Distinct adaptation patterns between grip dynamics and arm kinematics when the body is upside-down.

In humans, practically all movements are learnt and performed in a constant gravitational field. Yet, studies on arm movements and object manipulation in parabolic flight have highlighted very fast sensorimotor adaptations to altered gravity environments. Here, we wondered if the motor adjustments observed in those altered gravity environments could also be observed on Earth in a situation where the body is upside-down. To address this question, we asked participants to perform rhythmic arm movements in two different body postures (right-side-up and upside-down) while holding an object in precision grip. Analyses of grip-load force coordination and of movement kinematics revealed distinct adaptation patterns between grip and arm control. Grip force and load force were tightly synchronized from the first movements performed in upside-down posture, reflecting a malleable allocentric grip control. In contrast, velocity profiles showed a more progressive adaptation to the upside-down posture and reflected an egocentric planning of arm kinematics. In addition to suggesting distinct mechanisms between grip dynamics and arm kinematics for adaptation to novel contexts, these results also suggest the existence of general mechanisms underlying gravity-dependent motor adaptation that can be used for fast sensorimotor coordination across different postures on Earth and, incidentally, across different gravitational conditions in parabolic flights, in human centrifuges, or in Space.NEW & NOTEWORTHY During rhythmic arm movements performed in an upside-down posture, grip control adapted very quickly, but kinematics adaptation was more progressive. Our results suggest that grip control and movement kinematics planning might operate in different reference frames. Moreover, by comparing our results with previous results from parabolic flight studies, we propose that a common mechanism underlies adaptation to unfamiliar body postures and adaptation to altered gravity.

Multisensory components of rapid motor responses to fingertip loading.

Tactile and muscle afferents provide critical sensory information for grasp control, yet the contribution of each sensory system during online control has not been clearly identified. More precisely, it is unknown how these two sensory systems participate in online control of digit forces following perturbations to held objects. To address this issue, we investigated motor responses in the context of fingertip loading, which parallels the impact of perturbations to held objects on finger motion and fingerpad deformation, and characterized surface recordings of intrinsic (first dorsal interosseous, FDI) and extrinsic (flexor digitorum superficialis, FDS) hand muscles based on statistical modeling. We designed a series of experiments probing the effects of peripheral stimulation with or without anesthesia of the finger, and of task instructions. Loading of the fingertip generated a motor response in FDI at ~60 ms following the perturbation onset, which was only driven by muscle stretch, as the ring-block anesthesia reduced the gain of the response occurring later than 90 ms, leaving responses occurring before this time unaffected. In contrast, the motor response in FDS was independent of the lateral motion of the finger. This response started at ~90 ms on average and was immediately adjusted to task demands. Altogether these results highlight how a rapid integration of partially distinct sensorimotor circuits supports rapid motor responses to fingertip loading.NEW & NOTEWORTHY To grasp and manipulate objects, the brain uses touch signals related to skin deformation as well as sensory information about motion of the fingers encoded in muscle spindles. Here we investigated how these two sensory systems contribute to feedback responses to perturbation applied to the fingertip. We found distinct response components, suggesting that each sensory system engages separate sensorimotor circuits with distinct functions and latencies.

Peripheral vs. central determinants of vibrotactile adaptation.

Long-lasting mechanical vibrations applied to the skin induce a reversible decrease in the perception of vibration at the stimulated skin site. This phenomenon of vibrotactile adaptation has been studied extensively, yet there is still no clear consensus on the mechanisms leading to vibrotactile adaptation. In particular, the respective contributions of 1) changes affecting mechanical skin impedance, 2) peripheral processes, and 3) central processes are largely unknown. Here we used direct electrical stimulation of nerve fibers to bypass mechanical transduction processes and thereby explore the possible contribution of central vs. peripheral processes to vibrotactile adaptation. Three experiments were conducted. In the first, adaptation was induced with mechanical vibration of the fingertip (51- or 251-Hz vibration delivered for 8 min, at 40× detection threshold). In the second, we attempted to induce adaptation with transcutaneous electrical stimulation of the median nerve (51- or 251-Hz constant-current pulses delivered for 8 min, at 1.5× detection threshold). Vibrotactile detection thresholds were measured before and after adaptation. Mechanical stimulation induced a clear increase of vibrotactile detection thresholds. In contrast, thresholds were unaffected by electrical stimulation. In the third experiment, we assessed the effect of mechanical adaptation on the detection thresholds to transcutaneous electrical nerve stimuli, measured before and after adaptation. Electrical detection thresholds were unaffected by the mechanical adaptation. Taken together, our results suggest that vibrotactile adaptation is predominantly the consequence of peripheral mechanoreceptor processes and/or changes in biomechanical properties of the skin.

