Getting a grip: different actions and visual guidance of the thumb and finger in precision grasping

Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial

BACKGROUND

Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children.

METHODS

The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up.

DISCUSSION

The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills.

TRIAL REGISTRATION

This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024).

Somatosensory cortex of macaque monkeys is designed for opposable thumb

The evolution of opposable thumb has enabled fine grasping ability and precision grip, therefore the ability to finely manipulate the objects and refined tool use. Since tactile inputs to an opposable thumb are often spatially and temporally out of sync with inputs from the fingers, we hypothesized that inputs from the opposable thumb would be processed in an independent module in the primary somatosensory cortex (area 3b). Here we show that in area 3b of macaque monkeys, most neurons in the thumb representation do not respond to tactile stimulation of other digits and receive few intrinsic cortical inputs from other digits. However, neurons in the representations of other 4 digits respond to touch on any of the 4 digits and interconnect significantly more. The thumb inputs are thus processed in an independent module, whereas there is a significantly more interdigital information exchange between the other digits. This cortical organization reflects behavioral use of a hand with an opposable thumb.

Impact of Degraded Optics on Monocular and Binocular Vision: Lessons from Recent Advances in Highly-Aberrated Eyes

PURPOSE

Optical imperfections of the eye, characterized by higher-order wavefront aberrations, are exaggerated in corneal disease (e.g., keratoconus) and iatrogeny (e.g., keratorefractive surgery for myopia correction, keratoplasty for optical clarity restoration). This article reviews the recent advances on this topic for a comprehensive understanding of how optical degradations in disease models impact retinal image quality and monocular and binocular visual performance.

METHODS

Published literature over the last decade on retinal image quality and/or monocular and binocular visual functions with corneal irregularity was reviewed based on their relevance to the current topic, study population and strength of study design. The literature was summarized into four themes: 1) wavefront errors and retinal image quality of highly aberrated eyes, 2) monocular and binocular vision loss consequent to degraded optics and visual strategies to optimize performance, 3) impact of optical correction modalities on visual performance and 4) implications for clinical management of patients.

RESULTS

Across the 46 articles reviewed, the results clearly indicated that an increase in higher-order aberrations across these conditions had a significant negative impact on the patient's retinal image quality, and monocular and binocular visual functions. Interocular differences in retinal image quality deteriorated visual performance more than an overall worsening of image quality bilaterally. Minimizing optical degradation using rigid contact lenses and adaptive optics technology significantly improves retinal image quality and monocular and binocular vision, but performance remains sub-optimal relative to age-similar healthy controls.

CONCLUSION

Corneal disease and iatrogeny are useful models to understand the impact of optical degradation on retinal image quality and visual performance. Clinical management will greatly benefit from equalizing retinal image quality of both eyes of these patients. Future studies that deepen our understanding of the structure-function relation in these conditions are desirable for advancing vision science in this area and for developing novel clinical management strategies.

Integration of haptics and vision in human multisensory grasping

Grasping actions are directed not only toward objects we see but also toward objects we both see and touch (multisensory grasping). In this latter case, the integration of visual and haptic inputs improves movement performance compared to each sense alone. This performance advantage could be due to the integration of all the redundant positional and size cues or to the integration of only a subset of these cues. Here we selectively provided specific cues to tease apart how these different sensory sources contribute to visuo-haptic multisensory grasping. We demonstrate that the availability of the haptic positional cue together with the visual cues is sufficient to achieve the same grasping performance as when all cues are available. These findings provide strong evidence that the human sensorimotor system relies on non-visual sensory inputs and open new perspectives on their role in supporting vision during both development and adulthood.

