Loss of haptic feedback impairs control of hand posture: a study in chronically deafferented individuals when grasping and lifting objects.

Previous work has highlighted the role of haptic feedback for manual dexterity, in particular for the control of precision grip forces between the index finger and thumb. It is unclear how fine motor skills involving more than just two digits might be affected, especially given that loss of sensation from the hand affects many neurological patients, and impacts on everyday actions. To assess the functional consequences of haptic deficits on multi-digit grasp of objects, we studied the ability of three rare individuals with permanent large-fibre sensory loss involving the entire upper limb. All three reported difficulties in everyday manual actions (ABILHAND questionnaire). Their performance in a reach-grasp-lift task was compared to that of healthy controls. Twenty objects of varying shape, mass, opacity and compliance were used. In the reach-to-grasp phase, we found slower movement, larger grip aperture and less dynamic modulation of grip aperture in deafferented participants compared to controls. Hand posture during the lift phase also differed; deafferented participants often adopted hand postures that may have facilitated visual guidance, and/or reduced control complexity. For example, they would extend fingers that were not in contact with the object, or fold these fingers into the palm of the hand. Variability in hand postures was increased in deafferented participants, particularly for smaller objects. Our findings provide new insights into how the complex control required for whole hand actions is compromised by loss of haptic feedback, whose contribution is, thus, highlighted.

Correction to: Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements - a pilot study.

The original article [1] contained a minor error in the following sentence in the Discussion.

Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements - a pilot study.

BACKGROUND: Intensive robot-assisted training of the upper limb after stroke can reduce motor impairment, even at the chronic stage. However, the effectiveness of practice for recovery depends on the selection of the practised movements. We hypothesized that rehabilitation can be optimized by selecting the movements to be practiced based on the trainee's performance profile. METHODS: We present a novel principle ('steepest gradients') for performance-based selection of movements. The principle is based on mapping motor performance across a workspace and then selecting movements located at regions of the steepest transition between better and worse performance. To assess the benefit of this principle we compared the effect of 15 sessions of robot-assisted reaching training on upper-limb motor impairment, between two groups of people who have moderate-to-severe chronic upper-limb hemiparesis due to stroke. The test group (N = 7) received steepest gradients-based training, iteratively selected according to the steepest gradients principle with weekly remapping, whereas the control group (N = 9) received a standard "centre-out" reaching training. Training intensity was identical. RESULTS: Both groups showed improvement in Fugl-Meyer upper-extremity scores (the primary outcome measure). Moreover, the test group showed significantly greater improvement (twofold) compared to control. The score remained elevated, on average, for at least 4 weeks although the additional benefit of the steepest-gradients -based training diminished relative to control. CONCLUSIONS: This study provides a proof of concept for the superior benefit of performance-based selection of practiced movements in reducing upper-limb motor impairment due to stroke. This added benefit was most evident in the short term, suggesting that performance-based steepest-gradients training may be effective in increasing the rate of initial phase of practice-based recovery; we discuss how long-term retention may also be improved. TRIAL REGISTRATION: ISRCTN, ISRCTN65226825 , registered 12 June 2018 - Retrospectively registered.

Mapping upper-limb motor performance after stroke - a novel method with utility for individualized motor training.

BACKGROUND: Chronic upper limb motor impairment is a common outcome of stroke. Therapeutic training can reduce motor impairment. Recently, a growing interest in evaluating motor training provided by robotic assistive devices has emerged. Robot-assisted therapy is attractive because it provides a means of increasing practice intensity without increasing the workload of physical therapists. However, movements practised through robotic assistive devices are commonly pre-defined and fixed across individuals. More optimal training may result from individualizing the selection of the trained movements based on the individual's impairment profile. This requires quantitative assessment of the degree of the motor impairment prior to training, in relevant movement tasks. However, standard clinical measures for profiling motor impairment after stroke are often subjective and lack precision. We have developed a novel robot-mediated method for systematic and fine-grained mapping (or profiling) of individual performance across a wide range of planar arm reaching movements. Here we describe and demonstrate this mapping method and its utilization for individualized training. We also present a novel principle for the individualized selection of training movements based on the performance maps. METHODS AND RESULTS: To demonstrate the utility of our method we present examples of 2D performance maps produced from the kinetic and kinematics data of two individuals with stroke-related upper limb hemiparesis. The maps outline distinct regions of high motor impairment. The procedure of map-based selection of training movements and the change in motor performance following training is demonstrated for one participant. CONCLUSIONS: The performance mapping method is feasible to produce (online or offline). The 2D maps are easy to interpret and to be utilized for selecting individual performance-based training. Different performance maps can be easily compared within and between individuals, which potentially has diagnostic utility.

