Spatial mapping of posture-dependent resistance to passive displacement of the hypertonic arm post-stroke.

BACKGROUND: Muscles in the post-stroke arm commonly demonstrate abnormal reflexes that result in increased position- and velocity-dependent resistance to movement. We sought to develop a reliable way to quantify mechanical consequences of abnormal neuromuscular mechanisms throughout the reachable workspace in the hemiparetic arm post-stroke. METHODS: Survivors of hemiparetic stroke (HS) and neurologically intact (NI) control subjects were instructed to relax as a robotic device repositioned the hand of their hemiparetic arm between several testing locations that sampled the arm's passive range of motion. During transitions, the robot induced motions at either the shoulder or elbow joint at three speeds: very slow (6°/s), medium (30°/s), and fast (90°/s). The robot held the hand at the testing location for at least 20 s after each transition. We recorded and analyzed hand force and electromyographic activations from selected muscles spanning the shoulder and elbow joints during and after transitions. RESULTS: Hand forces and electromyographic activations were invariantly small at all speeds and all sample times in NI control subjects but varied systematically by transport speed during and shortly after movement in the HS subjects. Velocity-dependent resistance to stretch diminished within 2 s after movement ceased in the hemiparetic arms. Hand forces and EMGs changed very little from 2 s after the movement ended onward, exhibiting dependence on limb posture but no systematic dependence on movement speed or direction. Although each HS subject displayed a unique field of hand forces and EMG responses across the workspace after movement ceased, the magnitude of steady-state hand forces was generally greater near the outer boundaries of the workspace than in the center of the workspace for the HS group but not the NI group. CONCLUSIONS: In the HS group, electromyographic activations exhibited abnormalities consistent with stroke-related decreases in the stretch reflex thresholds. These observations were consistent across repeated testing days. We expect that the approach described here will enable future studies to elucidate stroke's impact on the interaction between the neural mechanisms mediating control of upper extremity posture and movement during goal-directed actions such as reaching and pointing with the arm and hand.

The Arm Movement Detection (AMD) test: a fast robotic test of proprioceptive acuity in the arm.

BACKGROUND: We examined the validity and reliability of a short robotic test of upper limb proprioception, the Arm Movement Detection (AMD) test, which yields a ratio-scaled, objective outcome measure to be used for evaluating the impact of sensory deficits on impairments of motor control, motor adaptation and functional recovery in stroke survivors. METHODS: Subjects grasped the handle of a horizontal planar robot, with their arm and the robot hidden from view. The robot applied graded force perturbations, which produced small displacements of the handle. The AMD test required subjects to respond verbally to queries regarding whether or not they detected arm motions. Each participant completed ten, 60s trials; in five of the trials, force perturbations were increased in small increments until the participant detected motion while in the others, perturbations were decreased until the participant could no longer detect motion. The mean and standard deviation of the 10 movement detection thresholds were used to compute a Proprioceptive Acuity Score (PAS). Based on the sensitivity and consistency of the estimated thresholds, the PAS quantifies the likelihood that proprioception is intact. Lower PAS scores correspond to higher proprioceptive acuity. Thirty-nine participants completed the AMD test, consisting of 25 neurologically intact control participants (NIC), seven survivors of stroke with intact proprioception in the more affected limb (HSS+P), and seven survivors of stroke with impaired or absent proprioception in the more affected limb (HSS-P). RESULTS: Significant group differences were found, with the NIC and HSS+P groups having lower (i.e., better) PAS scores than the HSS-P group. A subset of the participants completed the AMD test multiple times and the AMD test was found to be reliable across repetitions. CONCLUSIONS: The AMD test required less than 15 min to complete and provided an objective, ratio-scaled measure of proprioceptive acuity in the upper limb. In the future, this test could be utilized to evaluate the contributions of sensory deficits to motor recovery following stroke.

A robotic test of proprioception within the hemiparetic arm post-stroke.

