Sensitivity to basic emotional expressions and the emotion perception space in the absence of facial mimicry: The case of individuals with congenital facial palsy.

According to sensorimotor simulation models, recognition of another person's emotion is achieved by recreating the motor production of the perceived facial expression in oneself. Therefore, congenital difficulties in the production of facial expressions may affect emotion processing. The present study assessed a sample (N = 11) of Moebius syndrome (MBS) patients and a matched control group (N = 33), using a highly sensitive emotion recognition task. Leveraging the uniqueness of MBS, which is characterized by congenital facial paralysis, the role of facial mimicry and sensorimotor simulation in creating precise embodied concepts of emotion categories was investigated. Particularly, the research focused on how MBS patients (both as a group and individually, compared to controls) perceived the intensity of primary emotions and how well they discriminated between these and secondary (i.e., blended) emotions. The results showed that MBS patients registered significantly lower intensities for sadness, fear, anger, and disgust. Furthermore, these emotions appeared closely clustered-and therefore confused with anger and surprise-in the multidimensional scaling map, which was used to qualitatively analyze the emotion perception space. Further analysis of each MBS participant showed a stronger tendency in most patients to perceive primary emotions as less intense, relative to controls. Thus, the findings provide evidence for a residual deficit in emotion processing in adults with MBS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Home management of Covid-19 pneumonia in the early phases of the pandemic: analysis of real-life data of General Practitioners in the Province of Modena from the MAGMA study.] / Gestione domiciliare dei pazienti con polmonite da Covid-19 nelle fasi precoci della pandemia: analisi dei dati real-life della Medicina Generale della Provincia di Modena dallo studio MAGMA.

Primary care management of Covid-19 pneumonia in the Province of Modena in the early phases of the pandemic: data integration from MAGMA study. Retrospective study on patients affected of Covid-19 and followed by General Practitioner from March 2020 to April 2021. 5340 patients were studied, 27% of them developed pneumoniae. Among these, most of them were managed entirely at home with an elevated intensity of care. Daily remote monitoring and home visits, together with a personalized pharmacological treatment, especially for the most severe forms, appeared to be the most effective interventions in reducing hospitalizations.

Embodying Language through Gestures: Residuals of Motor Memories Modulate Motor Cortex Excitability during Abstract Words Comprehension.

There is a debate about whether abstract semantics could be represented in a motor domain as concrete language. A contextual association with a motor schema (action or gesture) seems crucial to highlighting the motor system involvement. The present study with transcranial magnetic stimulation aimed to assess motor cortex excitability changes during abstract word comprehension after conditioning word reading to a gesture execution with congruent or incongruent meaning. Twelve healthy volunteers were engaged in a lexical-decision task responding to abstract words or meaningless verbal stimuli. Motor cortex (M1) excitability was measured at different after-stimulus intervals (100, 250, or 500 ms) before and after an associative-learning training where the execution of the gesture followed word processing. Results showed a significant post-training decrease in hand motor evoked potentials at an early processing stage (100 ms) in correspondence to words congruent with the gestures presented during the training. We hypothesized that traces of individual semantic memory, combined with training effects, induced M1 inhibition due to the redundancy of evoked motor representation. No modulation of cortical excitability was found for meaningless or incongruent words. We discuss data considering the possible implications in research to understand the neural basis of language development and language rehabilitation protocols.

Degenerate pathway for processing smile and other emotional expressions in congenital facial palsy: an hdEEG investigation.

Influential theoretical models argue that an internal simulation mechanism (motor or sensorimotor simulation) supports the recognition of facial expressions. However, despite numerous converging sources of evidence, recent studies testing patients with congenital facial palsy (i.e. Moebius syndrome) seem to refute these theoretical models. However, these results do not consider the principles of neuroplasticity and degeneracy that could support the involvement of an alternative neural processing pathway in these patients. In the present study, we tested healthy participants and participants with Moebius syndrome in a highly sensitive facial expression discrimination task and concomitant high-density electroencephalographic recording. The results, both at the scalp and source levels, indicate the activation of two different pathways of facial expression processing in healthy participants and participants with Moebius syndrome, compatible, respectively, with a dorsal pathway that includes premotor areas and a ventral pathway. Therefore, these results support the reactivation of sensorimotor representations of facial expressions (i.e. simulation) in healthy subjects, in the place of an alternative processing pathway in subjects with congenital facial palsy. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.

Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis.

Rehabilitation after free gracilis muscle transfer (smile surgery, SS) is crucial for a functional recovery of the smiling skill, mitigating social and psychological problems resulting from facial paralysis. We compared two post-SS rehabilitation treatments: the traditional based on teeth clenching exercises and the FIT-SAT (facial imitation and synergistic activity treatment). FIT-SAT, based on observation/imitation therapy and on hand-mouth motor synergies would facilitate neuronal activity in the facial motor cortex avoiding unwanted contractions of the jaw, implementing muscle control. We measured the smile symmetry on 30 patients, half of whom after SS underwent traditional treatment (control group, CG meanage = 20 ± 9) while the other half FIT-SAT (experimental group, EG meanage= 21 ± 14). We compared pictures of participants while holding two postures: maximum and gentle smile. The former corresponds to the maximal muscle contraction, whereas the latter is strongly linked to the control of muscle strength during voluntary movements. No differences were observed between the two groups in the maximum smile, whereas in the gentle smile the EG obtained a better symmetry than the CG. These results support the efficacy of FIT-SAT in modulating the smile allowing patients to adapt their smile to the various social contexts, aspect which is crucial during reciprocal interactions.

Facial Expression Time Processing in Typical Development and in Patients with Congenital Facial Palsy.

Temporal dynamics of behavior, particularly facial expressions, are fundamental for communication between individuals from very early in development. Facial expression processing has been widely demonstrated to involve embodied simulative processes mediated by the motor system. Such processes may be impaired in patients with congenital facial palsy, including those affected by Moebius syndrome (MBS). The aims of this study were to investigate (a) the role of motor mechanisms in the processing of dynamic facial expression timing by testing patients affected by congenital facial palsy and (b) age-dependent effects on such processing. Accordingly, we recruited 38 typically developing individuals and 15 individuals with MBS, ranging in age from childhood to adulthood. We used a time comparison task where participants were asked to identify which one of two dynamic facial expressions was faster. Results showed that MBS individuals performed worse than controls in correctly estimating the duration of facial expressions. Interestingly, we did not find any performance differences in relation to age. These findings provide further evidence for the involvement of the motor system in processing facial expression duration and suggest that a sensorimotor matching mechanism may contribute to such timing perception from childhood.

Supercharged massetric-facial cross-graft for gracilis reinnervation in unilateral facial palsy treatment.

BACKGROUND: The choice of neurotization source for gracilis neuromuscular transplant is a key point in the treatment of unilateral long-standing paralysis. To combine the advantages of different donor nerves and overcome their disadvantages, mixed neurotization sources have been described with encouraging results. The authors present a preliminary report of a novel technique, the "supercharged" cross-graft, a two-step technique consisting of a double powered cross nerve graft provided by a zygomatic branch of the healthy facial nerve and the masseter nerve of the healthy side. PATIENTS AND METHODS: From January 2015 to December 2019 eight patients, aged between 19 and 61 years old (mean age at surgery 33.62) suffering unilateral established paralysis (congenital or acquired, >24 months) underwent gracilis reinnervation with the supercharged cross grafting technique. Subjects underwent a two-step surgical rehabilitation: in the first operation sural nerve was harvested and used as cross-graft cooptated by healthy side facial nerve branch and masseteric nerve. During second procedure gracilis neuromuscular transplant was performed reinnervarting the muscle with the cross-graft. Patients were evaluated using Emotrics software, which allowed for automated facial measurements on post-operative pictures taken at the last follow-up. The results of the different poses were compared to assess the contribution to smile excursion by the masseter and facial nerve, together and separately. Finally, we analyzed spontaneous smile to assess whether masseteric contribution is used in daily life. RESULTS: No major or minor complications occurred. Follow-up time ranged from 12 to 41 months, with a mean of 22.75 months. A good commissure excursion (mean 33.84 mm) was obtained during smile with no teeth clenching (without masseter activation), as well as during teeth clenching without smiling (activation of gracilis only - mean 32.55). When smiling and biting simultaneously the excursion was greater than the single two components (mean 35.91). In spontaneous smile, commissure excursion was higher (mean 34.23) than that provided by only the facial nerve (smile only) in most patients. CONCLUSIONS: This novel technique of mixed neurotization for gracilis transplant shows consistent results with powerful contraction and good smile coordination. It also allows us to extend the indications for mixed neurotization techniques.

