Individuals with hemiparetic stroke abnormally perceive their elbow torques when abducting their paretic shoulder.

OBJECTIVE: Individuals with hemiparetic stroke exhibit an abnormal coupling between shoulder abduction and elbow flexion, or flexion synergy, due to an increased reliance on cortico-bulbospinal pathways. While this motor impairment is well documented, its impact on how movements are perceived remains unexplored. This study investigates whether individuals with hemiparetic stroke accurately perceive torques at their paretic elbow while abducting at their shoulder. METHODS: Ten individuals with hemiparetic stroke participated. We recorded the extent of their abnormal joint coupling as the torque at their elbow, with respect to the maximum voluntary torque in elbow flexion, when abducting at their shoulder. Next, we estimated the perception of their elbow torque by reporting their errors on our torque-matching task. RESULTS: When abducting at the shoulder, the participants with stroke generated a greater non-volitional torque at their paretic elbow (13.2 ± 8.7%) than their non-paretic elbow (1.2 ± 11.2%) (p = 0.003). Regarding the perception of our torque-matching task, participants overestimated their torques to a lesser extent at their paretic elbow (1.8 ± 6.6%) than at their non-paretic elbow (6.2 ± 5.4%) (p = 0.004). CONCLUSIONS: Torque perception at the paretic elbow differed from the non-paretic elbow when abducting at the shoulder. SIGNIFICANCE: This work advances our understanding of the i) somatosensory deficits occurring post hemiparetic stroke and ii) neural basis of torque perception.

Perception of Torque is Impacted by a Subset of Features Related to the Motor Command.

Accurate perception of one's self-generated torques is integral to sensorimotor control. Here, we examined how features of the motor control task, specifically the variability, duration, muscle activation pattern, and magnitude of torque generation, relate to one's perception of torque. Nineteen participants generated and perceived 25% of their maximum voluntary torque (MVT) in elbow flexion while simultaneously abducting at their shoulder to 10%, 30%, or 50% of their MVT in shoulder abduction (MVT[Formula: see text]). Subsequently, participants matched the elbow torque without feedback and without activating their shoulder. The shoulder abduction magnitude affected the time to stabilize the elbow torque (p 0.001), but did not significantly impact the variability of generating the elbow torque (p = 0.120) or the co-contraction between the elbow flexor and extensor muscles (p = 0.265). The shoulder abduction magnitude influenced perception (p = 0.001) in that the error in matching the elbow torque increased with an increased shoulder abduction torque. However, the torque matching errors neither correlated with the time to stabilize and variability in generating the elbow torque, nor the co-contraction of the elbow muscles. These findings suggest that the total torque generated during a multi-joint task impacts the perception of a torque about a single joint; yet, effective and efficient generation of the torque about a single joint does not impact the torque percept.

Impact of Arm Dominance and Location on Detecting Electrotactile Stimuli During Voluntary Motor Activation in Older Adults.

Activation-related sensory gating is important for sensorimotor control, filtering signals irrelevant to a task. Literature on brain lateralization suggests that motor activation patterns during sensorimotor control differ depending on arm dominance. Whether the lateralization effect extends to how sensory signals modulate during voluntary sensorimotor control remains unaddressed. We compared tactile sensory gating during voluntary motor activation between the arms of older adults. Eight right-arm dominant participants received a single-pulse, 100 µs square-wave electrotactile stimulus at their testing arm's fingertip or elbow. We identified at both arms the threshold at which the electrotactile stimulus was detected when participants were at rest (baseline) and isometrically flexing about the elbow to 25% and 50% of their maximum voluntary torque. Results reveal a difference in the detection threshold at the fingertip (p 0.001) between the arms, yet not the elbow (p = 0.264). Additionally, results demonstrate that greater isometric flexion about the elbow yields increased detection thresholds at the elbow (p = 0.005), yet not the fingertip (p = 0.069). However, the changes in detection threshold during motor activation did not significantly differ between the arms (p = 0.154). The findings regarding an impact of arm dominance and location on tactile perception are important when considering sensorimotorhaptic perception and training, including post-unilateral injury.

Impact of Abducting at the Shoulder on Perceiving Torques about the Elbow.