BACKGROUND: Proprioception plays important roles in planning and control of limb posture and movement. The impact of proprioceptive deficits on motor function post-stroke has been difficult to elucidate due to limitations in current tests of arm proprioception. Common clinical tests only provide ordinal assessment of proprioceptive integrity (eg. intact, impaired or absent). We introduce a standardized, quantitative method for evaluating proprioception within the arm on a continuous, ratio scale. We demonstrate the approach, which is based on signal detection theory of sensory psychophysics, in two tasks used to characterize motor function after stroke. METHODS: Hemiparetic stroke survivors and neurologically intact participants attempted to detect displacement- or force-perturbations robotically applied to their arm in a two-interval, two-alternative forced-choice test. A logistic psychometric function parameterized detection of limb perturbations. The shape of this function is determined by two parameters: one corresponds to a signal detection threshold and the other to variability of responses about that threshold. These two parameters define a space in which proprioceptive sensation post-stroke can be compared to that of neurologically-intact people. We used an auditory tone discrimination task to control for potential comprehension, attention and memory deficits. RESULTS: All but one stroke survivor demonstrated competence in performing two-alternative discrimination in the auditory training test. For the remaining stroke survivors, those with clinically identified proprioceptive deficits in the hemiparetic arm or hand had higher detection thresholds and exhibited greater response variability than individuals without proprioceptive deficits. We then identified a normative parameter space determined by the threshold and response variability data collected from neurologically intact participants. By plotting displacement detection performance within this normative space, stroke survivors with and without intact proprioception could be discriminated on a continuous scale that was sensitive to small performance variations, e.g. practice effects across days. CONCLUSIONS: The proposed method uses robotic perturbations similar to those used in ongoing studies of motor function post-stroke. The approach is sensitive to small changes in the proprioceptive detection of hand motions. We expect this new robotic assessment will empower future studies to characterize how proprioceptive deficits compromise limb posture and movement control in stroke survivors.

The arm motion detection (AMD) test.

Stroke can lead to sensory deficits that impair functional control of arm movements. Here we describe a simple test of arm motion detection (AMD) that provides an objective, quantitative measure of movement perception related proprioceptive capabilities in the arm. Seven stroke survivors and thirteen neurologically intact control subjects performed the AMD test. In a series of ten trials that took less than 15 minutes to complete, participants used a two-button user interface to adjust the magnitude of hand displacements produced by a horizontal planar robot until the motions were just perceptible (i.e. on the threshold of detection). The standard deviation of movement detection threshold was plotted against the mean and a normative range was determined from the data collected with control subjects. Within this normative space, subjects with and without intact proprioception could be discriminated on a ratio scale that is meaningful for ongoing studies of degraded motor function. Thus, the AMD test provides a relatively fast, objective and quantitative measure of upper extremity proprioception of limb movement (i.e. kinesthesia).

Submovements during reaching movements after stroke.

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

Dual-tasking alleviated sleep deprivation disruption in visuomotor tracking: an fMRI study.

Effects of dual-responding on tracking performance after 49-h of sleep deprivation (SD) were evaluated behaviorally and with functional magnetic resonance imaging (fMRI). Continuous visuomotor tracking was performed simultaneously with an intermittent color-matching visual detection task in which a pair of color-matched stimuli constituted a target and non-matches were non-targets. Tracking error means were binned time-locked to stimulus onset of the detection task in order to observe changes associated with dual-responding by comparing the error during targets and non-targets. Similar comparison was made with fMRI data. Our result showed that despite a significant increase in the overall tracking error post SD, from 20 pixels pre SD to 45 pixels post SD, error decreased to a minimum of about 25 pixels 0-6s after dual-response. Despite an overall reduced activation post SD, greater activation difference between targets and non-targets was found post SD in task-related regions, such as the left cerebellum, the left somatosensory cortex, the left extrastriate cortex, bilateral precuneus, the left middle frontal gyrus, and the left motor cortex. Our results suggest that dual-response helps to alleviate performance impairment usually associated with SD. The duration of the alleviation effect was on the order of seconds after dual-responding.

Patterns of hypermetria and terminal cocontraction during point-to-point movements demonstrate independent action of trajectory and postural controllers.

We examined elbow muscle activities and movement kinematics to determine how subjects combine elementary control actions in performing movements with one and two trajectory segments. In reaching, subjects made a rapid elbow flexion to a visual target before stabilizing the limb with either a low or a higher level of elbow flexor/extensor coactivity (CoA), which was cued by target diameter. Cursor diameter provided real-time biofeedback of actual muscle CoA. In reversing, the limb was to reverse direction within the target and return to the origin with minimal CoA. We previously reported that subjects overshoot the goal when attempting a reversal after first having learned to reach accurately to the same target. Here we test the hypothesis that this hypermetria results because reversals co-opt the initial feedforward control action from the preceding trained reach, thereby failing to account for task-dependent changes in limb impedance induced by differences in flexor/extensor coactivity as the target is acquired (higher in reaching than reversing). Instructed increases in elbow CoA began mid-reach, thus increasing elbow impedance and reducing transient oscillations present in low CoA movments. Flexor EMG alone increased at movement onset. Test reversals incorporated the initial agonist activity of previous reaches but not the increased coactivity at the target, thus leading to overshoot. Moreover, we observed elevated coactivity in reversals upon returning to the origin even though coactivity in reaching was centered at the goal target. These findings refute the idea that the brain necessarily invokes distinct unitary control actions for reaches and reversals made to the same target. Instead, reaches and reversals share a common control action that initiates trajectories toward their target and another later control action that terminates movement and stabilizes the limb about its final resting posture, which differs in the two tasks.