Eye-hand coordination in reaching and grasping vertically moving targets

Previous investigations have uncovered a strong visual bias toward the index finger when reaching and grasping stationary or horizontally moving targets. The present research sought to explore whether the index finger or thumb would serve as a significant focus for gaze in tasks involving vertically translating targets. Participants executed right-handed reach-to-grasp movements towards upward or downward moving 2-D targets on a computer screen. When the target first appeared, participants made anticipatory fixations in the direction of the eventual movement path (i.e. well above upwardly moving targets or well below downwardly moving targets) and upon movement onset, fixations shifted toward the leading edge of the target. For upward moving targets, fixations remained toward the leading edge upon reach onset, whereas for downward moving targets, fixations shifted toward the centre of the target. The same central fixation location was observed at the time of grasp for all targets. Furthermore, for downwardly moving targets, the placement of the thumb appears to have influenced fixation location in conjunction with, not replacement of, the influence of the index finger. These findings are indicative of the increasingly relevant role of the thumb in mediating reaching and grasping downwardly moving targets.

Some binocular advantages for planning reach, but not grasp, components of prehension

Proficient (fast, accurate, precise) hand actions for reaching-to-grasp 3D objects are known to benefit significantly from the use of binocular vision compared to one eye alone. We examined whether these binocular advantages derive from increased reliability in encoding the goal object’s properties for feedforward planning of prehension movements or from enhanced feedback mediating their online control. Adult participants reached for, precision grasped and lifted cylindrical table-top objects (two sizes, 2 distances) using binocular vision or only their dominant/sighting eye or their non-dominant eye to program and fully execute their movements or using each of the three viewing conditions only to plan their reach-to-grasp during a 1 s preview, with vision occluded just before movement onset. Various kinematic measures of reaching and grasping proficiency, including corrective error rates, were quantified and compared by view, feedback and object type. Some significant benefits of binocular over monocular vision when they were just available for pre-movement planning were retained for the reach regardless of target distance, including higher peak velocities, straighter paths and shorter low velocity approach times, although these latter were contaminated by more velocity corrections and by poorer coordination with object contact. By contrast, virtually all binocular advantages for grasping, including improvements in peak grip aperture scaling, the accuracy and precision of digit placements at object contact and shorter grip application times preceding the lift, were eliminated with no feedback available, outcomes that were influenced by the object’s size. We argue that vergence cues can improve the reliability of binocular internal representations of object distance for the feedforward programming of hand transport, whereas the major benefits of binocular vision for enhancing grasping performance derive exclusively from its continuous presence online.

Predicting the duration of reach-to-grasp movements to objects with asymmetric contact surfaces

The duration of reach-to-grasp movements is influenced by the size of the contact surfaces, such that grasping objects with smaller contact surface areas takes longer. But what is the influence of asymmetric contact surfaces? In Experiment 1a, participants reached-to-lift wooden blocks off a table top, with the contact locations for the thumb and index finger varying in surface size. The time taken to lift the block was driven primarily by the thumb contact surface, which showed a larger effect size for the dependent variable of movement duration than the index finger's contact surface. In Experiment 1b participants reached-to-grasp (but not lift) the blocks. The same effect was found with duration being largely driven by contact surface size for the thumb. Experiment 2 tested whether this finding generalised to movements towards conical frusta grasped in a different plane mounted off the table top. Experiment 2 showed that movement duration again was dictated primarily by the size of the thumb's contact surface. The thumb contact surface was the visible surface in experiments 1 and 2 so Experiment 3 explored grasping when the index finger's contact surface was visible (participants grasped the frusta with the index finger at the top). An interaction between thumb and finger surface size was now found to determine movement duration. These findings provide the first empirical report of the impact of asymmetric contact surfaces on prehension, and may have implications for scientists who wish to model reach-to-grasp behaviours.

How removing visual information affects grasping movements

Our interaction with objects is facilitated by the availability of visual feedback. Here, we investigate how and when visual feedback affects the way we grasp an object. Based on the main views on grasping (reach-and-grasp and double-pointing views), we designed four experiments to test: (1) whether the availability of visual feedback influences the digits independently, and (2) whether the absence of visual feedback affects the initial part of the movement. Our results show that occluding (part of) the hand's movement path influences the movement trajectory from the beginning. Thus, people consider the available feedback when planning their movements. The influence of the visual feedback depends on which digit is occluded, but its effect is not restricted to the occluded digit. Our findings indicate that the control mechanisms are more complex than those suggested by current views on grasping.