Literature indicates that an individual's perception of their self-generated torques is largely influenced by their descending motor commands. These studies often rely on between-limbs matching protocols, which can introduce confounding factors when interpreting results from populations with unilateral impairments. Here, we demonstrate how changes in descending motor commands impact one's perception of torques using a single-arm protocol. Thirteen participants generated and perceived 25% of their maximum voluntary torque (MVT) in elbow flexion while simultaneously abducting at their shoulder to 10%, 30%, or 50% of their MVT in shoulder abduction (MVTSABD). Subsequently, the participants matched the elbow torque without feedback and without activating their shoulder. The accuracy in matching the elbow torque was influenced by the extent to which the shoulder abducted (p=0.002); the average error in matching elbow torques was greatest at 50% MVTSABD (3.9 ± 4.9 Nm), followed by 30% MVTSABD (2.1 ± 2.7 Nm), and then 10% MVTSABD (0.0 ±2.1 Nm). These results indicate that perception of a torque about the elbow is influenced by the extent of simultaneous activation about the biomechanically-coupled shoulder. Therefore, this approach can quantify, using a single arm, the impact of changes in muscle activation on torque perception.

Accuracy of older adults in judging self-generated elbow torques during multi-joint isometric tasks.

Successful execution of daily activities requires accurate perception of the torques one generates about multiple joints. Even so, previous studies are mostly limited to an individual's perception when torques are generated about a single joint. Consequently, this study investigates how accurately individuals judge torques at their arm during a multi-joint task. The accuracy of fifteen right-hand dominant participants (age: 60 ± 10 years) in matching isometric elbow torques, within the same arm, was quantified during single- and/or multi-joint tasks. Participants generated and matched elbow torques when the shoulder was: (1) not abducted (single-to-single-joint), (2) abducted (multi-to-multi-joint), and (3) abducted and then not abducted (multi-to-single-joint). The constant error for the multi-to-single-joint condition (dominant: 6.9 ± 5.9 Nm, non-dominant: 6.0 ± 5.5 Nm) was greater than that for the single-to-single-joint condition (dominant: 2.7 ± 3.1 Nm, non-dominant: 3.4 ± 2.8 Nm) (p < 0.001) and multi-to-multi-joint condition (dominant: 3.0 ± 2.8 Nm, non-dominant: 3.9 ± 2.7 Nm) (p < 0.001). The constant error for the multi-to-multi-joint condition did not significantly differ from that of the single-to-single-joint condition (p [Formula: see text] 0.780). Findings indicate that in older adults the perception of a self-generated torque during a 2-degree-of-freedom (DOF), multi-joint task is largely influenced by the motor commands associated with the 2-DOF task and is not specific to the DOF at each joint.

Individuals With Hemiparetic Stroke Accurately Match Torques They Generate About Each Elbow Joint.

Background: Successful execution of a task as simple as drinking from a cup and as complicated as cutting food with a fork and knife requires accurate perception of the torques that one generates in each arm. Prior studies have shown that individuals with hemiparetic stroke inaccurately judge their self-generated torques during bimanual tasks; yet, it remains unclear whether these individuals inaccurately judge their self-generated torques during unimanual tasks. Objective: The goal of this work was to determine whether stroke affected how accurately individuals with stroke perceive their self-generated torques during a single-arm task. Methods: Fifteen individuals with hemiparetic stroke and fifteen individuals without neurological impairments partook in this study. Participants generated a target torque about their testing elbow while receiving visual feedback, relaxed, and then matched the target torque about the same elbow without receiving feedback. This task was performed for two target torques (5 Nm, 25% of maximum voluntary torque), two movement directions (flexion, extension), and two arms (left, right). Results: Clinical assessments indicate that eleven participants with stroke had kinaesthetic deficits and two had altered pressure sense; their motor impairments spanned from mild to severe. These participants matched torques at each elbow, for each target torque and movement direction, with a similar accuracy and precision to controls, regardless of the arm tested (p > 0.050). Conclusions: These results indicate that an individual with sensorimotor deficits post-hemiparetic stroke may accurately judge the torques that they generate within each arm. Therefore, while survivors of a hemiparetic stroke may have deficits in accurately judging the torques they generate during bimanual tasks, such deficits do not appear to occur during unimanual tasks.

Development of a Training Game to Coordinate Torques Produced Between Arms.

The ability of individuals to accurately judge the forces that they generate is integral to seamlessly controlling their movements during everyday life. Individuals with chronic hemiparetic stroke have been shown to be impaired when matching forces between arms; this impairment may make activities as simple as carrying a tray challenging. Our goal was to develop a training protocol that individuals with stroke could use to improve their accuracy in judging the torques that they generate between arms. We designed a torque coordination game for this goal and tested its feasibility in six individuals without neurological impairments. Participants interacted with an instrumented isometric device at each arm and received automated audiovisual cues in response to the torques that they generated about each elbow joint. During the game, the participant's task was to keep a launched ball on its planned course. The participant achieved this task by sequentially applying required elbow torques at the correct times to close a left flap using the left arm and a right flap using the right arm. Participants performed this task 20 times when initiating with their left arm and 20 times when initiating with their right arm. Results indicate that all participants had a success rate in the range of 60% to 80% regardless of the arm dominance of the leading arm. Additionally, all participants anecdotally reported the game to be intuitive, and they provided an average difficulty rating that indicated the task was relatively easy to learn (i.e., 3 out of 10). Based on these findings, we conclude that this game may be suitable, enjoyable, and motivational for training coordination of torques between arms in individuals with stroke.

