Brain areas involved in interlimb coordination: a distributed network

Prioritized adjustments in posture stabilization and adaptive reaching during neuromuscular fatigue of lower-limb muscles

Neuromuscular fatigue (NMF) induces temporary reductions in muscle force production capacity, affecting various aspects of motor function. Although studies have extensively explored NMF's impact on muscle activation patterns and postural stability, its influence on motor adaptation processes remains less understood. This article investigates the effects of localized NMF on motor adaptation during upright stance, focusing on reaching tasks. Using a force-field perturbation paradigm, participants performed reaching movements while standing upright before and after inducing NMF in the ankle dorsiflexor muscles. Results revealed that despite maintained postural stability, participants in the NMF group exhibited larger movement errors during reaching tasks, suggesting impaired motor adaptation. This was evident in both initial and terminal phases of adaptation, indicating a disruption in learning processes rather than a decreased adaptation rate. Analysis of electromyography activation patterns highlighted distinct strategies between groups, with the NMF group showing altered activation of both fatigued and nonfatigued muscles. In addition, differences in coactivation patterns suggested compensatory mechanisms to prioritize postural stability despite NMF-induced disruptions. These findings underscore the complex interplay between NMF, motor adaptation, and postural control, suggesting a potential role for central nervous system mechanisms in mediating adaptation processes. Understanding these mechanisms has implications for sports performance, rehabilitation, and motor skill acquisition, where NMF may impact the learning and retention of motor tasks. Further research is warranted to elucidate the transient or long-term effects of NMF on motor adaptation and its implications for motor rehabilitation interventions.NEW & NOTEWORTHY We assessed motor adaptation during force-field reaching following exercise-induced neuromuscular fatigue (NMF) on postural muscles. NMF impaired adaptation in performance. Similarly, diverging activation strategies were observed in the muscles. No effects were seen on measures of postural control. These results suggest the remodulation of motor commands to the muscles in the presence of NMF, which may be relevant in settings where participants could be exposed to NMF while learning, such as sports and rehabilitation.

Exploring the Consistent Roles of Motor Areas Across Voluntary Movement and Locomotion

Multiple cortical motor areas are critically involved in the voluntary control of discrete movement (e.g., reaching) and gait. Here, we outline experimental findings in nonhuman primates with clinical reports and research in humans that explain characteristic movement control mechanisms in the primary, supplementary, and presupplementary motor areas, as well as in the dorsal premotor area. We then focus on single-neuron activity recorded while monkeys performed motor sequences consisting of multiple discrete movements, and we consider how area-specific control mechanisms may contribute to the performance of complex movements. Following this, we explore the motor areas in cats that we have considered as analogs of those in primates based on similarities in their cortical surface topology, anatomic connections, microstimulation effects, and activity patterns. Emphasizing that discrete movement and gait modification entail similar control mechanisms, we argue that single-neuron activity in each area of the cat during gait modification is compatible with the function ascribed to the activity in the corresponding area in primates, recorded during the performance of discrete movements. The findings that demonstrate the premotor areas' contribution to locomotion, currently unique to the cat model, should offer highly valuable insights into the control mechanisms of locomotion in primates, including humans.

Hands off, brain off? A meta-analysis of neuroimaging data during active and passive driving

BACKGROUND

Car driving is more and more automated, to such an extent that driving without active steering control is becoming a reality. Although active driving requires the use of visual information to guide actions (i.e., steering the vehicle), passive driving only requires looking at the driving scene without any need to act (i.e., the human is passively driven).

MATERIALS & METHODS

After a careful search of the scientific literature, 11 different studies, providing 17 contrasts, were used to run a comprehensive meta-analysis contrasting active driving with passive driving.

RESULTS

Two brain regions were recruited more consistently for active driving compared to passive driving, the left precentral gyrus (BA3 and BA4) and the left postcentral gyrus (BA4 and BA3/40), whereas a set of brain regions was recruited more consistently in passive driving compared to active driving: the left middle frontal gyrus (BA6), the right anterior lobe and the left posterior lobe of the cerebellum, the right sub-lobar thalamus, the right anterior prefrontal cortex (BA10), the right inferior occipital gyrus (BA17/18/19), the right inferior temporal gyrus (BA37), and the left cuneus (BA17).

DISCUSSION

From a theoretical perspective, these findings support the idea that the output requirement of the visual scanning process engaged for the same activity can trigger different cerebral pathways, associated with different cognitive processes. A dorsal stream dominance was found during active driving, whereas a ventral stream dominance was obtained during passive driving. From a practical perspective, and contrary to the dominant position in the Human Factors community, our findings support the idea that a transition from passive to active driving would remain challenging as passive and active driving engage distinct neural networks.

Effects of transcranial direct current stimulation over human motor cortex on cognitive-motor and sensory-motor functions

The primary motor cortex (M1) is broadly acknowledged for its crucial role in executing voluntary movements. Yet, its contributions to cognitive and sensory functions remain largely unexplored. Transcranial direct current stimulation (tDCS) is a noninvasive neurostimulation method that can modify brain activity, thereby enabling the establishment of a causal link between M1 activity and behavior. This study aimed to investigate the online effects of tDCS over M1 on cognitive-motor and sensory-motor functions. Sixty-four healthy participants underwent either anodal or sham tDCS while concurrently performing a set of standardized robotic tasks. These tasks provided sensitive and objective assessments of brain functions, including action selection, inhibitory control, cognitive control of visuomotor skills, proprioceptive sense, and bimanual coordination. Our results revealed that anodal tDCS applied to M1 enhances decision-making capacity in selecting appropriate motor actions and avoiding distractors compared to sham stimulation, suggesting improved action selection and inhibitory control capabilities. Furthermore, anodal tDCS reduces the movement time required to accomplish bimanual movements, suggesting enhanced bimanual performance. However, we found no impact of anodal tDCS on cognitive control of visuomotor skills and proprioceptive sense. This study suggests that augmenting M1 activity via anodal tDCS influences cognitive-motor and sensory-motor functions in a task-dependent manner.

fMRI changes during multi-limb movements in Parkinson's disease

Background

While motor coordination problems are frequently reported among individuals with Parkinson’s disease (PD), the effects of the disease on the performance of multi-limb movements and the brain changes underlying impaired coordination are not well-documented.

Objective

Functional magnetic resonance imaging (fMRI) was used to examine differences in brain activity during a task that involved the coordination of non-homologous limbs (i.e., ipsilateral hand and foot) in individuals with and without PD.

Methods

Participants included 20 PD and 20 healthy control participants (HC). They were instructed to generate force in a coordinated manner by simultaneously contracting their ipsilateral hand and foot. PD were tested off their antiparkinsonian medication and on their more affected side, whereas the side in controls was randomized.

Results

Although both groups were able to coordinate the two limbs to produce the expected level of force, PD had a slower rate of force production and relaxation compared to HC. Additionally, their globus pallidus and primary motor cortex were underactive, whereas their pre-supplementary motor area (pre-SMA) and lateral cerebellum were overactive relative to HC. Importantly, in PD, the fMRI activity within the pre-SMA correlated with the rate of force decrease.

Conclusion

Multi-limb force control deficits in PD appear to be related to widespread underactivation within the basal ganglia-cortical loop. An overactivation of higher-level motor regions within the prefrontal cortex and lateral cerebellum may reflect increased cognitive control and performance monitoring that emerges during more complex motor tasks such as those that involve the coordination of multiple limbs.