Anthropometry of Brazilian Air Force pilots

Anthropometric data are essential for the design of military equipment including sizing of aircraft cockpits and personal gear. Currently, there are no anthropometric databases specific to Brazilian military personnel. The aim of this study was to create a Brazilian anthropometric database of Air Force pilots. The methods, protocols, descriptions, definitions, landmarks, tools and measurements procedures followed the instructions outlined in Measurer's Handbook: US Army and Marine Corps Anthropometric Surveys, 2010-2011 - NATICK/TR-11/017. The participants were measured countrywide, in all five Brazilian Geographical Regions. Thirty-nine anthropometric measurements related to cockpit design were selected. The results of 2133 males and 206 females aged 16-52 years constitute a set of basic data for cockpit design, space arrangement issues and adjustments, protective gear and equipment design, as well as for digital human modelling. Another important implication is that this study can be considered a starting point for reducing gender bias in women's career as pilots. Practitioner Summary: This paper describes the first large-scale anthropometric survey of the Brazilian Air Force pilots and the development of the related database. This study provides critical data for improving aircraft cockpit design for ergonomics and comprehensive pilot accommodation, protective gear and uniform design, as well as digital human modelling.

Shaping of Reach-to-Grasp Kinematics by Intentions: A Meta-Analysis

When we reach to grasp something, we need to take into account both the properties of the object we are grasping and the intention we have in mind. Previous research has found these constraints to be visible in the reach-to-grasp kinematics, but there is no consensus on which kinematic parameters are the most sensitive. To examine this, a systematic literature search and meta-analyses were performed. The search identified studies assessing how changes in either an object property or a prior intention affect reach-to-grasp kinematics in healthy participants. Hereafter, meta-analyses were conducted using a restricted maximum likelihood random effect model. The meta-analyses showed that changes in both object properties and prior intentions affected reach-to-grasp kinematics. Based on these results, the authors argue for a tripartition of the reach-to-grasp movement in which the accelerating part of the reach is primarily associated with transporting the hand to the object (i.e., extrinsic object properties), the decelerating part of the reach is used as a preparation for object manipulation (i.e., prepare the grasp or the subsequent action), and the grasp is associated with manipulating the object's intrinsic properties, especially object size.

Fixation Biases towards the Index Finger in Almost-Natural Grasping

We use visual information to guide our grasping movements. When grasping an object with a precision grip, the two digits need to reach two different positions more or less simultaneously, but the eyes can only be directed to one position at a time. Several studies that have examined eye movements in grasping have found that people tend to direct their gaze near where their index finger will contact the object. Here we aimed at better understanding why people do so by asking participants to lift an object off a horizontal surface. They were to grasp the object with a precision grip while movements of their hand, eye and head were recorded. We confirmed that people tend to look closer to positions that a digit needs to reach more accurately. Moreover, we show that where they look as they reach for the object depends on where they were looking before, presumably because they try to minimize the time during which the eyes are moving so fast that no new visual information is acquired. Most importantly, we confirmed that people have a bias to direct gaze towards the index finger’s contact point rather than towards that of the thumb. In our study, this cannot be explained by the index finger contacting the object before the thumb. Instead, it appears to be because the index finger moves to a position that is hidden behind the object that is grasped, probably making this the place at which one is most likely to encounter unexpected problems that would benefit from visual guidance. However, this cannot explain the bias that was found in previous studies, where neither contact point was hidden, so it cannot be the only explanation for the bias.

