Proprioception Is Necessary for Body Schema Plasticity: Evidence from a Deafferented Patient

Minimal impact of chronic proprioceptive loss on implicit sensorimotor adaptation and perceived movement outcome

Implicit sensorimotor adaptation keeps our movements well calibrated amid changes in the body and environment. We have recently postulated that implicit adaptation is driven by a perceptual error: the difference between the desired and perceived movement outcome. According to this perceptual realignment model, implicit adaptation ceases when the perceived movement outcome-a multimodal percept determined by a prior belief conveying the intended action, the motor command, and feedback from proprioception and vision-is aligned with the desired movement outcome. Here, we examined the role of proprioception in implicit motor adaptation and perceived movement outcome by examining individuals who experience deafferentation (i.e., individuals with impaired proprioception and touch). We used a modified visuomotor rotation task designed to isolate implicit adaptation and probe perceived movement outcomes throughout the experiment. Surprisingly, both implicit adaptation and perceived movement outcome were minimally impacted by chronic deafferentation, posing a challenge to the perceptual realignment model of implicit adaptation.NEW & NOTEWORTHY We tested six individuals with chronic somatosensory deafferentation on a novel task that isolates implicit sensorimotor adaptation and probes perceived movement outcome. Strikingly, both implicit motor adaptation and perceptual movement outcome were not significantly impacted by chronic deafferentation, posing a challenge for theoretical models of adaptation that involve proprioception.

Effects of Collaborative Training Using Virtual Co-embodiment on Motor Skill Learning

Virtual reality (VR) is a promising tool for motor skill learning. Previous studies have indicated that observing and following a teacher's movements from a first-person perspective using VR facilitates motor skill learning. Conversely, it has also been pointed out that this learning method makes the learner so strongly aware of the need to follow that it weakens their sense of agency (SoA) for motor skills and prevents them from updating the body schema, thereby preventing long-term retention of motor skills. To address this problem, we propose applying "virtual co-embodiment" to motor skill learning. Virtual co-embodiment is a system in which a virtual avatar is controlled based on the weighted average of the movements of multiple entities. Because users in virtual co-embodiment overestimate their SoA, we hypothesized that learning using virtual co-embodiment with a teacher would improve motor skill retention. In this study, we focused on learning a dual task to evaluate the automation of movement, which is considered an essential element of motor skills. As a result, learning in virtual co-embodiment with the teacher improves motor skill learning efficiency compared with sharing the teacher's first-person perspective or learning alone.

Differential changes in somatosensory evoked potentials and motor performance: pursuit movement task versus force matching tracking task

Force modulation relies on accurate proprioception, and force-matching tasks alter corticocerebellar connectivity. Corticocerebellar (N24) and corticomotor pathways are impacted following the acquisition of a motor tracing task (MTT), measured using both somatosensory evoked potentials (SEPs) and transcranial magnetic stimulation. This study compared changes in early SEP peak amplitudes and motor performance following a force-matching tracking task (FMTT) to an MTT. Thirty (18 females) right-handed participants, aged 21.4 ± 2.76, were electrically stimulated over the right-median nerve at 2.47 Hz and 4.98 Hz (averaged 1,000 sweeps/rate) to elicit SEPs, recorded via a 64-channel electroencephalography cap, before, and after task acquisition using the right abductor pollicis brevis muscle. Retention was measured 24 h later. Significant time-by-group interactions occurred for the N20 SEP: 6.3% decrease post-FMTT versus 5.5% increase post-MTT (P = 0.013); P25 SEP: 4.0% decrease post-FMTT versus 10.3% increase post-MTT (P = 0.006); and N18 SEP: 113.4% increase post-FMTT versus 4.4% decrease post-MTT (P = 0.006). N18 and N30 showed significant effect of time (both P < 0.001). Motor performance: significant time-by-group interactions-postacquisition: FMTT improved 15.3% versus 24.3% for MTT (P = 0.025), retention: FMTT improved 17.4% and MTT by 30.1% (P = 0.004). Task-dependent differences occurred in SEP peaks associated with cortical somatosensory processing (N20 and P25), and cerebellar input (N18), with similar changes in sensorimotor integration (N30), with differential improvements in motor performance, indicating important differences in cerebellar and sensory processing for tasks reliant on proprioception.NEW & NOTEWORTHY This study demonstrates neurophysiological differences in cerebellar and somatosensory cortex pathways when learning a motor task requiring visuomotor tracking versus a task that requires force-matching modulation, in healthy individuals. The clear neurophysiological differences in early somatosensory evoked potentials associated with cortical somatosensory processing, cerebellar input, and sensorimotor integration between these two tasks demonstrate some of the neural correlates of force modulation and validate the force-matching task for use in future work.