The power of multivariate approach in identifying EEG correlates of interlimb coupling

Interlimb coupling refers to the interaction between movements of one limb and movements of other limbs. Understanding mechanisms underlying this effect is important to real life because it reflects the level of interdependence between the limbs that plays a role in daily activities including tool use, cooking, or playing musical instruments. Interlimb coupling involves multiple brain regions working together, including coordination of neural activity in sensory and motor regions across the two hemispheres. Traditional neuroscience research took a univariate approach to identify neural features that correspond to behavioural coupling measures. Yet, this approach reduces the complexity of the neural activity during interlimb tasks to one value. In this brief research report, we argue that identifying neural correlates of interlimb coupling would benefit from a multivariate approach in which full patterns from multiple sources are used to predict behavioural coupling. We demonstrate the feasibility of this approach in an exploratory EEG study where participants (n = 10) completed 240 trials of a well-established drawing paradigm that involves interlimb coupling. Using artificial neural network (ANN), we show that multivariate representation of the EEG signal significantly captures the interlimb coupling during bimanual drawing whereas univariate analyses failed to identify such correlates. Our findings demonstrate that analysing distributed patterns of multiple EEG channels is more sensitive than single-value techniques in uncovering subtle differences between multiple neural signals. Using such techniques can improve identification of neural correlates of complex motor behaviours.

Cortical contribution to visuomotor coordination in locomotion and reaching

One of the hallmarks of mammals is their ability to make precise visually guided limb movements to attain objects. This is best exemplified by the reach and grasp movements of primates, although it is not unique to this mammalian order. Precise, coordinated, visually guided movements are equally as important during locomotion in many mammalian species, especially in predators. In this context, vision is used to guide paw trajectory and placement. In this review we examine the contribution of the fronto-parietal network in the control of such movements. We suggest that this network is responsible for visuomotor coordination across behaviours and species. We further argue for analogies between cytoarchitectonically similar cortical areas in primates and cats.

Sex differences in the neural underpinnings of unimanual and bimanual control in adults

While many of the movements we make throughout our day involve just one upper limb, most daily movements require a certain degree of coordination between both upper limbs. Historically, sex differences in eye-hand coordination have been observed. As well, there are demonstrated sex-specific differences in hemisphere symmetry, interhemispheric connectivity, and motor cortex organization. While it has been suggested that these anatomical differences may underlie sex-related differences in performance, sex differences in the functional neural correlate underlying bimanual performance have not been explicitly investigated. In the current study we tested the hypothesis that the functional connectivity underlying bimanual movement control differed depending on the sex of an individual. Participants underwent MRI scanning to acquire anatomical and functional brain images. During the functional runs, participants performed unimanual and bimanual coordination tasks using two button boxes. The tasks included pressing the buttons in time to an auditory cue with either their left or their right hand individually (unimanual), or with both hands simultaneously (bimanual). The bimanual task was further divided into either an in-phase (mirror/symmetrical) or anti-phase (parallel/asymmetrical) condition. Participants were provided with extensive training to ensure task comprehension, and performance error rates were found to be equivalent between men and women. A generalized psychophysiological interaction (gPPI) analysis was implemented to examine how functional connectivity in each condition was modulated by sex. In support of our hypothesis, women and men demonstrated differences in the neural correlates underlying unimanual and bimanual movements. In line with previous literature, functional connectivity patterns showed sex-related differences for right- vs left-hand movements. Sex-specific functional connectivity during bimanual movements was not a sum of the functional connectivity underlying right- and left-hand unimanual movements. Further, women generally showed greater interhemispheric functional connectivity across all conditions compared to men and had greater connectivity between task-related cortical areas, while men had greater connectivity involving the cerebellum. Sex differences in brain connectivity were associated with both unimanual and bimanual movement control. Not only do these findings provide novel insight into the fundamentals of how the brain controls bimanual movements in both women and men, they also present potential clinical implications on how bimanual movement training used in rehabilitation can best be tailored to the needs of individuals.

Dual-site TMS as a tool to probe effective interactions within the motor network: a review

Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.

Changes in cortical activation during upright stance in individuals with chronic low back pain: An fNIRS study

Introduction

Postural control deficits are a potential cause of persistent and recurrent pain in patients with chronic low back pain (CLBP). Although some studies have confirmed that the dorsolateral prefrontal cortex (DLPFC) contributes to pain regulation in CLBP, its role in the postural control of patients with CLBP remains unclear. Therefore, this study aimed to investigate the DLPFC activation of patients with CLBP and healthy controls under different upright stance task conditions.

Methods

Twenty patients with CLBP (26.50 ± 2.48 years) and 20 healthy controls (25.75 ± 3.57 years) performed upright stance tasks under three conditions: Task-1 was static balance with eyes open; Task-2 was static balance with eyes closed; Task-3 involved dynamic balance on an unstable surface with eyes open. A wireless functional near-infrared spectroscopy (fNIRS) system measured cortical activity, including the bilateral DLPFC, pre-motor cortex (PMC) and supplementary motor area (SMA), the primary motor cortex (M1), the primary somatosensory cortex (S1), and a force platform measured balance parameters during upright stance.

Results

The two-way repeated measures ANOVA results showed significant interaction in bilateral PMC/SMA activation. Moreover, patients with CLBP had significantly increased right DLPFC activation and higher sway 32 area and velocity than healthy controls during upright stance.

Discussion

Our results imply that PMC/SMA and DLPFC maintain standing balance. The patients with CLBP have higher cortical activity and upright stance control deficits, which may indicate that the patients with CLBP have low neural efficiency and need more motor resources to maintain balance.

A secondary motor area contributing to interlimb coordination during visually guided locomotion in the cat

We investigated the contribution of cytoarchitectonic cortical area 4δc, in the caudal bank of the cruciate sulcus of the cat, to the control of visually guided locomotion. To do so, we recorded the activity of 114 neurons in 4δc while cats walked on a treadmill and stepped over an obstacle that advanced toward them. A total of 84/114 (74%) cells were task-related and 68/84 (81%) of these cells showed significant modulation of their discharge frequency when the contralateral limbs were the first to step over the obstacle. These latter cells included a substantial proportion (27/68 40%) that discharged between the passage of the contralateral forelimb and the contralateral hindlimb over the obstacle, suggesting a contribution of this area to interlimb coordination. We further compared the discharge in area 4δc with the activity patterns of cells in the rostral division of the same cytoarchitectonic area (4δr), which has been suggested to be a separate functional region. Despite some differences in the patterns of activity in the 2 subdivisions, we suggest that activity in each is compatible with a contribution to interlimb coordination and that they should be considered as a single functional area that contributes to both forelimb-forelimb and forelimb-hindlimb coordination.

A protocol to analyze the global literature on the clinical benefit of interlimb-coordinated intervention in gait recovery and the associated neurophysiological changes in patients with stroke

Background

Stroke is among the leading causes of disability of worldwide. Gait dysfunction is common in stroke survivors, and substantial advance is yet to be made in stroke rehabilitation practice to improve the clinical outcome of gait recovery. The role of the upper limb in gait recovery has been emphasized in the literature. Recent studies proposed that four limbs coordinated interventions, coined the term "interlimb-coordinated interventions," could promote gait function by increasing the neural coupling between the arms and legs. A high-quality review is essential to examine the clinical improvement and neurophysiological changes following interlimb-coordinated interventions in patients with stroke.

Methods

Systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature will be retrieved from the databases of OVID, MEDLINE, PubMed, Web of Science, EMBASE, and PsycINFO. Studies published in English over the past 15 years will be included. All of the clinical studies (e.g., randomized, pseudorandomized and non-randomized controlled trials, uncontrolled trials, and case series) that employed interlimb intervention and assessed gait function of patients with stroke will be included. Clinical functions of gait, balance, lower limb functions, and neurophysiologic changes are the outcome measures of interest. Statistical analyses will be performed using the Comprehensive Meta-Analysis version 3.