Visual field preferences of object analysis for grasping with one hand

When we grasp an object using one hand, the opposite hemisphere predominantly guides the motor control of grasp movements (Davare et al., 2007; Rice et al., 2007). However, it is unclear whether visual object analysis for grasp control relies more on inputs (a) from the contralateral than the ipsilateral visual field, (b) from one dominant visual field regardless of the grasping hand, or (c) from both visual fields equally. For bimanual grasping of a single object we have recently demonstrated a visual field preference for the left visual field (Le and Niemeier, 2013a,b), consistent with a general right-hemisphere dominance for sensorimotor control of bimanual grasps (Le et al., 2014). But visual field differences have never been tested for unimanual grasping. Therefore, here we asked right-handed participants to fixate to the left or right of an object and then grasp the object either with their right or left hand using a precision grip. We found that participants grasping with their right hand performed better with objects in the right visual field: maximum grip apertures (MGAs) were more closely matched to the object width and were smaller than for objects in the left visual field. In contrast, when people grasped with their left hand, preferences switched to the left visual field. What is more, MGA scaling with the left hand showed greater visual field differences compared to right-hand grasping. Our data suggest that, visual object analysis for unimanual grasping shows a preference for visual information from the ipsilateral visual field, and that the left hemisphere is better equipped to control grasps in both visual fields.

Age- and stereovision-dependent eye-hand coordination deficits in children with amblyopia and abnormal binocularity

PURPOSE

To examine factors contributing to eye-hand coordination deficits in children with amblyopia and impaired stereovision.

METHODS

Participants were 55 anisometropic or strabismic children aged 5.0 to 9.25 years with different degrees of amblyopia and abnormal binocularity, along with 28 age-matched visually-normal controls. Pilot data were obtained from four additional patients studied longitudinally at different treatment stages. Movements of the preferred hand were recorded using a 3D motion-capture system while subjects reached-to-precision grasp objects (two sizes, three locations) under binocular, dominant eye, and amblyopic/nonsighting eye conditions. Kinematic and "error" performance measures were quantified and compared by viewing condition and subject group using ANOVA, stepwise regression, and correlation analyses.

RESULTS

Movements of the younger amblyopes (age 5-6 years; n = 30) were much slower, particularly in the final approach to the objects, and contained more spatial errors in reaching (∼×1.25-1.75) and grasping (∼×1.75-2.25) under all three views (P < 0.05) than their age-matched controls (n = 13). Amblyopia severity was the main contributor to their slower movements with absent stereovision a secondary factor and the unique determinant of their increased error-rates. Older amblyopes (age 7-9 years; n = 25) spent longer contacting the objects before lifting them (P = 0.015) compared with their matched controls (n = 15), with absence of stereovision still solely related to increases in reach and grasp errors, although these occurred less frequently than in younger patients. Pilot prospective data supported these findings by showing positive treatment-related associations between improved stereovision and reach-to-grasp performance.

CONCLUSIONS

Strategies that children with amblyopia and abnormal binocularity use for reach-to-precision grasping change with age, from emphasis on visual feedback during the "in-flight" approach at ages 5 to 6 years to more reliance on tactile/kinesthetic feedback from object contact at ages 7 to 9 years. However, recovery of binocularity confers increasing benefits for eye-hand coordination speed and accuracy with age, and is a better predictor of these fundamental performance measures than the degree of visual acuity loss.

Distinct visual cues mediate aperture shaping for grasping and pantomime-grasping tasks

The authors examined whether the top-down requirements of dissociating the spatial relations between stimulus and response in a goal-directed grasping task renders the mediation of aperture trajectories via relative visual information. To address that issue, participants grasped differently sized target objects (i.e., grasping condition) and also grasped to a location that was dissociated from the target object (i.e., pantomime-grasping condition). Just noticeable difference (JND) values associated with the early through late stages of aperture shaping were computed to examine the extent to which motor output adhered to, or violated, the psychophysical principles of Weber's law. As expected, JNDs during the late stages of the grasping condition violated Weber's law: a result evincing the use of absolute visual information. In contrast, JNDs for the pantomime-grasping condition produced a continuous adherence to Weber's law. Such a result indicates that dissociating a stimulus from a response is a perception-based task and results in aperture shaping via relative visual information.