A quantitative and standardized robotic method for the evaluation of arm proprioception after stroke.

Stroke often results in both motor and sensory deficits, which may interact in the manifested functional impairment. Proprioception is known to play important roles in the planning and control of limb posture and movement; however, the impact of proprioceptive deficits on motor function has been difficult to elucidate due in part to the qualitative nature of available clinical tests. We present a quantitative and standardized method for evaluating proprioception in tasks directly relevant to those used to assess motor function. Using a robotic manipulandum that exerted controlled displacements of the hand, stroke participants were evaluated, and compared with a control group, in their ability to detect such displacements in a 2-alternative, forced-choice paradigm. A psychometric function parameterized the decision process underlying the detection of the hand displacements. The shape of this function was determined by a signal detection threshold and by the variability of the response about this threshold. Our automatic procedure differentiates between participants with and without proprioceptive deficits and quantifies functional proprioceptive sensation on a magnitude scale that is meaningful for ongoing studies of degraded motor function in comparable horizontal movements.

Combined adaptiveness of specific motor cortical ensembles underlies learning.

Learning motor skills entails adaptation of neural computations that can generate or modify associations between sensations and actions. Indeed, humans can use different strategies when adapting to dynamic loads depending on available sensory feedback. Here, we examined how neural activity in motor cortex was modified when monkeys made arm reaches to a visual target and locally adapted to curl force field with or without visual trajectory feedback. We found that firing rates of a large subpopulation of cells were consistently modulated depending on the distance of their preferred direction from the learned movement direction. The newly acquired activity followed a cosine-like function, with maximal increase in directions that opposed the perturbing force and decrease in opposite directions. As a result, the combined neuronal activity generated an adapted population vector. The results suggest that this could be achieved without changing the tuning properties of the cells. This population directional signal was however altered in the absence of visual feedback; while the cosine pattern of modulation was maintained, the population distributions of modulated cells differed across feedback consistent with the different trajectory shapes. Finally, we predicted generalization patterns of force-field learning based on the cosine-like modulation. These conformed to reported features of generalization in humans, suggesting that the generalization function was related to the observed rate modulations in the motor cortex. Overall, the findings suggest that the new combined activation of neuronal ensembles could underlie the change in the internal model of movement dynamics in a way that depends on available sensory feedback and chosen strategy.

Performance degradation and altered cerebral activation during dual performance: evidence for a bottom-up attentional system.

Subjects performed a continuous tracking concurrently with an intermittent visual detection task to investigate the existence of competition for a capacity-limited stage (a bottleneck stage). Both perceptual and response-related processes between the two tasks were examined behaviorally and the changes in brain activity during dual-tasking relative to single-task were also assessed. Tracking error and joystick speed were analyzed for changes that were time-locked to visual detection stimuli. The associated brain activations were examined with functional magnetic resonance imaging (fMRI). These were analyzed using mixed block and event-related models to tease apart sustained neural activity and activations associated with individual events. Increased tracking error and decreased joystick speed were observed relative to the target stimuli in the dual-task condition only, which supports the existence of a bottleneck stage in response-related processes. Neuroimaging data show decreased activation to target relative to non-target stimuli in the dual-task condition in the left primary motor and somatosensory cortices controlling right-hand tracking, consistent with the tracking interference observed in behavioral data. Furthermore, the ventral attention system, rather than the dorsal attention system, was found to mediate task coordination between tracking and visual detection.

Differences in context and feedback result in different trajectories and adaptation strategies in reaching.