A role of 3-D surface-from-motion cues in motion-induced blindness.

Motion-induced blindness (MIB), the illusory disappearance of local targets against a moving mask, has been attributed to both low-level stimulus-based effects and high-level processes, involving selection between local and more global stimulus contexts. Prior work shows that MIB is modulated by binocular disparity-based depth-ordering cues. We assessed whether the depth effect is specific to disparity by studying how monocular 3-D surface from motion affects MIB. Monocular kinetic depth cues were used to create a global 3-D hourglass with concave and convex surfaces. MIB increased for stationary targets on the convex relative to the concave area, extending the role of 3-D cues. Interestingly, this convexity effect was limited to the left visual field--replicating spatial anisotropies in MIB. The data indicate a causal role of general 3-D surface coding in MIB, consistent with MIB being affected by high-level, visual representations.

Perceptual organization without perception. The subliminal learning of global contour.

A critical step in visual perceptual processing is integrating local visual elements into contours so that shapes can be derived from them. It is often assumed that contour integration may reflect hardwired coding of low-level visual features. In this study, we present novel evidence indicating that integration of local elements into contours can be learned subliminally, despite being irrelevant to the training task and despite the local properties of the display varying randomly during training. Learning occurred only when contours were consistently paired with task-relevant targets--echoing the findings of previous studies on subliminal learning of low-level features. Our data indicate that task-irrelevant, exposure-based learning extends beyond local low-level visual features and may play a critical role at multiple levels of visual perceptual organization.

Sound-induced flash illusion is resistant to feedback training.

A single flash accompanied by two auditory beeps tends to be perceived as two flashes (Shams et al. Nature 408:788, 2000, Cogn Brain Res 14:147-152, 2002). This phenomenon is known as 'sound-induced flash illusion.' Previous neuroimaging studies have shown that this illusion is correlated with modulation of activity in early visual cortical areas (Arden et al. Vision Res 43(23):2469-2478, 2003; Bhattacharya et al. NeuroReport 13:1727-1730, 2002; Shams et al. NeuroReport 12(17):3849-3852, 2001, Neurosci Lett 378(2):76-81, 2005; Watkins et al. Neuroimage 31:1247-1256, 2006, Neuroimage 37:572-578, 2007; Mishra et al. J Neurosci 27(15):4120-4131, 2007). We examined how robust the illusion is by testing whether the frequency of the illusion can be reduced by providing feedback. We found that the sound-induced flash illusion was resistant to feedback training, except when the amount of monetary reward was made dependent on accuracy in performance. However, even in the latter case the participants reported that they still perceived illusory two flashes even though they correctly reported single flash. Moreover, the feedback training effect seemed to disappear once the participants were no longer provided with feedback suggesting a short-lived refinement of discrimination between illusory and physical double flashes rather than vanishing of the illusory percept. These findings indicate that the effect of sound on the perceptual representation of visual stimuli is strong and robust to feedback training, and provide further evidence against decision factors accounting for the sound-induced flash illusion.

Acquiring long-term representations of visual classes following extensive extrastriate damage.

Different areas of human visual cortex are thought to play different roles in the learning of visual information: whereas in low/intermediate cortical areas, plasticity may be manifested by enhanced selectivity to learned visual features, in higher-level areas, plasticity may result in generalization and development of tolerance to degraded versions of the learned stimuli. The most effective tolerance to degraded information is presumably achieved in the case of cooperation between the different forms of plasticity. Whether this tolerance to degraded information also applies when the visual input is degraded as a result of a lesion to lower levels of the visual system remains an open question. To address this, we studied visual classification learning in a patient with an extensive bilateral lesion affecting intermediate/low-level visual areas but sparing higher-level areas. Despite difficulty in perceiving the stimuli, the patient learned to classify them, albeit not as quickly as control participants. Moreover, the patient's learning was maintained over the long term and was accompanied by improved discrimination of individual stimuli. These findings demonstrate that degraded output from lesioned, lower areas can be exploited in the service of a new visual task and the results likely implicate a combination of bottom-up and top-down processing during visual learning.