Dissociation between dreams and wakefulness: Insights from body and action representations of rare individuals with massive somatosensory deafferentation

The realism of body and actions in dreams is thought to be induced by simulations based on internal representations used during wakefulness. As somatosensory signals contribute to the updating of body and action representations, these are impaired when somatosensory signals are lacking. Here, we tested the hypothesis that individuals with somatosensory deafferentation have impaired body and actions in their dreams, as in wakefulness. We questioned three individuals with a severe, acquired sensory neuropathy on their dreams. While deafferented participants were impaired in daily life, they could dream of themselves as able-bodied, with some sensations (touch, proprioception) and actions (such as running or jumping) which had not been experienced in physical life since deafferentation. We speculate that simulation in dreams could be based on former, "healthy" body and action representations. Our findings are consistent with the idea that distinct body and action representations may be used during dreams and wakefulness.

Anticipation and compensation for somatosensory deficits in object handling: evidence from a patient with large fiber sensory neuropathy

The purpose of this study was to determine the contributions of feedforward and feedback processes on grip force regulation and object orientation during functional manipulation tasks. One patient with massive somatosensory loss resulting from large fiber sensory neuropathy and 10 control participants were recruited. Three experiments were conducted: 1) perturbation to static holding; 2) discrete vertical movement; and 3) functional grasp and place. The availability of visual feedback was also manipulated to assess the nature of compensatory mechanisms. Results from experiment 1 indicated that both the deafferented patient and controls used anticipatory grip force adjustments before self-induced perturbation to static holding. The patient exhibited increased grip response time, but the magnitude of grip force adjustments remained correlated with perturbation forces in the self-induced and external perturbation conditions. In experiment 2, the patient applied peak grip force substantially in advance of maximum load force. Unlike controls, the patient's ability to regulate object orientation was impaired without visual feedback. In experiment 3, the duration of unloading, transport, and release phases were longer for the patient, with increased deviation of object orientation at phase transitions. These findings show that the deafferented patient uses distinct modes of anticipatory control according to task constraints and that responses to perturbations are mediated by alternative afferent information. The loss of somatosensory feedback thus appears to impair control of object orientation, whereas variation in the temporal organization of functional tasks may reflect strategies to mitigate object instability associated with changes in movement dynamics.NEW & NOTEWORTHY This study evaluates the effects of sensory neuropathy on the scaling and timing of grip force adjustments across different object handling tasks (i.e., holding, vertical movement, grasping, and placement). In particular, these results illustrate how novel anticipatory and online control processes emerge to compensate for the loss of somatosensory feedback. In addition, we provide new evidence on the role of somatosensory feedback for regulating object orientation during functional prehensile movement.