Inertial torque during reaching directly impacts grip-force adaptation to weightless objects.

A hallmark of movement control expressed by healthy humans is the ability to gradually improve motor performance through learning. In the context of object manipulation, previous work has shown that the presence of a torque load has a direct impact on grip-force control, characterized by a significantly slower grip-force adjustment across lifting movements. The origin of this slower adaptation rate remains unclear. On the one hand, information about tangential constraints during stationary holding may be difficult to extract in the presence of a torque. On the other hand, inertial torque experienced during movement may also potentially disrupt the grip-force adjustments, as the dynamical constraints clearly differ from the situation when no torque load is present. To address the influence of inertial torque loads, we instructed healthy adults to perform visually guided reaching movements in weightlessness while holding an unbalanced object relative to the grip axis. Weightlessness offered the possibility to remove gravitational constraints and isolate the effect of movement-related feedback on grip force adjustments. Grip-force adaptation rates were compared with a control group who manipulated a balanced object without any torque load and also in weightlessness. Our results clearly show that grip-force adaptation in the presence of a torque load is significantly slower, which suggests that the presence of torque loads experienced during movement may alter our internal estimates of how much force is required to hold an unbalanced object stable. This observation may explain why grasping objects around the expected location of the center of mass is such an important component of planning and control of manipulation tasks.

Gravity-dependent estimates of object mass underlie the generation of motor commands for horizontal limb movements.

Moving requires handling gravitational and inertial constraints pulling on our body and on the objects that we manipulate. Although previous work emphasized that the brain uses internal models of each type of mechanical load, little is known about their interaction during motor planning and execution. In this report, we examine visually guided reaching movements in the horizontal plane performed by naive participants exposed to changes in gravity during parabolic flight. This approach allowed us to isolate the effect of gravity because the environmental dynamics along the horizontal axis remained unchanged. We show that gravity has a direct effect on movement kinematics, with faster movements observed after transitions from normal gravity to hypergravity (1.8g), followed by significant movement slowing after the transition from hypergravity to zero gravity. We recorded finger forces applied on an object held in precision grip and found that the coupling between grip force and inertial loads displayed a similar effect, with an increase in grip force modulation gain under hypergravity followed by a reduction of modulation gain after entering the zero-gravity environment. We present a computational model to illustrate that these effects are compatible with the hypothesis that participants partially attribute changes in weight to changes in mass and scale incorrectly their motor commands with changes in gravity. These results highlight a rather direct internal mapping between the force generated during stationary holding against gravity and the estimation of inertial loads that limb and hand motor commands must overcome.

Adaptive control of grip force to compensate for static and dynamic torques during object manipulation.

Manipulating a cup by the handle requires compensating for the torque induced by the moment of the mass of the cup relative to the location of the handle. In the present study, we investigated the control strategy of subjects asked to perform grip-lift movements with an object with center of mass located away from the grip axis. Participants were asked to lift the manipulandum with a two-fingers precision grip and stabilize it in front of a visual target. Subjects showed a gradual and slow adaptation of the grip-force scaling across trials: the grip force tended to decrease slowly, and the temporal coordination between grip-force and load-torque rates displayed gradually, better-coordinated patterns. Importantly, this adaptation was much slower than the stabilization of the same parameters measured either when no torque came into play or after previous adaptation to the presence of a torque. In contrast, the maximum rotation induced by the torque was controlled efficiently after only few trials, and an unexpected decrease in the tangential torque produced significant overcompensation. An unexpected increase in torque produced a consistent opposite effect. This shows that the compensation for the dynamic torque was based on an anticipatory, dynamic counter-torque produced by the arm and wrist motor commands. The comparatively slow stabilization of grip-force control suggests a specific adaptation process engaged by the presence of the torque. This paradigm, including tangential torques, clearly constitutes a powerful tool to extract the adaptive component of grip control during object manipulation.

Grip force regulates hand impedance to optimize object stability in high impact loads.