Using simple clinical measures to predict insulin resistance or hyperglycemia in girls with polycystic ovarian syndrome.

BACKGROUND: Polycystic ovarian syndrome (PCOS) includes insulin resistance (IR) and impaired glucose tolerance (IGT) in youth, and a greatly elevated risk of type 2 diabetes in adulthood. Identifying IR is challenging and documenting IGT requires an oral glucose tolerance test (OGTT). OBJECTIVE: Identify easily applied surrogate measures for IR and IGT in girls with PCOS. METHODS: We studied 28 girls with PCOS (body mass index [BMI] percentile 98 (83.99); 15.5 (14.5,16.6) years of age) and 20 with normal menses [BMI percentile (97 (88.99); 15.5 (13.3,16.1) years]. Hyperinsulinemic-euglycemic clamps (insulin dose of 80 µU/ml/min) to determine glucose infusion rate (GIR) and a 75 g OGTT were performed. Surrogates for IR including fasting insulin, homeostatic model assessment-insulin resistant (HOMA-IR), Matsuda index, and estimate of insulin sensitivity (e-IS) were compared to IGT status and GIR. Spearman correlations were performed between surrogates and GIR or IGT, and receiver operator curve (ROC) analysis to predict GIR below the median or IGT status. RESULTS: GIR was lower in PCOS (12.9 ± 4.6 vs 17.1 ± 5.1 mg/kg fat-free mass·min; P = 0.01). Within PCOS, HOMA-IR (r = -0.78, P < 0.0001), e-IS (r = 0.70, P < 0.001), and Matsuda (r = 0.533, P < 0.001) correlated with GIR. e-IS provided a good sensitivity (100%) and specificity (71%) to identify IR (e-IS cutoff: <6.3, ROC-area under curve = 0.898). Fasting insulin >22 IU/mL had the best sensitivity (88%), specificity (78%), and ROC (0.760) for IGT status. CONCLUSIONS: Girls with PCOS have significant IR, and IGT is common. Both e-IS and fasting insulin are obtainable without an OGTT or clamp and could be used clinically to guide treatment in PCOS.

Insulin Resistance in Youth Without Diabetes Is Not Related to Muscle Mitochondrial Dysfunction.

Context: Obesity, insulin resistance (IR), and diabetes are increasing in youth, especially in girls. IR is associated with muscle mitochondrial dysfunction in youth and adults with diabetes. However, it is unknown whether this relationship is present in youth prior to development of diabetes. Objective: Assess IR and mitochondrial function, including sex differences, in nondiabetic youth. Design: Cross-sectional study of youth in the Exploring Perinatal Outcomes among Children, Resistance to InSulin in Type 1 And Type 2 diabetes, and Androgens and Insulin Resistance Study cohorts. Setting: Academic medical university. Participants: Two hundred seventy-five youth, 13 to 19 years old [43% males: 17.1 (16.52, 17.63) years, body mass index z-score (BMI-Z) 0.36, 64.7% Tanner 5; 57% females: 17.2 (16.43, 17.67) years, BMI-Z 0.72, 78.9% Tanner 5]. Interventions: Fasting laboratories, oral glucose tolerance test, and 31P magnetic resonance spectroscopy. Main Outcome Measures: IR [triglyceride:high-density lipoprotein (HDL) ratio, Matsuda index, and homeostasis model for insulin resistance (HOMA-IR)] and muscle mitochondrial function (adenosine 5'-diphosphate time constant and oxidative phosphorylation rate). Results: Compared with males, females were more insulin resistant, with higher triglyceride:HDL ratio [1.95 (1.30, 2.79) vs 1.69 (1.21, 2.23), P = 0.042], HOMA-IR [3.18 (2.42, 4.39) vs 2.76 (2.02, 4.08), P = 0.035], and fasting free fatty acids (FFAs) and lower Matsuda score [3.98 (2.71, 5.96) vs 5.39 (3.43, 7.57), P < 0.001]. After adjustment for the higher BMI and Tanner stage and lower physical activity levels seen in females, there were no sex differences in mitochondrial function nor in any IR measure except FFAs. We did not find an association between measures of IR and mitochondrial function. Conclusions: The greater IR seen in adolescent girls vs boys is mostly explained by differences in BMI and physical activity. Mitochondrial function does not appear to be related to IR in a large cohort of nondiabetic youth.