A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies.

Objective: To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method: A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.

Long-term results of facial animation surgery in patients with Moebius syndrome.

Gracilis neuromuscular transplant is considered the gold standard for facial animation in Moebius syndrome patients. However, long-term evaluation of the results has not been critically examined in the international literature. Thus, it remains unknown how the transplanted flap changes with facial growth, and whether contraction (smiling) is maintained. Pediatric patients with Moebius syndrome who underwent facial animation surgery with at least 5 years of follow-up were retrospectively examined. Photographs taken at the 1-year and most recent follow-up visits were analyzed and compared using Emotrics software. Analyses focused on the rest position, and on gentle and maximum smiles. Eighteen patients were enrolled. Seven patients had bilateral and 11 unilateral Moebius syndrome; therefore, 25 gracilis transplants were analyzed. The latest follow-ups ranged from 5 to 13.2 years (mean 7.6 years). The three principal facial expressions that were examined did not differ significantly between 1 year and a mean of 7.6 years after surgery, but tended to improve in most patients. Commissure excursion and smile angle for the maximum smile did improve significantly (p = 0.002 and 0.029, respectively). The series examined in this study supports the limited literature regarding the long-term stability of gracilis transplantation to animate the faces of Moebius syndrome children.

Learning new sport actions: Pilot study to investigate the imitative and the verbal instructive teaching methods in motor education.

The aim of the project was to investigate the effects of two strategies of teaching new sport actions on performance of eight-year-old children: observational-imitative method (OIM) and descriptive-directive method (DDM). The OIM group was provided with a pre-practice instruction in the form of expert modeling observation by an expert athlete. The DDM group received only verbal explanations of few selected static images. Thirty-six children (18 males and 18 females, mean age = 8,8) participated in the experiment. Subjects were randomly assigned to the OIM or DDM groups. Participants were instructed to perform four sport motor sequences never performed before (shoulder stand, soccer action, vortex howler throw, step action). Actions were videotaped and 2D kinematic analysis performed. A 10-point Likert questionnaire was administered to blind sport experts to assess the correctness and accuracy of each action. Results suggest that the OIM is the most effective instruction method when participants have no experience with the sport action to be performed. On the contrary, if the athlete needs to learn specific aspects of an exercise (such as grasping a tool) the best method is the DDM. In fact, detailed information on how to grab the vortex helped children in throwing it. We also found gender differences which might reflect cultural influences in specific sports (e.g. soccer). Finally, repetition of the exercise also improved the DDM group's performance. This has potential applications in sport teaching, suggesting that in the absence of a model performing the action to be imitated, the DDM can be as effective as the OIM if the observer repeats the sport action many times.

Language, Gesture, and Emotional Communication: An Embodied View of Social Interaction.

Spoken language is an innate ability of the human being and represents the most widespread mode of social communication. The ability to share concepts, intentions and feelings, and also to respond to what others are feeling/saying is crucial during social interactions. A growing body of evidence suggests that language evolved from manual gestures, gradually incorporating motor acts with vocal elements. In this evolutionary context, the human mirror mechanism (MM) would permit the passage from "doing something" to "communicating it to someone else." In this perspective, the MM would mediate semantic processes being involved in both the execution and in the understanding of messages expressed by words or gestures. Thus, the recognition of action related words would activate somatosensory regions, reflecting the semantic grounding of these symbols in action information. Here, the role of the sensorimotor cortex and in general of the human MM on both language perception and understanding is addressed, focusing on recent studies on the integration between symbolic gestures and speech. We conclude documenting some evidence about MM in coding also the emotional aspects conveyed by manual, facial and body signals during communication, and how they act in concert with language to modulate other's message comprehension and behavior, in line with an "embodied" and integrated view of social interaction.