Anticipatory grip force adjustments are a prime example of the predictive nature of motor control. An object held in precision grip is stabilized by fine adjustments of the grip force against changes in tangential load force arising from inertia during acceleration and deceleration. When an object is subject to sudden impact loads, prediction becomes critical as the time available for sensory feedback is very short. Here, we investigated the control of grip force when participants performed a targeted tapping task with a hand-held object. During the initial transport phase of the movement, load force varied smoothly with acceleration. In contrast, in the collision, load forces sharply increased to very large values. In the transport phase, grip force and load force were coupled in phase, as expected. However, in the collision, grip force did not parallel load force. Rather, it exhibited a stereotyped profile with maximum ∼65 ms after peak load at contact. By using catch trials and a virtual environment, we demonstrate that this peak of grip force is pre-programmed. This observation is validated across experimental manipulations involving different target stiffness and directions of movement. We suggest that the central nervous system optimizes stability in object manipulation-as in catching-by regulating mechanical parameters including stiffness and damping through grip force. This study provides novel insights about how the brain coordinates grip force in manipulation involving an object interacting with the environment.

Effect of skin hydration on the dynamics of fingertip gripping contact.

The dynamics of fingertip contact manifest themselves in the complex skin movements observed during the transition from a stuck state to a fully developed slip. While investigating this transition, we found that it depended on skin hydration. To quantify this dependency, we asked subjects to slide their index fingertip on a glass surface while keeping the normal component of the interaction force constant with the help of visual feedback. Skin deformation inside the contact region was imaged with an optical apparatus that allowed us to quantify the relative sizes of the slipping and sticking regions. The ratio of the stuck skin area to the total contact area decreased linearly from 1 to 0 when the tangential force component increased from 0 to a maximum. The slope of this relationship was inversely correlated to the normal force component. The skin hydration level dramatically affected the dynamics of the contact encapsulated in the course of evolution from sticking to slipping. The specific effect was to reduce the tendency of a contact to slip, regardless of the variations of the coefficient of friction. Since grips were more unstable under dry skin conditions, our results suggest that the nervous system responds to dry skin by exaggerated grip forces that cannot be simply explained by a change in the coefficient of friction.

Movement stability under uncertain internal models of dynamics.

Sensory noise and feedback delay are potential sources of instability and variability for the on-line control of movement. It is commonly assumed that predictions based on internal models allow the CNS to anticipate the consequences of motor actions and protect the movements from uncertainty and instability. However, during motor learning and exposure to unknown dynamics, these predictions can be inaccurate. Therefore a distinct strategy is necessary to preserve movement stability. This study tests the hypothesis that in such situations, subjects adapt the speed and accuracy constraints on the movement, yielding a control policy that is less prone to undesirable variability in the outcome. This hypothesis was tested by asking subjects to hold a manipulandum in precision grip and to perform single-joint, discrete arm rotations during short-term exposure to weightlessness (0 g), where the internal models of the limb dynamics must be updated. Measurements of grip force adjustments indicated that the internal predictions were altered during early exposure to the 0 g condition. Indeed, the grip force/load force coupling reflected that the grip force was less finely tuned to the load-force variations at the beginning of the exposure to the novel gravitational condition. During this learning period, movements were slower with asymmetric velocity profiles and target undershooting. This effect was compared with theoretical results obtained in the context of optimal feedback control, where changing the movement objective can be directly tested by adjusting the cost parameters. The effect on the simulated movements quantitatively supported the hypothesis of a change in cost function during early exposure to a novel environment. The modified optimization criterion reduces the trial-to-trial variability in spite of the fact that noise affects the internal prediction. These observations support the idea that the CNS adjusts the movement objective to stabilize the movement when internal models are uncertain.

Fingertip moisture is optimally modulated during object manipulation.

Coordination between the normal force exerted by fingers on a held object and the tangential constraints at the fingertips helps to successfully manipulate objects. It is well established that the minimal grip force required to prevent an object from slipping strongly depends on the frictional properties at the finger-object interface. Moreover, interindividual variation in the modulation of grip force suggests that the moisture level of the skin could influence grip force strategy. In the present study we asked subjects to perform a horizontal point-to-point task holding an object with a precision grip. The object was equipped with a moisture sensor. We found large inter- and intraindividual moisture level variations. There was a strong correlation between grip force exerted and moisture level at the fingertips. Indeed, the grip force was minimal when the fingertip moisture was optimal with respect to friction. Furthermore, fingertip moisture tended toward this optimal level at which grip force is minimal. In conclusion, we showed a modulation of the grip force with moisture level and hypothesized novel mechanisms of moisture regulation that tend to stabilize the moisture level toward the value that minimizes grip force.

Forward models of inertial loads in weightlessness.