Computational models of motor control have often explained the straightness of horizontal planar reaching movements as a consequence of optimal control. Departure from rectilinearity is thus regarded as sub-optimal. Here we examine if subjects may instead select to make curved trajectories following adaptation to force fields and visuomotor rotations. Separate subjects adapted to force fields with or without visual feedback of their hand trajectory and were retested after 24 hours. Following adaptation, comparable accuracies were achieved in two ways: with visual feedback, adapted trajectories in force fields were straight whereas without it, they remained curved. The results suggest that trajectory shape is not always straight, but is also influenced by the calibration of available feedback signals for the state estimation required by the task. In a follow-up experiment, where additional subjects learned a visuomotor rotation immediately after force field, the trajectories learned in force fields (straight or curved) were transferred when directions of the perturbations were similar but not when directions were opposing. This demonstrates a strong bias by prior experience to keep using a recently acquired control policy that continues to produce successful performance inspite of differences in tasks and feedback conditions. On relearning of force fields on the second day, facilitation by intervening visuomotor rotations occurred only when required motor adjustments and calibration of feedback signals were similar in both tasks. These results suggest that both the available feedback signals and prior history of learning influence the choice and maintenance of control policy during adaptations.

Learning of a sequential motor skill comprises explicit and implicit components that consolidate differently.

The ability to perform accurate sequential movements is essential to normal motor function. Learning a sequential motor behavior is comprised of two basic components: explicit identification of the order in which the sequence elements should be performed and implicit acquisition of spatial accuracy for each element. Here we investigated the time course of learning of these components for a first sequence (SEQA) and their susceptibility to interference from learning a second sequence (SEQB). We assessed explicit learning with a discrete index, the number of correct anticipatory movements, and implicit learning with a continuous variable, spatial error, which decreased during learning without subject awareness. Spatial accuracy to individual sequence elements reached asymptotic levels only when the whole sequence order was known. Interference with recall of the order of SEQA persisted even when SEQB was learned 24 h after SEQA. However, there was resistance to interference by SEQB with increased initial training with SEQA. For implicit learning of spatial accuracy, SEQB interfered at 5 min but not 24 h after SEQA. As in the case of sequence order, prolonged initial training with SEQA induced resistance to interference by SEQB. We conclude that explicit sequence learning is more susceptible to anterograde interference and implicit sequence learning is more susceptible to retrograde interference. However, both become resistant to interference with saturation training. We propose that an essential feature of motor skill learning is the process by which discrete explicit task elements are combined with continuous implicit features of movement to form flawless sequential actions.

Separate adaptive mechanisms for controlling trajectory and final position in reaching.

We examined control of the hand's trajectory (direction and shape) and final equilibrium position in horizontal planar arm movements by quantifying transfer of learned visuomotor rotations between two tasks that required aiming the hand to the same spatial targets. In a trajectory-reversal task ("slicing"), the hand reversed direction within the target and returned to the origin. In a positioning task ("reaching"), subjects moved the hand to the target and held it there; cursor feedback was provided only after movement ended to isolate learning of final position from trajectory direction. We asked whether learning acquired in one task would transfer to the other. Transfer would suggest that the hand's entire trajectory, including its endpoint, was controlled using a common spatial plan. Instead we found minimal transfer, suggesting that the brain used different representations of target position to specify the hand's initial trajectory and its final stabilized position. We also observed asymmetrical practice effects on hand trajectory, including systematic curvature of reaches made after rotation training and hypermetria of untrained slice reversals after reach training. These are difficult to explain with a unified control model, but were replicated in computer simulations that specified the hand's initial trajectory and its final equilibrium position. Our results suggest that the brain uses different mechanisms to plan the hand's initial trajectory and final position in point-to-point movements, that it implements these control actions sequentially, and that trajectory planning does not account for specific impedance values to be implemented about the final stabilized posture.

Different learned coordinate frames for planning trajectories and final positions in reaching.

We previously reported that the kinematics of reaching movements reflect the superimposition of two separate control mechanisms specifying the hand's spatial trajectory and its final equilibrium position. We now asked whether the brain maintains separate representations of the spatial goals for planning hand trajectory and final position. One group of subjects learned a 30 degrees visuomotor rotation about the hand's starting point while performing a movement reversal task ("slicing") in which they reversed direction at one target and terminated movement at another. This task required accuracy in acquiring a target mid-movement. A second group adapted while moving to -- and stabilizing at -- a single target ("reaching"). This task required accuracy in specifying an intended final position. We examined how learning in the two tasks generalized both to movements made from untrained initial positions and to movements directed toward untrained targets. Shifting initial hand position had differential effects on the location of reversals and final positions: Trajectory directions remained unchanged and reversal locations were displaced in slicing whereas final positions of both reaches and slices were relatively unchanged. Generalization across directions in slicing was consistent with a hand-centered representation of desired reversal point as demonstrated previously for this task whereas the distributions of final positions were consistent with an eye-centered representation as found previously in studies of pointing in three-dimensional space. Our findings indicate that the intended trajectory and final position are represented in different coordinate frames, reconciling previous conflicting claims of hand-centered (vectorial) and eye-centered representations in reach planning.