Perception of body shape and size without touch or proprioception: evidence from individuals with congenital and acquired neuropathy

The degree to which mental representations of the body can be established and maintained without somatosensory input remains unclear. We contrast two "deafferented" adults, one who acquired large fibre sensory loss as an adult (IW) and another who was born without somatosensation (KS). We compared their responses to those of matched controls in three perceptual tasks: first accuracy of their mental image of their hands (assessed by testing recognition of correct hand length/width ratio in distorted photographs and by locating landmarks on the unseen hand); then accuracy of arm length judgements (assessed by judgement of reaching distance), and finally, we tested for an attentional bias towards peri-personal space (assessed by reaction times to visual target presentation). We hypothesised that IW would demonstrate responses consistent with him accessing conscious knowledge, whereas KS might show evidence of responses dependent on non-conscious mechanisms. In the first two experiments, both participants were able to give consistent responses about hand shape and arm length, but IW displayed a better awareness of hand shape than KS (and controls). KS demonstrated poorer spatial accuracy in reporting hand landmarks than both IW and controls, and appears to have less awareness of her hands. Reach distance was overestimated by both IW and KS, as it was for controls; the precision of their judgements was slightly lower than that of the controls. In the attentional task, IW showed no reaction time differences across conditions in the visual detection task, unlike controls, suggesting that he has no peri-personal bias of attention. In contrast, KS did show target location-dependent modulation of reaction times, when her hands were visible. We suggest that both IW and KS can access a conscious body image, although its accuracy may reflect their different experience of hand action. Acquired sensory loss has deprived IW of any subconscious body awareness, but the congenital absence of somatosensation may have led to its partial replacement by a form of visual proprioception in KS.

The Body Across Adulthood: On the Relation Between Interoception and Body Representations

Interoceptive information plays a pivotal role in building body representations (BR), but the association between interoception and the different types of BR in healthy individuals has never been systematically investigated. Thus, this study aimed to explore the association between BR and interoceptive sensibility (IS) throughout adulthood. One hundred thirty-seven healthy participants (50 aged from 18 to 40 years old; 50 aged from 41 to 60 years old; and 37 over 60 years old) were given a self-report tool for assessing IS (the Self-Awareness Questionnaire; SAQ), and a specific battery including tasks evaluating three different BR (i.e., the body schema, using the Hand Laterality Task; the body structural representation, using the Frontal Body Evocation task, FBE; and body semantics, using the Object-Body Part Association Task) as well as control tasks (i.e., tasks with non-body stimuli). The older age group (aged over 60 years old) showed lower performances on the tasks probing the body schema and body structural representation than younger groups (aged 18 to 40 and 41 to 60 years old). More interestingly, worse performances on a task assessing the body schema were significantly associated with higher IS with older age, suggesting that higher awareness of one's inner body sensations would decrease the plasticity of this BR. These findings are interpreted according to the neuropsychological model of BR development and the effects of aging on the brain.

Interpersonal Motor Interactions Shape Multisensory Representations of the Peripersonal Space

This perspective review focuses on the proposal that predictive multisensory integration occurring in one's peripersonal space (PPS) supports individuals' ability to efficiently interact with others, and that integrating sensorimotor signals from the interacting partners leads to the emergence of a shared representation of the PPS. To support this proposal, we first introduce the features of body and PPS representations that are relevant for interpersonal motor interactions. Then, we highlight the role of action planning and execution on the dynamic expansion of the PPS. We continue by presenting evidence of PPS modulations after tool use and review studies suggesting that PPS expansions may be accounted for by Bayesian sensory filtering through predictive coding. In the central section, we describe how this conceptual framework can be used to explain the mechanisms through which the PPS may be modulated by the actions of our interaction partner, in order to facilitate interpersonal coordination. Last, we discuss how this proposal may support recent evidence concerning PPS rigidity in Autism Spectrum Disorder (ASD) and its possible relationship with ASD individuals' difficulties during interpersonal coordination. Future studies will need to clarify the mechanisms and neural underpinning of these dynamic, interpersonal modulations of the PPS.