Children with facial paralysis due to Moebius syndrome exhibit reduced autonomic modulation during emotion processing.

BACKGROUND: Facial mimicry is crucial in the recognition of others' emotional state. Thus, the observation of others' facial expressions activates the same neural representation of that affective state in the observer, along with related autonomic and somatic responses. What happens, therefore, when someone cannot mimic others' facial expressions? METHODS: We investigated whether psychophysiological emotional responses to others' facial expressions were impaired in 13 children (9 years) with Moebius syndrome (MBS), an extremely rare neurological disorder (1/250,000 live births) characterized by congenital facial paralysis. We inspected autonomic responses and vagal regulation through facial cutaneous thermal variations and by the computation of respiratory sinus arrhythmia (RSA). These parameters provide measures of emotional arousal and show the autonomic adaptation to others' social cues. Physiological responses in children with MBS were recorded during dynamic facial expression observation and were compared to those of a control group (16 non-affected children, 9 years). RESULTS: There were significant group effects on thermal patterns and RSA, with lower values in children with MBS. We also observed a mild deficit in emotion recognition in these patients. CONCLUSION: Results support "embodied" theory, whereby the congenital inability to produce facial expressions induces alterations in the processing of facial expression of emotions. Such alterations may constitute a risk for emotion dysregulation.

Autonomic Responses to Emotional Stimuli in Children Affected by Facial Palsy: The Case of Moebius Syndrome.

According to embodied simulation theories, others' emotions are recognized by the unconscious mimicking of observed facial expressions, which requires the implicit activation of the motor programs that produce a specific expression. Motor responses performed during the expression of a given emotion are hypothesized to be directly linked to autonomic responses associated with that emotional behavior. We tested this hypothesis in 9 children (M age = 5.66) affected by Moebius syndrome (MBS) and 15 control children (M age = 6.6). MBS is a neurological congenital disorder characterized by underdevelopment of the VI and VII cranial nerves, which results in paralysis of the face. Moebius patients' inability to produce facial expressions impairs their capacity to communicate emotions through the face. We therefore assessed Moebius children's autonomic response to emotional stimuli (video cartoons) by means of functional infrared thermal (fIRT) imaging. Patients showed weaker temperature changes compared to controls, suggesting impaired autonomic activity. They also showed difficulties in recognizing facial emotions from static illustrations. These findings reveal that the impairment of facial movement attenuates the intensity of emotional experience, probably through the diminished activation of autonomic responses associated with emotional stimuli. The current study is the first to investigate emotional responses in MBS children, providing important insights into the role of facial expressions in emotional processing during early development.

Congenital facial palsy and emotion processing: The case of Moebius syndrome.

According to the Darwinian perspective, facial expressions of emotions evolved to quickly communicate emotional states and would serve adaptive functions that promote social interactions. Embodied cognition theories suggest that we understand others' emotions by reproducing the perceived expression in our own facial musculature (facial mimicry) and the mere observation of a facial expression can evoke the corresponding emotion in the perceivers. Consequently, the inability to form facial expressions would affect the experience of emotional understanding. In this review, we aimed at providing account on the link between the lack of emotion production and the mechanisms of emotion processing. We address this issue by taking into account Moebius syndrome, a rare neurological disorder that primarily affects the muscles controlling facial expressions. Individuals with Moebius syndrome are born with facial paralysis and inability to form facial expressions. This makes them the ideal population to study whether facial mimicry is necessary for emotion understanding. Here, we discuss behavioral ambiguous/mixed results on emotion recognition deficits in Moebius syndrome suggesting the need to investigate further aspects of emotional processing such as the physiological responses associated with the emotional experience during developmental age.

The effect of motor context on semantic processing: A TMS study.