Preclinical Huntington's disease: compensatory brain responses during learning.

Motor sequence learning is abnormal in presymptomatic Huntington's disease (p-HD). The neural substrates underlying this early manifestation of HD are poorly understood. To study the mechanism of this cognitive abnormality in p-HD, we used positron emission tomography to record brain activity during motor sequence learning in these subjects. Eleven p-HD subjects (age, 45.8 +/- 11.0 years; CAG repeat length, 41.6 +/- 1.8) and 11 age-matched control subjects (age, 45.3 +/- 13.4 years) underwent H(2) (15)O positron emission tomography while performing a set of kinematically controlled motor sequence learning and execution tasks. Differences in regional brain activation responses between groups and conditions were assessed. In addition, we identified discrete regions in which learning-related activity correlated with performance. We found that sequence learning was impaired in p-HD subjects despite normal motor performance. In p-HD, activation responses during learning were abnormally increased in the left mediodorsal thalamus and orbitofrontal cortex (OFC; BA 11/47). Impaired learning performance in these subjects was associated with increased activation responses in the precuneus (BA 18/31). These data suggest that enhanced activation of thalamocortical pathways during motor learning can compensate for caudate degeneration in p-HD. Nonetheless, this mechanism may not be sufficient to sustain a normal level of task performance, even during the presymptomatic stage of the disease.

A new approach to spatial covariance modeling of functional brain imaging data: ordinal trend analysis.

In neuroimaging studies of human cognitive abilities, brain activation patterns that include regions that are strongly interactive in response to experimental task demands are of particular interest. Among the existing network analyses, partial least squares (PLS; McIntosh, 1999; McIntosh, Bookstein, Haxby, & Grady, 1996) has been highly successful, particularly in identifying group differences in regional functional connectivity, including differences as diverse as those associated with states of awareness and normal aging. However, we address the need for a within-group model that identifies patterns of regional functional connectivity that exhibit sustained activity across graduated changes in task parameters. For example, predictions of sustained connectivity are commonplace in studies of cognition that involve a series of tasks over which task difficulty increases (Baddeley, 2003). We designed ordinal trend analysis (OrT) to identify activation patterns that increase monotonically in their expression as the experimental task parameter increases, while the correlative relationships between brain regions remain constant. Of specific interest are patterns that express positive ordinal trends on a subject-by-subject basis. A unique feature of OrT is that it recovers information about functional connectivity based solely on experimental design variables. In particular, there is no requirement by OrT to provide either a quantitative model of the uncertain relationship between functional brain circuitry and subject variables (e.g., task performance and IQ) or partial information about the regions that are functionally connected. In this letter, we provide a step-by-step recipe of the computations performed in the new OrT analysis, including a description of the inferential statistical methods applied. Second, we describe applications of OrT to an event-related fMRI study of verbal working memory and H(2)15O-PET study of visuo-motor learning. In sum, OrT has potential applications to not only studies of young adults and their cognitive abilities, but also studies of normal aging and neurological and psychiatric disease.

Adaptation to visuomotor transformations: consolidation, interference, and forgetting.

The paradigm task A-->task B-->task A, which varies the time interval between task A and task B, has been used extensively to investigate the consolidation of motor memory. Consolidation is defined as resistance to retrograde interference (interference by task B on initial learning of task A). Consolidation has been demonstrated for simple skills, motor sequencing, and learning of force fields. In contrast, evidence to date suggests that visuomotor learning does not consolidate. We have shown previously that adaptation to a 30 degrees screen-cursor rotation is faster and more complete on relearning 24 hr later. This improvement is prevented if a 30 degrees counter-rotation is learned 5 min after the original rotation. Here, we sought to identify conditions under which rotation learning becomes resistant to interference by a counter-rotation. In experiment 1, we found that interference persists even when the counter-rotation is learned 24 hr after the initial rotation. In experiment 2, we removed potential anterograde interference (interference by task B on relearning of task A) by introducing washout blocks before all of the learning blocks. In contrast to experiment 1, we found resistance to interference (i.e., consolidation) when the counter-rotation was learned after 24 hr but not after 5 min. In experiment 3, we doubled the amount of initial rotation learning and found resistance to interference even after 5 min. Our results suggest that persistent interference is attributable to anterograde effects on memory retrieval. When anterograde effects are removed, rotation learning consolidates both over time and with increased initial training.