The long developmental trajectory of body representation plasticity following tool use

Humans evolution is distinctly characterized by their exquisite mastery of tools, allowing them to shape their environment in more elaborate ways compared to other species. This ability is present ever since infancy and most theories indicate that children become proficient with tool use very early. In adults, tool use has been shown to plastically modify metric aspects of the arm representation, as indexed by changes in movement kinematics. To date, whether and when the plastic capability of updating the body representation develops during childhood remains unknown. This question is particularly important since body representation plasticity could be impacted by the fact that the human body takes years to achieve a stable metric configuration. Here we assessed the kinematics of 90 young participants (8-21 years old) required to reach for an object before and after tool use, as a function of their pubertal development. Results revealed that tool incorporation, as indexed by the adult typical kinematic pattern, develops very slowly and displays a u-shaped developmental trajectory. From early to mid puberty, the changes in kinematics following tool use seem to reflect a shortened arm representation, opposite to what was previously reported in adults. This pattern starts reversing after mid puberty, which is characterized by the lack of any kinematics change following tool use. The typical adult-like pattern emerges only at late puberty, when body size is stable. These findings reveal the complex dynamics of tool incorporation across development, possibly indexing the transition from a vision-based to a proprioception-based body representation plasticity.

EFFECT OF EXTREME CONDITIONING TRAINING ON BODY PERCEPTION

ABSTRACT Introduction Extreme conditioning training (ECT) has become a popular method, characterized by a wide variety of exercises. For good technical performance, practitioners must have good perception of the different parts of the body; however, it is not known whether this perception differs between practitioners and non-practitioners of ECT. Objective To analyze the perception of body dimensions among subjects submitted to an ECT session. Methods Adult men were divided into TRAINED (n = 10) and UNTRAINED (n = 10). All subjects were submitted to a combination of high-effort multiarticular exercises for a set period of nine minutes (“the largest possible number of repetitions” [AMRAP]). For the procedure of marking the body pattern, the subjects were scored in terms of acromioclavicular joints, waist and trochanter. Results Regarding the general perception of body size, the TRAINED and UNTRAINED groups were classified as adequate for each stage. In the dimension of body segments, there was an overestimation of the shoulder region in both groups (TRAINED Pre = 105.2 ± 8.37; Post = 117.23 ± 22.11 [ES = 0.79]; 30 min = 101.34 ± 14.21 [ES = 0.34] and UNTRAINED Pre = 96.72 ± 12.79; Post = 99.47 ± 12.17 [ES = 0.22]; 30 min = 111.05 ± 11.06 [ES = 1.27]). The perception of the waist region improved significantly after training (TRAINED Pre = 114.11 ± 16.4; Post = 117.7 ± 20.16 [ES = 0.20]; 30 min = 104.59 ± 11.46 [ES = 0.68] and UNTRAINED Pre = 114.66 ± 9.88; Post = 104.64 ± 12.87; [ES = 0.88]; 30 min = 108.36 ± 12.32 [ES = 0.57]). Conclusion ECT can promote better perception of body dimensions. In addition, the assessment of body size in active, but untrained individuals showed a better body perception, albeit a transitory effect. Level of evidence II; Therapeutic studies - investigation of treatment results.

Online proprioception feeds plasticity of arm representation following tool-use in healthy aging

Following tool-use, the kinematics of free-hand movements are altered. This modified kinematic pattern has been taken as a behavioral hallmark of the modification induced by tool-use on the effector representation. Proprioceptive inputs appear central in updating the estimated effector state. Here we questioned whether online proprioceptive modality that is accessed in real time, or offline, memory-based, proprioception is responsible for this update. Since normal aging affects offline proprioception only, we examined a group of 60 year-old adults for proprioceptive acuity and movement's kinematics when grasping an object before and after tool-use. As a control, participants performed the same movements with a weight-equivalent to the tool-weight-attached to their wrist. Despite hampered offline proprioceptive acuity, 60 year-old participants exhibited the typical kinematic signature of tool incorporation: Namely, the latency of transport components peaks was longer and their amplitude reduced after tool-use. Instead, we observed no kinematic modifications in the control condition. In addition, online proprioception acuity correlated with tool incorporation, as indexed by the amount of kinematics changes observed after tool-use. Altogether, these findings point to the prominent role played by online proprioception in updating the body estimate for the motor control of tools.