Discussion

The findings of this study will provide insight into the clinical benefits and the neurophysiological adaptations of the nervous system induced by interlimb-coordinated intervention in patients with stroke. This would guide clinical decision-making and the future development of targeted neurorehabilitation protocol in stroke rehabilitation to improve gait and motor function in patients with stroke. Increasing neuroplasticity through four-limb intervention might complement therapeutic rehabilitation strategies in this patient group. The findings could also be insightful for other cerebral diseases.

A study on brain neuronal activation based on the load in upper limb exercise (STROBE)

This study aimed to determine the level of brain activation in separate regions, including the lobes, cerebellum, and limbic system, depending on the weight of an object during elbow flexion and extension exercise using functional magnetic resonance imaging (fMRI). The study was conducted on ten male undergraduates (22.4 ± 1.2 years). The functional images of the brain were obtained using the 3T MRI. The participants performed upper limb flexion and extension exercise at a constant speed and as the weight of the object for lifting was varied (0 g and 1000 g). The experiment consisted of four blocks that constituted 8 minutes. Each block was designed to comprise a rest phase (1 minute) and a lifting phase (1 minute). The results showed that, in the parietal lobe, the activation was higher for the 0 g-motion condition than for the 1000 g-motion condition; however, in the occipital lobe, cerebellum, sub-lobar, and limbic system, the activation was higher for the 1000 g-motion condition than for the 0 g-motion condition. The brain region for the perception of object weight was identified as the ventral area (occipital, temporal, and frontal lobe), and the activation of the ventral pathway is suggested to have increased as the object came into vision and as its shape, size, and weight were perceived. For holding an object in hand, compared to not holding it, the exercise load was greater for controlling the motion to maintain the posture (arm angle at 90°), controlling the speed to repeat the motion at a constant speed, and producing an accurate posing. Therefore, to maintain such varied conditions, the activation level increased in the regions associated with control and regulation through the motion coordination from vision to arm movements (control of muscles). A characteristic reduced activation was observed in the regions associated with visuo-vestibular interaction and voluntary movement when the exercise involved lifting a 1000-g object compared to the exercise without object lifting.

Age and Interlimb Coordination Complexity Modulate Oscillatory Spectral Dynamics and Large-scale Functional Connectivity

Interlimb coordination deteriorates as a result of aging. Due to its ubiquity in daily life, a greater understanding of the underlying neurophysiological changes is required. Here, we combined electroencephalography time-frequency spectral power and functional connectivity analyses to provide a comprehensive overview of the neural dynamics underlying the age-related deterioration of interlimb coordination involving all four limbs. Theta, alpha and beta oscillations in the frontal, central and parietal regions were analyzed in twenty younger (18-30 years) and nineteen older adults (65-78 years) during a complex interlimb reaction time task. Reaction time was significantly higher in older adults across all conditions, and the discrepancy between both age groups was largest in the most complex movement condition. Older adults demonstrated enhanced beta event-related desynchronization (i.e., the attenuation of beta power), which further increased along with task complexity and was positively linked to behavioral performance. Theta functional connectivity between frontal, central and parietal regions generally increased with movement complexity, irrespective of age group. In general, frontoparietal alpha band functional connectivity tended to be reduced in older versus younger adults, although these contrasts did not survive multiple comparison corrections. Overall, spectral results suggest that enhanced beta desynchronization in older adults reflects a successful compensatory mechanism to cope with increased difficulty during complex interlimb coordination. Functional connectivity results suggest that theta and alpha band connectivity are prone to respectively task- and age-related modulations. Future work could target these spectral and functional connectivity dynamics through noninvasive brain stimulation to potentially improve interlimb coordination in older adults.

Mapping brain structure and function in professional fencers: A model to study training effects on central nervous system plasticity

Brain magnetic resonance imaging (MRI) studies have shown different patterns of structural and functional reorganization in high‐level athletes compared with controls, but little is known about their relationship with interlimb coordination mechanisms. To this aim, we investigated brain structural and functional differences in high‐level fencers compared with nonathlete controls and the MRI substrates of interlimb coordination in elite athletes. Fourteen right‐handed male fencers (median age = 22.3 years) and 15 right‐handed age‐ and sex‐matched healthy subjects (median age = 22.4 years) underwent structural and functional MRI acquisition during the execution of cyclic bimanual‐movements as well as during in‐phase and antiphase hand/foot‐movements of the dominant‐right limbs. No between‐group differences were found in gray matter volumes and white matter architecture. Active‐fMRI showed that controls versus fencers had higher activations in parietal and temporal areas during bimanual‐task; whereas fencers versus controls had higher activations in the basal ganglia. During in‐phase task, controls versus fencers showed higher activation of right cerebellum, whereas fencers had higher activity mainly in frontal areas. The functional‐connectivity (FC) analysis showed that fencers versus controls had an increased FC between left motor cortex and fronto‐temporal areas as well as bilateral thalami during the different tasks. Intensive and prolonged fencing activity is associated with brain functional changes mainly involving frontal regions related to high‐level motor control and planning of complex tasks. These modifications are likely to reflect an optimization of brain networks involved in motor activities, including interlimb coordination tasks, occurring after intensive training.

Corticospinal excitability and somatosensory information processing of the lower limb muscle during upper limb voluntary or electrically induced muscle contractions

Neural interactions between upper and lower limbs underlie motor coordination in humans. Specifically, upper limb voluntary muscle contraction can facilitate spinal and corticospinal excitability of the lower limb muscles. However, little remains known on the involvement of somatosensory information in arm-leg neural interactions. Here, we investigated effects of voluntary and electrically induced wrist flexion on corticospinal excitability and somatosensory information processing of the lower limbs. In Experiment 1, we measured transcranial magnetic stimulation (TMS)-evoked motor evoked potentials (MEPs) of the resting soleus (SOL) muscle at rest or during voluntary or neuromuscular electrical stimulation (NMES)-induced wrist flexion. The wrist flexion force was matched to 10% of the maximum voluntary contraction (MVC). We found that SOL MEPs were significantly increased during voluntary, but not NMES-induced, wrist flexion, compared to the rest (P < 0.001). In Experiment 2, we examined somatosensory evoked potentials (SEPs) following tibial nerve stimulation under the same conditions. The results showed that SEPs were unchanged during both voluntary and NMES-induced wrist flexion. In Experiment 3, we examined the modulation of SEPs during 10%, 20%, and 30% MVC voluntary wrist flexion. During 30% MVC voluntary wrist flexion, P50-N70 SEP component was significantly attenuated compared to the rest (P = 0.003). Our results propose that the somatosensory information generated by NMES-induced upper limb muscle contractions may have a limited effect on corticospinal excitability and somatosensory information processing of the lower limbs. However, voluntary wrist flexion modulated corticospinal excitability and somatosensory information processing of the lower limbs via motor areas.

Task-Based Functional Connectivity and Blood-Oxygen-Level-Dependent Activation During Within-Scanner Performance of Lumbopelvic Motor Tasks: A Functional Magnetic Resonance Imaging Study

There are a limited number of neuroimaging investigations into motor control of the lumbopelvic musculature. Most investigation examining motor control of the lumbopelvic musculature utilize transcranial magnetic stimulation (TMS) and focus primarily on the motor cortex. This has resulted in a dearth of knowledge as it relates to how other regions of the brain activate during lumbopelvic movement. Additionally, task-based functional connectivity during lumbopelvic movements has not been well elucidated. Therefore, we used functional magnetic resonance imaging (fMRI) to examine brain activation and ROI-to-ROI task-based functional connectivity in 19 healthy individuals (12 female, age 29.8 ± 4.5 years) during the performance of three lumbopelvic movements: modified bilateral bridge, left unilateral bridge, and right unilateral bridge. The whole brain analysis found robust, bilateral activation within the motor regions of the brain during the bilateral bridge task, and contralateral activation of the motor regions during unilateral bridging tasks. Furthermore, the ROI-to-ROI analysis demonstrated significant connectivity of a motor network that included the supplemental motor area, bilateral precentral gyrus, and bilateral cerebellum regardless of the motor task performed. These data suggest that while whole brain activation reveals unique patterns of activation across the three tasks, functional connectivity is very similar. As motor control of the lumbopelvic area is of high interest to those studying low back pain (LBP), this study can provide a comparison for future research into potential connectivity changes that occur in individuals with LBP.

Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases

Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.

Brain Network Organization Following Post-Stroke Neurorehabilitation

Brain network analysis can offer useful information to guide the rehabilitation of post-stroke patients. We applied functional network connection models based on multiplex-multilayer network analysis (MMN) to explore functional network connectivity changes induced by robot-aided gait training (RAGT) using the Ekso, a wearable exoskeleton, and compared it to conventional overground gait training (COGT) in chronic stroke patients. We extracted the coreness of individual nodes at multiple locations in the brain from EEG recordings obtained before and after gait training in a resting state. We found that patients provided with RAGT achieved a greater motor function recovery than those receiving COGT. This difference in clinical outcome was paralleled by greater changes in connectivity patterns among different brain areas central to motor programming and execution, as well as a recruitment of other areas beyond the sensorimotor cortices and at multiple frequency ranges, contemporarily. The magnitude of these changes correlated with motor function recovery chances. Our data suggest that the use of RAGT as an add-on treatment to COGT may provide post-stroke patients with a greater modification of the functional brain network impairment following a stroke. This might have potential clinical implications if confirmed in large clinical trials.

Dance-based exergaming on postural stability and kinematics in people with chronic stroke - A preliminary study

INTRODUCTION

The study evaluated the feasibility, and compliance of a dance-based exergaming (DBExG) on postural stability (PS) and lower extremity (LE) kinematics, along with post-intervention changes in gait function and falls self-efficacy in people with chronic stroke (PwCS).

METHODS

Fifteen PwCS underwent DBExG for six weeks using Kinect "Just Dance 3." Pre- to post- changes were recorded during DBExG assessment on a fast-paced song (130 bpm) using an 8-camera motion capture system to assess PS (center of mass [CoM] excursions [EXs] in the anterior-posterior [AP] and mediolateral [ML] directions) and LE kinematics (hip, knee, and ankle joint angle EXs). Gait function was also assessed with gait parameters, such as gait speed, cadence, and gait symmetry on an electronic walkway. Falls self-efficacy was recorded with Falls Efficacy Scale (FES).

RESULTS

The AP and ML CoM EXs and paretic joint angle EXs significantly increased pre- to post- DBExG assessment (p < .05). Gait parameters, and falls self-efficacy measures significantly changed pre- to post- DBExG (p < .05).

CONCLUSIONS

Results exhibited the feasibility of the proposed DBExG for positively impacting postural stability, and kinematics, along with increasing gait function and falls self-efficacy among PwCS.

Unraveling somatotopic organization in the human brain using machine learning and adaptive supervoxel-based parcellations

In addition to the well-established somatotopy in the pre- and post-central gyrus, there is now strong evidence that somatotopic organization is evident across other regions in the sensorimotor network. This raises several experimental questions: To what extent is activity in the sensorimotor network effector-dependent and effector-independent? How important is the sensorimotor cortex when predicting the motor effector? Is there redundancy in the distributed somatotopically organized network such that removing one region has little impact on classification accuracy? To answer these questions, we developed a novel experimental approach. fMRI data were collected while human subjects performed a precisely controlled force generation task separately with their hand, foot, and mouth. We used a simple linear iterative clustering (SLIC) algorithm to segment whole-brain beta coefficient maps to build an adaptive brain parcellation and then classified effectors using extreme gradient boosting (XGBoost) based on parcellations at various spatial resolutions. This allowed us to understand how data-driven adaptive brain parcellation granularity altered classification accuracy. Results revealed effector-dependent activity in regions of the post-central gyrus, precentral gyrus, and paracentral lobule. SMA, regions of the inferior and superior parietal lobule, and cerebellum each contained effector-dependent and effector-independent representations. Machine learning analyses showed that increasing the spatial resolution of the data-driven model increased classification accuracy, which reached 94% with 1755 supervoxels. Our SLIC-based supervoxel parcellation outperformed classification analyses using established brain templates and random simulations. Occlusion experiments further demonstrated redundancy across the sensorimotor network when classifying effectors. Our observations extend our understanding of effector-dependent and effector-independent organization within the human brain and provide new insight into the functional neuroanatomy required to predict the motor effector used in a motor control task.

The Efficacy of Interlimb-Coordinated Intervention on Gait and Motor Function Recovery in Patients with Acute Stroke: A Multi-Center Randomized Controlled Trial Study Protocol

BACKGROUND

The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training since most everyday activities require the coordinated use of both hands to complete a task. This study investigates the efficacy of interlimb-coordinated training on gait and upper limb functional recovery over a short-medium term period.

METHODS

A total of 226 acute stroke patients will be recruited from four centres over four years. Patients will be randomly allocated to either conventional therapy or conventional therapy plus interlimb-coordinated training. Outcomes will be recorded at baseline, after 2 weeks of intervention, and at 3- and 6-months post-intervention. Gait speed is the primary outcome measure. Secondary outcome measures include Fugl-Meyer Assessment of Motor Recovery, Berg Balance Scale, Timed Up and Go test, Action Research Arm Test, electroencephalography, and magnetic resonance imaging.

CONCLUSION

The results of this trial will provide an in-depth understanding of the efficacy of early interlimb-coordinated intervention on gait and upper functional rehabilitation and how it may relate to the neural plasticity process.

Development of the Relationships Among Dynamic Balance Control, Inter-limb Coordination, and Torso Coordination During Gait in Children Aged 3-10 Years

Knowledge about the developmental process of dynamic balance control comprised of upper arms and upper legs coordination and trunk and pelvis twist coordination is important to advance effective balance assessment for abnormal development. However, the mechanisms of these coordination and stability control during gait in childhood are unknown.This study examined the development of dynamic postural stability, upper arm and upper leg coordination, and trunk and pelvic twist coordination during gait, and investigated the potential mechanisms integrating the central nervous system with inter-limb coordination and trunk and pelvic twist coordination to control extrapolated center of the body mass (XCOM). This study included 77 healthy children aged 3-10 years and 15 young adults. The child cohort was divided into four groups by age: 3-4, 5-6, 7-8, and 9-10 years. Participants walked barefoot at a self-selected walking speed along an 8 m walkway. A three-dimensional motion capture system was used for calculating the XCOM, the spatial margin of stability (MoS), and phase coupling movements of the upper arms, upper legs, trunk, and pelvic segments. MoS in the mediolateral axis was significantly higher in the young adults than in all children groups. Contralateral coordination (ipsilateral upper arm and contralateral upper leg combination) gradually changed to an in-phase pattern with increasing age until age 9 years. Significant correlations of XCOMML with contralateral coordination and with trunk and pelvic twist coordination (trunk/pelvis coordination) were found. Significant correlations between contralateral coordination and trunk/pelvis coordination were observed only in the 5-6 years and at 7-8 years groups.Dynamic postural stability during gait was not fully mature at age 10. XCOM control is associated with the development of contralateral coordination and trunk and pelvic twist coordination. The closer to in-phase pattern of contralateral upper limb coordination improved the XCOM fluctuations. Conversely, the out-of-phase pattern (about 90 degrees) of the trunk/pelvis coordination increased theXCOM fluctuation. Additionally, a different control strategy was used among children 3-8 years of age and individuals over 9 years of age, which suggests that 3-4-year-old children showed a disorderly coordination strategy between limb swing and torso movement, and in children 5-8 years of age, limb swing depended on trunk/pelvis coordination.