Differential cortical and subcortical activations in learning rotations and gains for reaching: a PET study.

Previous studies suggest that horizontal reaching movements are planned vectorially with independent specification of direction and extent. The transformation from visual to hand-centered coordinates requires the learning of a task-specific reference frame and scaling factor. We studied learning of a novel reference frame by imposing a screen-cursor rotation and learning of a scaling factor by imposing a novel gain. Previous work demonstrates that rotation and gain learning have different time courses and patterns of generalization. Here we used PET to identify and compare brain areas activated during rotation and gain learning, with a baseline motor-execution task as the subtracted control. Previous work has shown that the time courses of rotation and gain adaptation have a short rapid phase followed by a longer slow phase. We therefore also sought to compare activations associated with the rapid and slower phases of adaptation. We isolated the rapid phase by alternating opposite values of the rotation or gain every 16 movements. The rapid phase of rotation adaptation activated the preSMA. More complete adaptation to the rotation activated right ventral premotor cortex, right posterior parietal cortex, and the left lateral cerebellum. The rapid phase of gain learning only activated subcortical structures: bilateral putamen and left cerebellum. More complete gain learning failed to show any significant activation. We conclude that the time course of rotation adaptation is paralleled by a frontoparietal shift in activated cortical regions. In contrast, early gain adaptation involves only subcortical structures, which we suggest reflects a more automatic process of contextual recalibration of a scaling factor.

Impaired sequence learning in carriers of the DYT1 dystonia mutation.

Previous positron emission tomography (PET) studies have shown that nonmanifesting carriers of the DYT1 dystonia mutation express an abnormal pattern of resting glucose metabolism. To determine whether motor behavior is impaired in these subjects, we compared movement and sequence learning in 12 clinically unaffected DYT1 carriers with 12 age-matched controls. Regional differences in brain function during task performance were assessed with simultaneous H(2) (15)O/PET. We found that motor performance was similar in the DYT1 and control groups, with no significant differences in movement time and spatial accuracy measured during each of the tasks. In contrast, sequence learning was reduced in gene carriers relative to controls (p < 0.01). PET imaging during motor execution showed increased activation in gene carriers (p < 0.001, uncorrected) in the left premotor cortex and right supplementary motor area, with concomitant reduction in the posterior medial cerebellum. During sequence learning, activation responses in DYT1 carriers were increased in the left ventral prefrontal cortex, and lateral cerebellum. These findings suggest that abnormalities in motor behavior and brain function exist in clinically nonmanifesting DYT1 carriers. Although localized increases in neural activity may enable normal movement execution in these subjects, this mechanism may not compensate for their defect in sequence learning.

Learning networks in health and Parkinson's disease: reproducibility and treatment effects.

In a previous H(2) (15)O/PET study of motor sequence learning, we used principal components analysis (PCA) of region of interest (ROI) data to identify performance-related activation patterns in normal subjects and patients with Parkinson's disease (PD). In the present study, we determined whether these patterns predicted learning performance in subsequent normal and untreated PD cohorts. Using a voxel-based PCA approach, we correlated the changes in network activity that occurred during antiparkinsonian treatment and their relationship to learning performance. We found that the previously identified ROI-based patterns correlated with learning performance in the prospective normal (P < 0.01) and untreated PD (P < 0.05) cohorts. Voxel analysis revealed that target retrieval was related to a network characterized by bilateral activation of the dorsolateral prefrontal, premotor and anterior cingulate cortex, the precuneus, and the occipital association areas as well as the right ventral prefrontal and inferior parietal regions. Target acquisition was associated with a different network involving activation of the caudate, putamen, and right dentate nucleus, as well as the left ventral prefrontal and inferior parietal areas. Antiparkinsonian therapy gave rise to changes in retrieval performance that correlated with network modulation (P < 0.01). Increases in network activation and learning performance occurred with internal pallidal deep brain stimulation (GPi DBS); decrements in these measures were present with levodopa. Our findings suggest that network analysis of activation data can provide stable descriptors of learning performance. Network quantification can provide an objective means of assessing the effects of therapy on cognitive functioning in neurodegenerative disorders.