Effect of tool-use observation on metric body representation and peripersonal space

In everyday life, we constantly act and interact with objects and with others' people through our body. To properly perform actions, the representations of the dimension of body-parts (metric body representation, BR) and of the space surrounding the body (peripersonal space, PPS) need to be constantly updated. Previous evidence has shown that BR and PPS representation are highly flexible, being modulated by sensorimotor experiences, such as the active use of tools to reach objects in the far space. In this study, we investigate whether the observation of another person using a tool to interact with objects located in the far space is sufficient to influence the plasticity of BR and PPS representation in a similar way to active tool-use. With this aim, two groups of young healthy participants were asked to perform 20 min trainings based on the active use of a tool to retrieve far cubes (active tool-use) and on the first-person observation of an experimenter doing the same tool-use training (observational tool-use). Behavioural tasks adapted from literature were used to evaluate the effects of the active and observational tool-use on BR (body-landmarks localization task-group 1), and PPS (audio-tactile interaction task - group 2). Results show that after active tool-use, participants perceived the length of their arm as longer than at baseline, while no significant differences appear after observation. Similarly, significant modifications in PPS representation, with comparable multisensory facilitation on tactile responses due to near and far sounds, were seen only after active tool-use, while this did not occur after observation. Together these results suggest that a mere observational training could not be sufficient to significantly modulate BR or PPS. The dissociation found in the active and observational tool-use points out differences between action execution and action observation, by suggesting a fundamental role of the motor planning, the motor intention, and the related sensorimotor feedback in driving BR and PPS plasticity.

An Instrumented Assessment of a Rhythmic Finger Task among Children with Motor Coordination Difficulties

BACKGROUND

Coordination is crucial for motor function, yet objective clinical evaluations are limited. We therefore developed and tested the reliability and validity of a low-cost sensorized evaluation of a rhythmic finger task.

METHODS

Children with coordination difficulties (n = 24) and typically developing children (n = 24) aged from 5 to 7 years performed the Sensorized Finger Sequencing Test (SFST), a finger sequencing test that records the correct sequence, total time, and the standard deviation (SD) of touch time. Additionally, motor performance tests and parents' reports were applied in order to test the reliability and validity of the SFST.

RESULTS

The study group had significantly greater thumb-finger test scores-total time in the dominant hand (p = 0.035) and the SD of the touch time in both dominant (p = 0.036) and non-dominant (p = 0.032) hands. Motor performance tests were not correlated with the SFST. Test-retest reliability in 10 healthy children was found for the SD of touch time in the dominant hand (r = 0.87, p = 0.003).

CONCLUSIONS

The SFST was successful in assessing the movement pattern variability reported in children with motor difficulties. This exploratory study indicates that the low-cost SFST could be utilized as an objective measure for the assessment of proprioception components, which currently are overlooked by standardized motor performance assessments.

Neural activity for hip-knee control in those with anterior cruciate ligament reconstruction: A task-based functional connectivity analysis

Anterior cruciate ligament injury may induce neurophysiological changes for sensorimotor control. Neuroimaging investigations have revealed unique brain activity patterns for knee movement following injury, indicating potential neural mechanisms underlying aberrant neuromuscular control that may contribute to heightened risk of secondary injury, altered movement patterns and poor patient outcomes. However, neuroimaging paradigms thus far have been limited to single joint, single motion knee tasks. Therefore, we sought to overcome prior limitations to understand the effects of injury on neural control of lower extremity movement by employing a multi-joint motor paradigm and determining differences in neural activity between ACL-reconstructed (ACLr) individuals relative to healthy matched controls. Fifteen patients with left anterior cruciate ligament reconstruction and fifteen matched healthy controls participated in this study. Neural activity was examined using functional magnetic resonance imaging during a block-designed knee-hip movement paradigm (similar to a supine heel-slide). Participants for each group were monitored and task performance was controlled via a metronome to ensure the same spatial-temporal parameters. We observed that those with ACL reconstruction displayed increased activation within the intracalcarine cortex, lingual gyrus, occipital fusiform gyrus, lateral occipital cortex, angular gyrus, and superior parietal lobule relative to controls. A follow-up task-based functional connectivity analyses using seed regions identified from the group analysis revealed connectivity among fronto-insular-temporal and sensorimotor regions within the ACLr participants. The results of this fMRI investigation suggest ACLr individuals require increased activity and connectivity in areas responsible for visual-spatial cognition and orientation, and attention for hip and knee motor control.