Distinct representation of ipsilateral hand movements in sensorimotor areas

There is ample evidence that the contralateral sensorimotor areas play an important role in movement generation, with the primary motor cortex and the primary somatosensory cortex showing a detailed spatial organization of the representation of contralateral body parts. Interestingly, there are also indications for a role of the motor cortex in controlling the ipsilateral side of the body. However, the precise function of ipsilateral sensorimotor cortex in unilateral movement control is still unclear. Here, we show hand movement representation in the ipsilateral sensorimotor hand area, in which hand gestures can be distinguished from each other and from contralateral hand gestures. High‐field functional magnetic resonance imaging (fMRI) data acquired during the execution of six left‐ and six right‐hand gestures by healthy volunteers showed ipsilateral activation mainly in the anterior section of precentral gyrus and the posterior section of the postcentral gyrus. Despite the lower activation in ipsilateral areas closer to the central sulcus, activity patterns for the 12 hand gestures could be mutually distinguished in these areas. The existence of a unique representation of ipsilateral hand movements in the human sensorimotor cortex favours the notion of transcallosal integrative processes that support optimal coordination of hand movements.

Disconnection of posterior part of the frontal aslant tract causes acute phase motor functional deficit

The frontal aslant tract (FAT) mainly connects the supplementary motor area (SMA) and inferior frontal gyrus. The left FAT is involved in language-related functions, while the functional role of the right FAT is not fully understood. The aim of this study was to investigate the function of the right FAT by dividing it into three segments according to the anatomical structure. A total of 34 right frontal gliomas who had undergone surgery were studied. Participants were assessed for the acute and chronic phases of several neuropsychological and motor functions. FAT was reconstructed into the anterior, middle, and posterior segments according to the cortical connections as the medial prefrontal cortex, pre-SMA, and SMA proper, respectively. The relationships between the damaged severity of each FAT segment and behavioral scores were analyzed. A significant relationship was observed only in the acute phase motor function and posterior segment of the FAT. The middle segment was involved in motor function, but it did not have a sufficient significance level compared to the posterior segment. Our study revealed that the right FAT can be divided into three segments and that its posterior segment is related to acute phase motor function.

Intermuscular coherence analysis in older adults reveals that gait-related arm swing drives lower limb muscles via subcortical and cortical pathways

KEY POINTS

Gait-related arm swing in humans supports efficient lower limb muscle activation, indicating a neural coupling between the upper and lower limbs during gait. Intermuscular coherence analyses of gait-related electromyography from upper and lower limbs in 20 healthy participants identified significant coherence in alpha and beta/gamma bands indicating that upper and lower limbs share common subcortical and cortical drivers that coordinate the rhythmic four-limb gait pattern. Additional directed connectivity analyses revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. The results provide a neural underpinning that arm swing may serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

ABSTRACT

Human gait benefits from arm swing, as it enhances efficient lower limb muscle activation in healthy participants as well as patients suffering from neurological impairment. The underlying neuronal mechanisms of such coupling between upper and lower limbs remain poorly understood. The aim of the present study was to examine this coupling by intermuscular coherence analysis during gait. Additionally, directed connectivity analysis of this coupling enabled assessment of whether gait-related arm swing indeed drives lower limb muscles. To that end, electromyography recordings were obtained from four lower limb muscles and two upper limb muscles bilaterally, during gait, of 20 healthy participants (mean (SD) age 67 (6.8) years). Intermuscular coherence analysis revealed functional coupling between upper and lower limb muscles in the alpha and beta/gamma band during muscle specific periods of the gait cycle. These effects in the alpha and beta/gamma bands indicate involvement of subcortical and cortical sources, respectively, that commonly drive the rhythmic four-limb gait pattern in an efficiently coordinated fashion. Directed connectivity analysis revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. This indicates that gait-related arm swing reflects the recruitment of neuronal support for optimizing the cyclic movement pattern of the lower limbs. These findings thus provide a neural underpinning for arm swing to potentially serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

The influence of accuracy constraints on bimanual and unimanual sequence learning

An experiment was designed to determine whether accuracy constraints can influence how unimanual and bimanual motor sequences are produced and learned. The accuracy requirements of the task were manipulated using principles derived from Fitts' Law to create relatively low (ID = 3) and high (ID = 5) accuracy demands. Right-limb dominant participants (N = 28, age = 21.9 yrs; 15 females and 13 males) were required to produce unimanual left, unimanual right or bimanual movement sequences using elbow extension and flexion movements to hit a series of illuminated targets. The targets were illuminated in a repeating sequence of 16 elements. Participants performed 20 practice trials. Thirty minutes following the practice trials participants performed a retention test. Element duration (time interval between target hits) and segment harmonicity (hesitations/adjustments in movement pattern) were calculated. The results indicate longer element duration and lower harmonicity values (more adjustments) when the task required higher accuracy demands (ID = 5) compared to low accuracy demands (ID = 3). Element duration was shorter and harmonicity was higher at ID = 5 for both unimanual groups than the bimanual group. However, element duration was shorter and harmonicity was higher at ID = 3 for the bimanual group than for both unimanual groups. These results indicate that the accuracy demands of the task can influence both performance and learning of motor sequences and suggest differences between unimanual and bimanual motor sequence learning. It appears there is a bimanual advantage for tasks with lower accuracy demands whereas performance is more accurate with unimanual performance, regardless of limb, with higher accuracy demands. These results are consistent with recent research indicating that accuracy requirements change the control processes for bimanual performance differently than for unimanual tasks.

Dissociating the causal role of left and right dorsal premotor cortices in planning and executing bimanual movements - A neuro-navigated rTMS study

BACKGROUND

The dorsal premotor cortex (PMd) is a key region in bimanual coordination. However, causal evidence linking PMd functionality during motor planning and execution to movement quality is lacking.

OBJECTIVE

We investigated how left (PMd_L) and right PMd (PMd_R) are causally involved in planning and executing bimanual movements, using short-train repetitive transcranial magnetic stimulation (rTMS). Additionally, we explored to what extent the observed rTMS-induced modulation of performance could be explained by rTMS-induced modulation of PMd-M1 interhemispheric interactions (IHI).

METHODS

Twenty healthy adults (mean age ± SD = 22.85 ± 3.73 years) participated in two sessions, in which either PMd_L or PMd_R was targeted with rTMS (10 Hz) in a pseudo-randomized design. PMd functionality was transiently modulated during the planning or execution of a complex bimanual task, whereby the participant was asked to track a moving dot by controlling two dials. The effect of rTMS on several performance measures was investigated. Concurrently, rTMS-induced modulation of PMd-M1 IHI was measured using a dual-coil paradigm, and associated with the rTMS-induced performance modulation.

RESULTS

rTMS over PMd_L during planning increased bilateral hand movement speed (p = 0.03), thereby improving movement accuracy (p = 0.02). In contrast, rTMS over PMd_R during both planning and execution induced deterioration of movement stability (p = 0.04). rTMS-induced modulation of PMd-M1 IHI during planning did not predict rTMS-induced performance modulation.

CONCLUSION

The current findings support the growing evidence on PMd_L dominance during motor planning, as PMd_L was crucially involved in planning the speed of each hand, subserving bimanual coordination accuracy. Moreover, the current results suggest that PMd_R fulfills a role in continuous adjustment processes of movement.

Drawing lines and circles in Parkinson's Disease: The lateralized symptoms interfere with the movements of the unaffected hand

INTRODUCTION

Evidence about altered bimanual coordination has been reported in Parkinson's Disease. However, no previous study has explored such an alteration quantifying the interference effect that the trajectory of each hand might impose on the other one. Thus, in the present research, we applied the traditional Circles-Lines Coupling Task, which allowed assessing the motor coordination of the two hands, in the context of Parkinson's Disease.

