are imaged and recorded while a subject performs a manual task. METHOD A video camera images the subject's hand and objects to be manipulated in the SLO laser-beam raster, producing a video image of a subject's hand, fingers, and objects on the subject's retina while the objects are manipulated. A subject with bilateral central scotomas and an age-matched control subject with normal vision traced an ellipse with the index finger, tapped four disks in sequence, and carried out a pattern duplication task with pegs. Retinal positions of the fovea or preferred retinal locus (PRL), fingers, and objects were measured from digitized SLO images. RESULTS In all tasks, the fovea or PRL was directed to an object or position before the fingers arrived. This lead time was much greater for the scotoma subject than the control subject ( approximately 1400 vs. approximately 400 ms, respectively). The scotoma subject was much less accurate in placing the PRL and fingers on objects and required substantially more time for task completion than the control subject. CONCLUSIONS The coordination of foveal fixation and finger placement found with the SLO method was similar to that found by others using eyetracking techniques with visually normal subjects. The presence of a central scotoma and use of a PRL caused marked deterioration in the quality of this coordination. Unlike eyetracking methods, the SLO technique does not require calibration because the positions of the fingers and objects are directly observable on the retina. This method could be useful in studying eye-hand coordination of individuals with scotomas that affect foveal vision.
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Abstract
We report a preliminary analysis of the interactions between eye and hand during tracing and drawing of four simple shapes. Eye and hand movements were recorded using the ASL 504 system and the Flock of Birds system, respectively. During tracing, pen tip and eye were tightly coupled, with participants making a series of small saccades just in front of the moving pen, interspersed with periods of smooth pursuit. During drawing, saccades were fewer and larger and pursuit was less frequent. Observed eye-hand interactions suggested a bidirectional relationship between the eye and hand. These findings are explained in terms of the differing degree that the two tasks employ visual detail, external or internal cues and eye-hand coordination.
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Affiliation(s)
- Emma Gowen
- Behavioural Brain Sciences, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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