Body Size Judgments at 17 ms: Evidence From Perceptual and Attitudinal Body Image Indexes

Evidence related to temporal control for stimuli presentation of whole-body image is generally associated with attentional bias to ideal thin bodies. Few studies present evidence concerning whole-body stimuli recognition during fast visual exposure intervals. The aim of this study was to evaluate the accuracy and reaction times for the judgment of different sized body silhouettes presented at 17 ms in a non-clinical sample. Thirty-one participants were divided in attitudinal and perceptual body image groups based on Figure Rating Scale output and performed two experiments. First experiment assessed perception and the clarity of visual experience for human and non-human body stimuli at 17 ms. A general accuracy of 69.17% was registered with no differences between perceptual and attitudinal body image groups. These results indicated that the way participants perceive their own bodies does not influence the recognition of general visual silhouette stimuli. It was also observed that the clarity of visual experience is positively correlated to stimuli recognition accuracy. In the second experiment participants had to respond in a seven-point Likert scale if the presented image of body silhouettes were bigger, equal or thinner than their own bodies. Trials were divided in two blocks based on spatial rotation, half at 0° and half at 180°. General accuracy for body silhouettes recognition was 41.1%. Greater accuracy recognition for regular positioned stimuli was observed. Attitudinal dimension of body image was not a predictor of differential performance whereas perceptual body image groups recorded contrasting recognition performance. Distorted body image participants presented higher accuracy than undistorted body image participants, with greater accuracy to thinner silhouette figures. Women had significantly higher overall accuracy than men considering both experimental blocks. When comparing the cumulative accuracy curves across experimental trials, an exposure effect was registered only for the first experiment. Results showed that body silhouette stimuli were judged in a fast exposure interval with differential accuracy rates only for perceptual body image groups. Such evidence signals that conscious body image can be associated to implicit detection of visual human body stimuli. Future studies should further test how traditional explicit body image outputs perform within experimental approaches.

Tool-Use Training Induces Changes of the Body Schema in the Limb Without Using Tool

Previous studies have shown that tool use affects the plasticity of the body schema. In other words, people will perceive the tool as a part of their body, and thus feel like they have “longer limbs” after using tools. However, it is unclear whether tool embodiment could spread to a limb that is not using the tool, and whether other limbs could utilize the proprioception of a limb. In Experiment 1, blindfolded participants were asked to search with a cane (Condition 1) or to walk with a cane (Condition 2). The results in Condition 1 illustrated that the tactile distance perception on the forearm was lengthened after tool use, while other body parts did not significantly change. In Condition 2, the tactile distance perception on the hand and forearm extended significantly after using tools. Additionally, tool-use training even induced an increased perception of the calf that was not using the tool. Possible interference from the difference between walking and standing was excluded in Experiment 2. These results demonstrate that the proprioception information of one limb could be exploited by another limb to extend the body schema even though that limb was not using a tool. It was also observed that the effect of direction was task-dependent in the tactile perception task.