In this experiment, we investigated whether the CNS uses internal forward models of inertial loads to maintain the stability of a precision grip when manipulating objects in the absence of gravity. The micro-gravity condition causes profound changes in the profile of tangential constraints at the finger-object interface. In order to assess the ability to predict the micro-gravity-specific variation of inertial loads, we analyzed the grip force adjustments that occurred when naive subjects held an object in a precision grip and performed point-to-point movements under the weightless condition induced by parabolic flight. Such movements typically presented static and dynamic phases, which permitted distinction between a static component of the grip force (measured before the movement) and a dynamic component of the grip force (measured during the movement). The static component tended to gradually decrease across the parabolas, whereas the dynamic component was rapidly modulated with the micro-gravity-specific inertial loads. In addition, the amplitude of the modulation significantly correlated with the amplitude of the tangential constraints for the dynamic component. These results strongly support the hypothesis that the internal representation of arm and object dynamics adapts to new gravitational contexts. In addition, the difference in time scales of adaptation of static and dynamic components suggests that they can be processed independently. The prediction of self-induced variation of inertial loads permits fine modulation of grip force, which ensures a stable grip during manipulation of an object in a new environment.

Relationships between motor impairments and activity limitations in patients with neuromuscular disorders.

AIM: The strength and nature of the relationships between motor impairments and activity limitations assessed by the ACTIVLIM questionnaire were investigated in 245 patients with neuromuscular disorders. METHODS: Measures of motor impairments consisted of: (1) a grip strength test using a Jamar dynamometer, (2) a Manual Muscle Testing bilaterally performed in 18 muscle groups and (3) a gait speed spontaneously adopted by the patients using the 10 m timed walking test. RESULTS: Activity limitations were poorly correlated with grip strength in both hands (r = 0.3 and 0.36) and moderately correlated with gait speed (r = 0.53). Spearman's coefficients of correlation between the manual muscle testing and activity limitations were moderate to very poor (rho = 0.5 to 0.17). CONCLUSION: The relationships between motor impairments and activity limitations are not straightforward in patients with neuromuscular disorders, indicating that the activity limitations should be separately assessed and cannot be simply inferred from motor impairment measures.

A new device to measure the three dimensional forces and torques in precision grip.

Fine prehension is ubiquitous in everyday skilled hand manipulations. The anticipatory nature of the control of normal grip forces exerted against tangential loads has been extensively used to provide insights into the working of neural control of movements. We designed a new versatile device to measure the three dimensional forces and torques during a broad panel of precision grip tasks. The instrument measures constraints exerted independently on two grip surfaces by the thumb and the opposing fingers. In addition, the device can be loaded to increase the weight and/or induce torques and can be easily integrated in a variety of experimental contexts. Its compactness improves its stability during movement and allows an ergonomic manipulation for impaired persons or children.

Moisture Evaluator: a direct measure of fingertip skin hydration during object manipulation.

BACKGROUND/PURPOSE: The mechanical properties of the fingertip skin are very important when studying dexterous manipulation. These properties are strongly influenced by the level of skin hydration. Currently, there is no device capable of measuring skin moisture during object manipulation. METHODS: Skin moisture levels during object manipulation were measured using the Moisture Evaluator, a probe consisting of gold-covered electrodes connected to a resistor-capacitor circuit. In vivo calibration was performed by comparison with measurements obtained using a Corneometer at two normal force levels (0.2 and 2 N). RESULTS: Measurements from the Moisture Evaluator were well correlated with those from the Corneometer. CONCLUSION: A new device for evaluating skin moisture at the fingertip has been designed and validated.

Functional assessment in physiotherapy. A literature review.

The present literature review on functional assessment in physiotherapy was carried out for the following reasons: 1) to identify the functional instruments used in the field of physiotherapy that were supported by published evidence of their psychometric qualities; 2) to investigate how these instruments relate to the International Classification of Functioning, Disability and Health (ICF); and 3) to investigate the use of functional instruments in the financing of physiotherapy. A search of Medline from 1990 to December 2005, in the domains of functional evaluation, psychometric qualities, functional classification, and health policy in relation to physiotherapy resulted in a list of 1,567 studies. Two reviewers examined the resulting references on the basis of their title and abstract, in order to select the studies that presented data on the psychometric qualities of functional evaluation tests, leading to a final selection of 44 such studies. A selection of functional tests was identified in four major diagnostic groups treated in community physiotherapy: musculoskeletal disorders (including lower back pain), stroke, the elderly, and traumatic brain injuries. The functional tests authors identified essentially cover the body and activities dimension of the ICF. The selected tests could be used as a basis for the standardisation of functional evaluation of the major diagnostic groups treated in community physiotherapy. This means that standards are available for reporting and following the evolution of patients both longitudinally and transversally. Nevertheless, in the current literature review no attempt at using functional outcomes as a rationale for financing physiotherapy could be found to date.