METHODS

Thirty-six individuals affected by Parkinson's Disease were consecutively recruited and assigned to two groups according to their symptoms' lateralization. Moreover, eighteen age-matched healthy controls participated in the study. We capitalized on the Circles-Lines Coupling Task, in which the performance during incongruent movements (drawing lines with one hand and circles with the other hand) was compared with the performance during congruent movements (drawing lines with both hands). A bimanual coupling index was computed to compare the interference effect of each hand on the other one.

RESULTS

In healthy controls, the bimanual coupling index did not differ between the two hands. Crucially, in both groups of individuals affected by Parkinson's Disease, the less affected hand showed a significantly higher bimanual coupling index, due to the abnormal interference exerted by the most affected one, than vice versa.

CONCLUSIONS

Our results highlighted an altered spatial bimanual coupling in Parkinson's disease, depending on the symptoms' lateralization. We offered different explanations of our results according to the theoretical frameworks about the mechanisms subserving bimanual coordination.

Left hemisphere damage produces deficits in predictive control of bilateral coordination

Previous research has demonstrated hemisphere-specific motor deficits in ipsilesional and contralesional unimanual movements in patients with hemiparetic stroke due to MCA infarct. Due to the importance of bilateral motor actions on activities of daily living, we now examine how bilateral coordination may be differentially affected by right or left hemisphere stroke. To avoid the caveat of simply adding unimanual deficits in assessing bimanual coordination, we designed a unique task that requires spatiotemporal coordination features that do not exist in unimanual movements. Participants with unilateral left (LHD) or right hemisphere damage (RHD) and age-matched controls moved a virtual rectangle (bar) from a midline start position to a midline target. Movement along the long axis of the bar was redundant to the task, such that the bar remained in the center of and parallel to an imaginary line connecting each hand. Thus, to maintain midline position of the bar, movements of one hand closer to or further away from the bar midline required simultaneous, but oppositely directed displacements with the other hand. Our findings indicate that left (LHD), but not right (RHD) hemisphere-damaged patients showed poor interlimb coordination, reflected by significantly lower correlations between displacements of each hand along the bar axis. These left hemisphere-specific deficits were only apparent prior to peak velocity, likely reflecting predictive control of interlimb coordination. In contrast, the RHD group bilateral coordination was not significantly different than that of the control group. We conclude that predictive mechanisms that govern bilateral coordination are dependent on left hemisphere mechanisms. These findings indicate that assessment and training in cooperative bimanual tasks should be considered as part of an intervention framework for post-stroke physical rehabilitation.

Foot-placement accuracy during planned and reactive target stepping during walking in stroke survivors and healthy adults

BACKGROUND

The high prevalence of falls due to trips and slips following stroke may signify difficulty adjusting foot-placement in response to the environment. However, little is known about under what circumstances foot-placement adjustment becomes difficult for stroke survivors (SS), making the design of targeted rehabilitation interventions to improve independent community mobility difficult.

RESEARCH QUESTION

To investigate the effect of planned and reactive target-stepping on foot-placement accuracy in stroke survivors and young and older healthy adults?

METHODS

Young (N = 11, 30 ± 6 years) and older (N = 10, 64 ± 8 years) healthy adults and SS (N = 11, 67 ± 9 years) walked, at preferred pace, on a force instrumented treadmill. Each participant walked to illuminated targets, visible two steps in advance (planned) or appearing at contralateral midstance (reactive). Foot-placement error (magnitude and bias) and number of missed targets were compared.

RESULTS

All participants missed more reactive than planned targets (p = 0.05), and SS missed more targets than young (p < 0.001) and older (p = 0.001) adults. But no interaction showing SS missed more reactive targets than other groups was found. For all groups: reactive adaptations to steps in the antero-posterior plane resulted in lower error than planned adaptations (p = 0.027). Lengthening steps where undershot more than shortening (p < 0.001) by all groups. Reactive medio-lateral adaptations over all induced larger error (p = 0.029) than planned and changed the direction of bias (p = 0.018).

SIGNIFICANCE

SS experience difficulty making all adjustments, they showed increased error in all conditions but less pronounced difference between planned and reactive stepping. SS may use a reactive control strategy for all adjustments, in contrast to healthy young adults who may plan foot-placement in advance. The likelihood of stroke survivors misplacing a step is large, with 9.8% targets missed; possibly leading to falls. Further investigation is needed to understand foot-placement control strategies used by SS and the role of planning in gait adaptability.

Interlimb Responses to Perturbations of Bilateral Movements are Asymmetric

Previous research has revealed rapid feedback mediated responses in one arm to mechanical perturbations applied to the other arm during shared bimanual tasks. We now ask whether these interlimb responses are expressed symmetrically. We tested this question in a virtual reality environment: a cursor representing each hand was used to 'pick up' each end of a virtual bar and place it into a target trough. Near the onset of occasional, unpredictable trials, one arm was perturbed. Regardless of which arm was perturbed, ipsilateral responses were significant during the perturbation. However, responses in the arm contralateral to the perturbation were asymmetric. While the non-dominant arm showed a significant kinematic response to correct the bar orientation when the dominant arm was mechanically perturbed, the dominant arm did not respond when the non-dominant arm was perturbed. We also saw an asymmetric response in early EMG activity, in which only the non-dominant anterior deltoid showed a significant reflex response within 100 milliseconds of perturbation onset in response to dominant arm. This response was consistent with correcting the bar position, but not with correcting its orientation. We conclude that responses to perturbations during bilateral movements are expressed asymmetrically, such that non-dominant arm responses to perturbations to the dominant arm are stronger than dominant arm responses to non-dominant arm perturbations.

A Review of Robot-Assisted Lower-Limb Stroke Therapy: Unexplored Paths and Future Directions in Gait Rehabilitation

Stroke affects one out of every six people on Earth. Approximately 90% of stroke survivors have some functional disability with mobility being a major impairment, which not only affects important daily activities but also increases the likelihood of falling. Originally intended to supplement traditional post-stroke gait rehabilitation, robotic systems have gained remarkable attention in recent years as a tool to decrease the strain on physical therapists while increasing the precision and repeatability of the therapy. While some of the current methods for robot-assisted rehabilitation have had many positive and promising outcomes, there is moderate evidence of improvement in walking and motor recovery using robotic devices compared to traditional practice. In order to better understand how and where robot-assisted rehabilitation has been effective, it is imperative to identify the main schools of thought that have prevailed. This review intends to observe those perspectives through three different lenses: the goal and type of interaction, the physical implementation, and the sensorimotor pathways targeted by robotic devices. The ways that researchers approach the problem of restoring gait function are grouped together in an intuitive way. Seeing robot-assisted rehabilitation in this unique light can naturally provoke the development of new directions to potentially fill the current research gaps and eventually discover more effective ways to provide therapy. In particular, the idea of utilizing the human inter-limb coordination mechanisms is brought up as an especially promising area for rehabilitation and is extensively discussed.

Challenging balance during sensorimotor adaptation increases generalization

From reaching to walking, real-life experience suggests that people can generalize between motor behaviors. One possible explanation for this generalization is that real-life behaviors often challenge our balance. We propose that the exacerbated body motions associated with balance-challenged whole body movements increase the value to the nervous system of using a comprehensive internal model to control the task. Because it is less customized to a specific task, a more comprehensive model is also a more generalizable model. Here we tested the hypothesis that challenging balance during adaptation would increase generalization of a newly learned internal model. We encouraged participants to learn a new internal model using prism lenses that created a new visuomotor mapping. Four groups of participants adapted to prisms while performing either a standing-based reaching or precision walking task, with or without a manipulation that challenged balance. To assess generalization after the adaptation phase, participants performed a single trial of each of the other groups' tasks without prisms. We found that both the reaching and walking balance-challenged groups showed significantly greater generalization to the equivalent, nonadapted task than the balance-unchallenged groups. Additionally, we found some evidence that all groups generalized across tasks, for example, from walking to reaching and vice versa, regardless of balance manipulation. Overall, our results demonstrate that challenging balance increases the degree to which a newly learned internal model generalizes to untrained movements.NEW & NOTEWORTHY Real-life experience indicates that people can generalize between motor behaviors. Here we show that challenging balance during the learning of a new internal model increases the degree of generalization to untrained movements for both reaching and walking tasks. These results suggest that the effects of challenging balance are not specific to the task but instead apply to motor learning more broadly.