Somatosensory Cortex Efficiently Processes Touch Located Beyond the Body

The extent to which a tool is an extension of its user is a question that has fascinated writers and philosophers for centuries [1]. Despite two decades of research [2-7], it remains unknown how this could be instantiated at the neural level. To this aim, the present study combined behavior, electrophysiology and neuronal modeling to characterize how the human brain could treat a tool like an extended sensory "organ." As with the body, participants localize touches on a hand-held tool with near-perfect accuracy [7]. This behavior is owed to the ability of the somatosensory system to rapidly and efficiently use the tool as a tactile extension of the body. Using electroencephalography (EEG), we found that where a hand-held tool was touched was immediately coded in the neural dynamics of primary somatosensory and posterior parietal cortices of healthy participants. We found similar neural responses in a proprioceptively deafferented patient with spared touch perception, suggesting that location information is extracted from the rod's vibrational patterns. Simulations of mechanoreceptor responses [8] suggested that the speed at which these patterns are processed is highly efficient. A second EEG experiment showed that touches on the tool and arm surfaces were localized by similar stages of cortical processing. Multivariate decoding algorithms and cortical source reconstruction provided further evidence that early limb-based processes were repurposed to map touch on a tool. We propose that an elementary strategy the human brain uses to sense with tools is to recruit primary somatosensory dynamics otherwise devoted to the body.

The impact of diabetic peripheral neuropathy on pinch proprioception

This study aims to investigate the impact of type 2 diabetes (T2D) and diabetic peripheral neuropathy (DPN) on pinch proprioception and to establish the correlations with sensory impairments. We collected data from a total of 36 participants (healthy, n = 12; T2D without DPN, n = 11; and T2D + DPN, n = 13), all matched for age, 60 ± 6 years. Pinch proprioception was determined through 3 trials of attempts to actively reproduce 15° of pinch position without visual feedback. Target accuracy and precision was compared between groups using Kruskal-Wallis test. Sensation was tested through the two-point discrimination and Semmes-Weinstein monofilaments applied on the fingers. Sensory measures were correlated with pinch proprioception measures via Spearman's rank test. The T2D + DPN group showed significant decrements in accuracy and precision as compared to the T2D-only (p = 0.003 and p = 0.006, respectively) and the healthy groups (both p = 0.002); no significant differences were found between T2D-only and healthy. Spearman's rank showed moderate (r = 0.45-0.66, p < 0.001) correlations between pinch proprioception and sensory measures. Our results showed pinch proprioception disruption in people with T2D + DPN, but not in people with T2D-only. The awareness of pinch proprioceptive deficits is paramount for the safety of individuals with T2D and DPN. Moderate correlations between sensory impairments and pinch proprioceptive deficits suggest that not only superficial/discriminative sensation is implicated in proprioceptive decrements. Other mechanisms such as damage to muscle spindles or central nervous system associated with T2D + DPN warrant further investigations.

Tool Use Modulates Somatosensory Cortical Processing in Humans

Tool use leads to plastic changes in sensorimotor body representations underlying tactile perception. The neural correlates of this tool-induced plasticity in humans have not been adequately characterized. This study used ERPs to investigate the stage of sensory processing modulated by tool use. Somatosensory evoked potentials, elicited by median nerve stimulation, were recorded before and after two forms of object interaction: tool use and hand use. Compared with baseline, tool use-but not use of the hand alone-modulated the amplitude of the P100. The P100 is a mid-latency component that indexes the construction of multisensory models of the body and has generators in secondary somatosensory and posterior parietal cortices. These results mark one of the first demonstrations of the neural correlates of tool-induced plasticity in humans and suggest that tool use modulates relatively late stages of somatosensory processing outside primary somatosensory cortex. This finding is consistent with what has been observed in tool-trained monkeys and suggests that the mechanisms underlying tool-induced plasticity have been preserved across primate evolution.