Role of the ipsilateral primary motor cortex in controlling the timing of hand muscle recruitment.

The precise contribution of the ipsilateral primary motor cortex (iM1) to hand movements remains controversial. To address this issue, we elicited transient virtual lesions of iM1 by means of transcranial magnetic stimulation (TMS) in healthy subjects performing either a grip-lift task or a step-tracking task with their right dominant hand. We found that, irrespective of the task, a virtual lesion of iM1 altered the timing of the muscle recruitment. In the grip-lift task, this led to a less coordinated sequence of grip and lift movements and in the step-tracking task, to a perturbation of the movement trajectory. In the step-tracking task, we have demonstrated that disrupting iM1 activity may, depending on the TMS delay, either advance or delay the muscle recruitment. The present study suggests that iM1 plays a critical role in hand movements by contributing to the setting of the muscle recruitment timing, most likely through either inhibitory or facilitatory transcallosal influences onto the contralateral M1 (cM1). iM1 would therefore contribute to shape precisely the muscular command originating from cM1.

The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment.

BACKGROUND AND PURPOSE: Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities. METHODS: One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software. RESULTS: The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures. CONCLUSIONS: The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.

High frequency of cytolytic T lymphocytes directed against a tumor-specific mutated antigen detectable with HLA tetramers in the blood of a lung carcinoma patient with long survival.

We have identified an antigen recognized by autologous CTL on the lung carcinoma cells of a patient who enjoyed a favorable clinical evolution, being alive 10 years after partial resection of the primary tumor. The antigenic peptide is presented by HLA-A2 molecules and encoded by a mutated sequence in the gene coding for malic enzyme, an essential enzyme that converts malate to pyruvate. In the tumor cell line derived from the patient, only the mutated malic enzyme allele is expressed, because of a loss of heterozygosity in the region of chromosome 6 that contains this locus. Tetramers of soluble HLA-A2 molecules loaded with the antigenic peptide stained approximately 0.4% of the patient's blood CD8 T cells. When these cells were stimulated in clonal conditions, 25% of them proliferated, and the resulting clones were lytic and specific for the mutated malic enzyme peptide. T-cell receptor analysis indicated that almost all of these antimalic CTLs shared the same receptor. Antimalic T cells were consistently found in blood samples collected from the patient between 1990 and 1999, at frequencies ranging from 0.1 to 0.4% of the CD8 cells. Their frequency appeared to double within 2 weeks after intradermal inoculation of lethally irradiated autologous tumor cells. These results indicate that nonmelanoma cancer patients may also have a high frequency of blood CTLs directed against a tumor-specific antigen.

The use of outcome measures in physical medicine and rehabilitation within Europe.

The aim of the study was to survey the use of outcome measures in rehabilitation within Europe. It was envisaged that this would provide the basis for further studies on the cross-cultural validity of outcome measures. A postal questionnaire was distributed in November 1998 to 866 units providing rehabilitation. In total, 418 questionnaires were returned, corresponding to a response rate of 48%. These 418 centres treated an estimated 113,000 patients annually, undertaking 360,000 assessments. The survey focused on nine diagnostic groups: hip and knee replacement, low back pain, lower limb amputees, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke and traumatic brain injury. It identified a relatively small number of dominant outcome assessments for each diagnostic group and some variation in the preference for measures across regions. A large number of measures, however, are being used in one or a small number of locations and with relatively few patients. For rehabilitation of orthopaedic patients the majority of assessments undertaken are at the impairment level. For patients with neurological disorders the emphasis is mostly upon measures of disability.

Chronic demyelinating hypertrophic brachial plexus neuropathy.

A patient with unilateral, painless, chronic progressive upper limb sensorimotor deficit showed electrophysiological evidence of a focal demyelinating neuropathy with almost complete conduction block across the brachial plexus. Magnetic resonance imaging disclosed marked brachial plexus hypertrophy. Intravenous immunoglobulin led to fast and complete recovery, maintained by intermittent perfusions. Hypertrophic brachial plexus neuropathy can be a presentation of focal chronic inflammatory demyelinating polyradiculoneuropathy. Objective and quantitative assessment of hand function is useful to evaluate treatment results and to optimize treatment regimens.