Double obstacles increase gait asymmetry during obstacle crossing in people with Parkinson's disease and healthy older adults: A pilot study

Gait asymmetry during unobstructed walking in people with Parkinson’s disease (PD) has been well documented. However, under complex situations, such as environments with double obstacles, gait asymmetry remains poorly understood in PD. Therefore, the aim of this study was to analyze inter-limb asymmetry while crossing a single obstacle and double obstacles (with different distances between them) in people with PD and healthy older adults. Nineteen people with PD and 19 healthy older people performed three conditions: (i) walking with one obstacle (Single); (ii) walking with two obstacles with a 50 cm distance between them (Double-50); (iii) walking with two obstacles with a 108 cm distance between them (Double-108). The participants performed the obstacle crossing with both lower limbs. Asymmetry Index was calculated. We found that people with PD presented higher leading and trailing toe clearance asymmetry than healthy older people. In addition, participants increased asymmetry in the Double-50 compared to Single condition. It can be concluded that people with PD show higher asymmetry during obstacle crossing compared to healthy older people, independently of the number of obstacles. In addition, a challenging environment induces asymmetry during obstacle crossing in both people with PD and healthy older people.

Pre-Movement Cortico-Muscular Dynamics Underlying Improved Parkinson Gait Initiation after Instructed Arm Swing

BACKGROUND

The supplementary motor area (SMA) is implicated in both motor initiation and stereotypic multi-limb movements such as walking with arm swing. Gait in Parkinson's disease exhibits starting difficulties and reduced arm swing, consistent with reduced SMA activity.

OBJECTIVE

We tested whether enhanced arm swing could improve Parkinson gait initiation and assessed whether increased SMA activity during preparation might facilitate such improvement.

METHODS

Effects of instructed arm swing on cortical activity, muscle activity and kinematics were assessed by ambulant EEG, EMG, accelerometers and video in 17 Parkinson patients and 19 controls. At baseline, all participants repeatedly started walking after a simple auditory cue. Next, patients started walking at this cue, which now meant starting with enhanced arm swing. EEG changes over the putative SMA and leg motor cortex were assessed by event related spectral perturbation (ERSP) analysis of recordings at Fz and Cz.

RESULTS

Over the putative SMA location (Fz), natural PD gait initiation showed enhanced alpha/theta synchronization around the auditory cue, and reduced alpha/beta desynchronization during gait preparation and movement onset, compared to controls. Leg muscle activity in patients was reduced during preparation and movement onset, while the latter was delayed compared to controls. When starting with enhanced arm swing, these group differences virtually disappeared.

CONCLUSION

Instructed arm swing improves Parkinson gait initiation. ERSP normalization around the cue indicates that the attributed information may serve as a semi-internal cue, recruiting an internalized motor program to overcome initiation difficulties.

Diurnal repeated exercise promotes slow-wave activity and fast-sigma power during sleep with increase in body temperature: a human crossover trial

The effects of exercise on sleep have been explored from various perspectives, but little is known about how the effects of acute exercise on sleep are produced through physiological functions. We used a protocol of multiple daytime sessions of moderate-intensity aerobic exercise and examined the subsequent effects on sleep structure, core body temperature (CBT), distal-proximal skin temperature gradient (DPG), and subjective parameters. Fourteen healthy men who did not exercise regularly were evaluated under the baseline (no exercise) and exercise conditions on a within-subject crossover basis. Under the exercise condition, each participant performed a 40-min aerobic workout at 40% of maximal oxygen intake, four times between morning and early evening. We observed a 33% increase in slow-wave sleep (SWS; P = 0.005), as well as increases in slow-wave activity (SWA; P = 0.026), the fast-sigma power/SWA ratio (P = 0.005), and subjective sleep depth and restorativeness the following morning. Moreover, both CBT and the DPG increased during sleep after exercise (P = 0.021 and P = 0.047, respectively). Regression analysis identified an increased nocturnal DPG during sleep after exercise as a factor in the increase in SWA. The fast-sigma/SWA ratio correlated with CBT. The performance of acute exercise promotes SWS with nocturnal elevation in the DPG. Both CBT and fast-sigma power may play a role in the specific physiological status of the body after exercise. NEW & NOTEWORTHY We used multiple daytime sessions of moderate-intensity aerobic exercise to examine the effects on the sleep structure, core body temperature (CBT), distal-proximal skin temperature gradient (DPG), and subjective parameters. Significant increases in slow-wave activity (SWA), CBT, DPG, fast-sigma power, and subjective parameters were observed during the night and the following morning. Nocturnal DPG is a factor in the increased SWA.

EEG time-frequency analysis provides arguments for arm swing support in human gait control

BACKGROUND

Human gait benefits from arm swing, which requires four-limb co-ordination. The Supplementary Motor Area (SMA) is involved in multi-limb coordination. With its location anterior to the leg motor cortex and the pattern of its connections, this suggests a distinct role in gait control.

RESEARCH QUESTION

Is the SMA functionally implicated in gait-related arm swing?

METHODS

Ambulant electroencephalography (EEG) was employed during walking with and without arm swing in twenty healthy subjects (mean age: 64.9yrs, SD 7.2). Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation (ERSP) analysis over both the putative SMA at electrode position Fz and additional sensorimotor regions.

RESULTS

During walking with arm swing, midline electrodes Fz and Cz showed a step-related pattern of Event Related Desynchronization (ERD) followed by Event Related Synchronization (ERS). Walking without arm swing was associated with significant ERD-ERS power reduction in the high-beta/low-gamma band over Fz and a power increase over Cz. Electrodes C3 and C4 revealed a pattern of ERD during contralateral- and ERS during ipsilateral leg swing. This ERD power decreased in gait without arm swing (low-frequency band). The ERSP pattern during walking with arm swing was similar at CP1 and CP2: ERD was seen during double support and the initial swing phase of the right leg, while a strong ERS emerged during the second half of the left leg's swing. Walking without arm swing showed a significant power reduction of this ERD-ERS pattern over CP2, while over CP1, ERS during left leg's swing turned into ERD.

CONCLUSION

The relation between arm swing in walking and a step-related ERD-ERS pattern in the high-beta/low-gamma band over the putative SMA, points at an SMA contribution to integrated cyclic anti-phase movements of upper- and lower limbs. This supports a cortical underpinning of arm swing support in gait control.

Abnormal gray matter asymmetry in alcohol dependence

Previous voxel-based morphometry studies have provided evidence that patients with alcohol dependence (AD) have widespread gray matter morphological abnormalities. However, brain structural asymmetry in AD has not been assessed to date. Here, we aimed to use a recently developed voxel-based morphometry-based approach to investigate global and regional gray matter asymmetry alterations in AD. A total of 39 male individuals, including 19 AD patients and 20 age-matched healthy controls, underwent high-resolution structural MRI. Global and voxel-wise gray matter asymmetries were measured separately by the Dice coefficient and the asymmetry index, which were compared between the two groups. We found no difference in the global gray matter asymmetry between AD patients and healthy controls. However, voxel-wise gray matter asymmetry analysis showed that AD patients and healthy controls had different distribution patterns of brain regions with a rightward asymmetry and a leftward asymmetry Furthermore, we observed an increased rightward asymmetry of gray matter in the hemispheric I-IV and V of the cerebellum and lingual gyrus in AD patients. These findings suggest that abnormal structural asymmetry in the cerebellum and the primary visual cortex may be the neural mechanisms contributing toward motor and visual impairments in AD.