Somatosensory-guided tool use modifies arm representation for action

Tool-use changes both peripersonal space and body representations, with several effects being nowadays termed tool embodiment. Since somatosensation was typically accompanied by vision in most previous tool use studies, whether somatosensation alone is sufficient for tool embodiment remains unknown. Here we address this question via a task assessing arm length representation at an implicit level. Namely, we compared movement’s kinematics in blindfolded healthy participants when grasping an object before and after tool-use. Results showed longer latencies and smaller peaks in the arm transport component after tool-use, consistent with an increased length of arm representation. No changes were found in the hand grip component and correlations revealed similar kinematic signatures in naturally long-armed participants. Kinematics changes did not interact with target object position, further corroborating the finding that somatosensory-guided tool use may increase the represented size of the participants’ arm. Control experiments ruled out alternative interpretations based upon altered hand position sense. In addition, our findings indicate that tool-use effects are specific for the implicit level of arm representation, as no effect was observed on the explicit estimate of the forearm length. These findings demonstrate for the first time that somatosensation is sufficient for incorporating a tool that has never been seen, nor used before.

Proprioceptive loss and the perception, control and learning of arm movements in humans: evidence from sensory neuronopathy

It is uncertain how vision and proprioception contribute to adaptation of voluntary arm movements. In normal participants, adaptation to imposed forces is possible with or without vision, suggesting that proprioception is sufficient; in participants with proprioceptive loss (PL), adaptation is possible with visual feedback, suggesting that proprioception is unnecessary. In experiment 1 adaptation to, and retention of, perturbing forces were evaluated in three chronically deafferented participants. They made rapid reaching movements to move a cursor toward a visual target, and a planar robot arm applied orthogonal velocity-dependent forces. Trial-by-trial error correction was observed in all participants. Such adaptation has been characterized with a dual-rate model: a fast process that learns quickly, but retains poorly and a slow process that learns slowly and retains well. Experiment 2 showed that the PL participants had large individual differences in learning and retention rates compared to normal controls. Experiment 3 tested participants’ perception of applied forces. With visual feedback, the PL participants could report the perturbation’s direction as well as controls; without visual feedback, thresholds were elevated. Experiment 4 showed, in healthy participants, that force direction could be estimated from head motion, at levels close to the no-vision threshold for the PL participants. Our results show that proprioceptive loss influences perception, motor control and adaptation but that proprioception from the moving limb is not essential for adaptation to, or detection of, force fields. The differences in learning and retention seen between the three deafferented participants suggest that they achieve these tasks in idiosyncratic ways after proprioceptive loss, possibly integrating visual and vestibular information with individual cognitive strategies.

The recalibration of tactile perception during tool use is body-part specific

Two decades of research have demonstrated that using a tool modulates spatial representations of the body. Whether this embodiment is specific to representations of the tool-using limb or extends to representations of other body parts has received little attention. Several studies of other perceptual phenomena have found that modulations to the primary somatosensory representation of the hand transfers to the face, due in part to their close proximity in primary somatosensory cortex. In the present study, we investigated whether tool-induced recalibration of tactile perception on the hand transfers to the cheek. Participants verbally estimated the distance between two tactile points applied to either their hand or face, before and after using a hand-shaped tool. Tool use recalibrated tactile distance perception on the hand-in line with previous findings-but left perception on the cheek unchanged. This finding provides support for the idea that embodiment is body-part specific. Furthermore, it suggests that tool-induced perceptual recalibration occurs at a level of somatosensory processing, where representations of the hand and face have become functionally disentangled.

Visual illusion of tool use recalibrates tactile perception

Brief use of a tool recalibrates multisensory representations of the user's body, a phenomenon called tool embodiment. Despite two decades of research, little is known about its boundary conditions. It has been widely argued that embodiment requires active tool use, suggesting a critical role for somatosensory and motor feedback. The present study used a visual illusion to cast doubt on this view. We used a mirror-based setup to induce a visual experience of tool use with an arm that was in fact stationary. Following illusory tool use, tactile perception was recalibrated on this stationary arm, and with equal magnitude as physical use. Recalibration was not found following illusory passive tool holding, and could not be accounted for by sensory conflict or general interhemispheric plasticity. These results suggest visual tool-use signals play a critical role in driving tool embodiment.