BACKGROUND: Strong embodiment theories claimed that action language representation is grounded in the sensorimotor system, which would be crucially to semantic understanding. However, there is a large disagreement in literature about the neural mechanisms involved in abstract (symbolic) language comprehension. OBJECTIVE: In the present study, we investigated the role of motor context in the semantic processing of abstract language. We hypothesized that motor cortex excitability during abstract word comprehension could be modulated by previous presentation of a stimuli which associated a congruent motor content (i.e., a semantically related gesture) to the word. METHODS AND RESULTS: We administered a semantic priming paradigm where postures of gestures (primes) were followed by semantically congruent verbal stimuli (targets, meaningful or meaningless words). Transcranial Magnetic Stimulation was delivered to left motor cortex 100, 250 and 500 ms after the presentation of each target. Results showed that Motor evoked potentials of hand muscle significantly increased in correspondence to meaningful compared to meaningless words, but only in the earlier phase of semantic processing (100 and 250 ms from target onset). CONCLUSION: Results suggested that the gestural motor representation was integrated with corresponding word meaning in order to accomplish (and facilitate) the lexical task. We concluded that motor context resulted crucial to highlight motor system involvement during semantic processing of abstract language.

Vitality Forms Expressed by Others Modulate Our Own Motor Response: A Kinematic Study.

During social interaction, actions, and words may be expressed in different ways, for example, gently or rudely. A handshake can be gentle or vigorous and, similarly, tone of voice can be pleasant or rude. These aspects of social communication have been named vitality forms by Daniel Stern. Vitality forms represent how an action is performed and characterize all human interactions. In spite of their importance in social life, to date it is not clear whether the vitality forms expressed by the agent can influence the execution of a subsequent action performed by the receiver. To shed light on this matter, in the present study we carried out a kinematic study aiming to assess whether and how visual and auditory properties of vitality forms expressed by others influenced the motor response of participants. In particular, participants were presented with video-clips showing a male and a female actor performing a "giving request" (give me) or a "taking request" (take it) in visual, auditory, and mixed modalities (visual and auditory). Most importantly, requests were expressed with rude or gentle vitality forms. After the actor's request, participants performed a subsequent action. Results showed that vitality forms expressed by the actors influenced the kinematic parameters of the participants' actions regardless to the modality by which they are conveyed.

A proposal for new neurorehabilitative intervention on Moebius Syndrome patients after 'smile surgery'. Proof of concept based on mirror neuron system properties and hand-mouth synergistic activity.

Studies of the last twenty years on the motor and premotor cortices of primates demonstrated that the motor system is involved in the control and initiation of movements, and in higher cognitive processes, such as action understanding, imitation, and empathy. Mirror neurons are only one example of such theoretical shift. Their properties demonstrate that motor and sensory processing are coupled in the brain. Such knowledge has been also central for designing new neurorehabilitative therapies for patients suffering from brain injuries and consequent motor deficits. Moebius Syndrome patients, for example, are incapable of moving their facial muscles, which are fundamental for affective communication. These patients face an important challenge after having undergone a corrective surgery: reanimating the transplanted muscles to achieve a voluntarily control of smiling. We propose two new complementary rehabilitative approaches on MBS patients based on observation/imitation therapy (Facial Imitation Therapy, FIT) and on hand-mouth motor synergies (Synergistic Activity Therapy, SAT). Preliminary results show that our intervention protocol is a promising approach for neurorehabilitation of patients with facial palsy.

The Effects of Meaning and Emotional Content of a Sentence on the Kinematics of a Successive Motor Sequence Mimiking the Feeding of a Conspecific.