Synergistic influences of sensory and central stimuli on non-voluntary rhythmic arm movements

In recent years, neuromodulation of the cervical spinal circuitry has become an area of interest for investigating rhythmogenesis of the human spinal cord and interaction between cervical and lumbosacral circuitries, given the involvement of rhythmic arm muscle activity in many locomotor tasks. We have previously shown that arm muscle vibrostimulation can elicit non-voluntary upper limb oscillations in unloading body conditions. Here we investigated the excitability of the cervical spinal circuitry by applying different peripheral and central stimuli in healthy humans. The rationale for applying combined stimuli is that the efficiency of only one stimulus is generally limited. We found that low-intensity electrical stimulation of the superficial arm median nerve can evoke rhythmic arm movements. Furthermore, the movements were enhanced by additional peripheral stimuli (e.g., arm muscle vibration, head turns or passive rhythmic leg movements). Finally, low-frequency transcranial magnetic stimulation of the motor cortex significantly facilitated rhythmogenesis. The findings are discussed in the general framework of a brain-spinal interface for developing adaptive central pattern generator-modulating therapies.

Embodied time: Time production in advanced Quadrato and Aikido practitioners

Over the last few years, several studies have investigated the possible effects of mindfulness meditation on time perception. Mindfulness meditation has been linked to both longer time production (TP) and increased bodily perception, and bodily processes are in turn thought to lie at the core of human time perception. Nevertheless, the connection between mindful movements (MMs; i.e., specific types of mind-body coordination-demanding physical activity) and time perception has been ignored. Consequently, in the current study we examined the effect of MMs on TP. A mixed observational study design was adopted to investigate whether (1) the extensive practice of MMs is associated with longer TP and interlimb coordination efficiency, and (2) there is a relationship between these two variables. Thirty-four healthy adults volunteered, including 11 Aikido and nine advanced Quadrato Motor Training (aQMT) practitioners, and 14 physically non-active controls. Practitioners of aQMT had significantly longer produced durations in contrast to the Aikido and control groups. In addition, longer produced duration was associated with increased coordination efficiency. In conclusion, the current results are in line with previous studies linking embodied time and mindful meditation, and suggest the importance of incorporating movement meditation, especially in the context of time estimation and the self.

Neural Oscillations and the Initiation of Voluntary Movement

The brain processes involved in the planning and initiation of voluntary action are of great interest for understanding the relationship between conscious awareness of decisions and the neural control of movement. Voluntary motor behavior has generally been considered to occur when conscious decisions trigger movements. However, several studies now provide compelling evidence that brain states indicative of forthcoming movements take place before a person becomes aware of a conscious decision to act. While such studies have created much debate over the nature of ‘free will,’ at the very least they suggest that unconscious brain processes are predictive of forthcoming movements. Recent studies suggest that slow changes in neuroelectric potentials may play a role in the timing of movement onset by pushing brain activity above a threshold to trigger the initiation of action. Indeed, recent studies have shown relationships between the phase of low frequency oscillatory activity of the brain and the onset of voluntary action. Such studies, however, cannot determine whether this underlying neural activity plays a causal role in the initiation of movement or is only associated with the intentional behavior. Non-invasive transcranial alternating current brain stimulation can entrain neural activity at particular frequencies in order to assess whether underlying brain processes are causally related to associated behaviors. In this review, we examine the evidence for neural coding of action as well as the brain states prior to action initiation and discuss whether low frequency alternating current brain stimulation could influence the timing of a persons’ decision to act.

Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis

BACKGROUND

Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dual-task performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS.

MATERIALS AND METHODS

All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3 T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures.

RESULTS

Eighteen females with relapsing-remitting MS [mean age = 45.5 ± 8.2 SD; mean symptom duration = 12.3 ± 6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability.

CONCLUSIONS

The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to objectively report in MS; diffusion tensor imaging could show microstructural improvements and suggest improved connectivity.

Vestibulo-Hippocampal Function Is Enhanced and Brain Structure Altered in Professional Ballet Dancers

Background and Objective: Life-long balance training has been shown to affect brain structure, including the hippocampus. Data are missing in this respect on professional ballet dancers of both genders. It is also unknown whether transfer effects exist on general balancing as well as spatial orientation abilities, a function mainly supported by the hippocampus. We aimed to assess differences in gray matter (GM) structure, general balancing skills, and spatial orientation skills between professional ballet dancers and non-dancers. Methods: Nineteen professional ballet dancers aged 18-35 (27.5 ± 4.1 years; 10 females) and nineteen age-matched non-dancers (26.5 ± 2.1 years; 10 females) were investigated. Main outcomes assessed were the score of a 30-item clinical balance test (CBT), the average error distance (in centimeters) on triangle completion task, and difference in GM density as seen by voxel-based morphometric analysis (VBM, SPM). Results: Ballet group performed significantly better on all conditions of the CBT and in the wheelchair (vestibular-dependent) condition of the spatial orientation test. Larger GM volumes for ballet dancers were observed in the right hippocampus, parahippocampal gyrus, insula, and cingulate motor cortex, whereas both larger and smaller volumes were detected within cerebellum bilaterally in comparison to non-dancers. Conclusion: Our results indicate that life-long ballet training could lead to better clinically relevant balancing abilities as well as vestibular-dependent spatial orientation capabilities; both of the benefits might be caused by positive influence of ballet training on the vestibular system function, and-possibly-its connectivity with temporal lobe regions responsible for vestibular-dependent orienting in space.

Early Findings on Functional Connectivity Correlates of Behavioral Outcomes of Brain-Computer Interface Stroke Rehabilitation Using Machine Learning

The primary goal of this work was to apply data-driven machine learning regression to assess if resting state functional connectivity (rs-FC) could estimate measures of behavioral domains in stroke subjects who completed brain-computer interface (BCI) intervention for motor rehabilitation. The study cohort consisted of 20 chronic-stage stroke subjects exhibiting persistent upper-extremity motor deficits who received the intervention using a closed-loop neurofeedback BCI device. Over the course of this intervention, resting state functional MRI scans were collected at four distinct time points: namely, pre-intervention, mid-intervention, post-intervention and 1-month after completion of intervention. Behavioral assessments were administered outside the scanner at each time-point to collect objective measures such as the Action Research Arm Test, Nine-Hole Peg Test, and Barthel Index as well as subjective measures including the Stroke Impact Scale. The present analysis focused on neuroplasticity and behavioral outcomes measured across pre-intervention, post-intervention and 1-month post-intervention to study immediate and carry-over effects. Rs-FC, changes in rs-FC within the motor network and the behavioral measures at preceding stages were used as input features and behavioral measures and associated changes at succeeding stages were used as outcomes for machine-learning-based support vector regression (SVR) models. Potential clinical confounding factors such as age, gender, lesion hemisphere, and stroke severity were included as additional features in each of the regression models. Sequential forward feature selection procedure narrowed the search for important correlates. Behavioral outcomes at preceding time-points outperformed rs-FC-based correlates. Rs-FC and changes associated with bilateral primary motor areas were found to be important correlates of across several behavioral outcomes and were stable upon inclusion of clinical variables as well. NIH Stroke Scale and motor impairment severity were the most influential clinical variables. Comparatively, linear SVR models aided in evaluation of contribution of individual correlates and seed regions while non-linear SVR models achieved higher performance in prediction of behavioral outcomes.