AIM: Do the emotional content and meaning of sentences affect the kinematics of successive motor sequences? MATERIAL AND METHODS: Participants observed video-clips of an actor pronouncing sentences expressing positive or negative emotions and meanings (related to happiness or anger in Experiment 1 and food admiration or food disgust in Experiment 2). Then, they reached-to-grasp and placed a sugar lump on the actor's mouth. Participants acted in response to sentences whose content could convey (1) emotion (i.e., face expression and prosody) and meaning, (2) meaning alone, or (3) emotion alone. Within each condition, the kinematic effects of sentences expressing positive and negative emotions were compared. Stimuli (positive for food admiration and negative for food disgust), conveyed either by emotion or meaning affected similarly the kinematics of both grasp and reach. RESULTS: In Experiment 1, the kinematics did not vary between positive and negative sentences either when the content was expressed by both emotion and meaning, or meaning alone. In contrast, in the case of sole emotion, sentences with positive valence made faster the approach of the conspecific. In Experiment 2, the valence of emotions (positive for food admiration and negative for food disgust) affected the kinematics of both grasp and reach, independently of the modality. DISCUSSION: The lack of an effect of meaning in Experiment 1 could be due to the weak relevance of sentence meaning with respect to the motor sequence goal (feeding). Experiment 2 demonstrated that, indeed, this was the case, because when the meaning and the consequent emotion were related to the sequence goal, they affected the kinematics. In contrast, the sole emotion activated approach or avoidance toward the actor according to positive and negative valence. The data suggest a behavioral dissociation between effects of emotion and meaning.

Factors affecting athletes' motor behavior after the observation of scenes of cooperation and competition in competitive sport: the effect of sport attitude.

AIM: This study delineated how observing sports scenes of cooperation or competition modulated an action of interaction, in expert athletes, depending on their specific sport attitude. METHOD: In a kinematic study, athletes were divided into two groups depending on their attitude toward teammates (cooperative or competitive). Participants observed sport scenes of cooperation and competition (basketball, soccer, water polo, volleyball, and rugby) and then they reached for, picked up, and placed an object on the hand of a conspecific (giving action). Mixed-design ANOVAs were carried out on the mean values of grasping-reaching parameters. RESULTS: Data showed that the type of scene observed as well as the athletes' attitude affected reach-to-grasp actions to give. In particular, the cooperative athletes were speeded when they observed scenes of cooperation compared to when they observed scenes of competition. DISCUSSION: Participants were speeded when executing a giving action after observing actions of cooperation. This occurred only when they had a cooperative attitude. A match between attitude and intended action seems to be a necessary prerequisite for observing an effect of the observed type of scene on the performed action. It is possible that the observation of scenes of competition activated motor strategies which interfered with the strategies adopted by the cooperative participants to execute a cooperative (giving) sequence.

Gesture and word analysis: the same or different processes?

The present study aimed at determining whether elaboration of communicative signals (symbolic gestures and words) is always accompanied by integration with each other and, if present, this integration can be considered in support of the existence of a same control mechanism. Experiment 1 aimed at determining whether and how gesture is integrated with word. Participants were administered with a semantic priming paradigm with a lexical decision task and pronounced a target word, which was preceded by a meaningful or meaningless prime gesture. When meaningful, the gesture could be either congruent or incongruent with word meaning. Duration of prime presentation (100, 250, 400 ms) randomly varied. Voice spectra, lip kinematics, and time to response were recorded and analyzed. Formant 1 of voice spectra, and mean velocity in lip kinematics increased when the prime was meaningful and congruent with the word, as compared to meaningless gesture. In other words, parameters of voice and movement were magnified by congruence, but this occurred only when prime duration was 250 ms. Time to response to meaningful gesture was shorter in the condition of congruence compared to incongruence. Experiment 2 aimed at determining whether the mechanism of integration of a prime word with a target word is similar to that of a prime gesture with a target word. Formant 1 of the target word increased when word prime was meaningful and congruent, as compared to meaningless congruent prime. Increase was, however, present for whatever prime word duration. Experiment 3 aimed at determining whether symbolic prime gesture comprehension makes use of motor simulation. Transcranial Magnetic Stimulation was delivered to left primary motor cortex 100, 250, 500 ms after prime gesture presentation. Motor Evoked Potential of First Dorsal Interosseus increased when stimulation occurred 100 ms post-stimulus. Thus, gesture was understood within 100 ms and integrated with the target word within 250 ms. Experiment 4 excluded any hand motor simulation in order to comprehend prime word. Thus, the same type of integration with a word was present for both prime gesture and word. It was probably successive to understanding of the signal, which used motor simulation for gesture and direct access to semantics for words.