Processing of visual information compromises the ability of older adults to control novel fine motor tasks

The Role of Visual Performance in Fine Motor Skills

The aim of this study was to analyse the relationship between fine motor skills (FMSs) and visual performance. Thirty young participants with normal binocular vision performed five fine motor tasks: Purdue, Grooved, and O'Connor pegboards, a needle threading task, and a water pouring task, which were characterised by the time taken to complete the task, the number of pegs inserted, the error made in pouring the water, and the volume spilled. To evaluate visual performance, near visual acuity, near contrast sensitivity (CS), and disability glare were assessed. Fine motor skills and visual performance were assessed under monocular and binocular viewing conditions. An overall visual performance score (OVPS) and an overall fine motor skills score (OFMSS) were calculated. All visual functions measured binocularly were better than in monocular conditions, and all FMSs tasks were performed worse monocularly than binocularly (p < 0.001), except for the error made in the water pouring task (p = 0.024). There was a positive correlation between OVPS and OFMSS (rho = 0.329; p = 0.010). The regression model showed that the OFMSS can be predicted by age and CS at 21.3%. Individuals with normal binocular vision and better near visual function exhibit superior fine motor abilities. CS stands out as the visual function that has the greatest bearing on the performance of FMSs.

Effects of repetition of a car-driving pedal maneuver and neural output in older adults

Understanding the ability of older adults to control pedal position angle and investigating whether this ability can be enhanced through practice may contribute to the prevention of traffic accidents. This study aimed to investigate repetitive effects on variability of the pedal position and neural drive during car-pedal operation in older adults. Thirteen older and 11 young adults performed 105 (21 sets × 5 repetitions) pedal angle control tasks with plantar flexor contraction. High-density surface electromyograms were recorded of triceps surae muscles. A cumulative spike train as a neural drive was calculated using continuously active motor unit activities. The coefficient of variation of the angle was higher in older (1.47 ± 1.06 %) than young (0.41 ± 0.21 %) adults in the first sets, and improved to 0.67 ± 0.51 % in the final sets in older adults only. There was no significant difference in neural drive variability between older and young adults. Our results suggest that repetition improves angular steadiness in older adults. However, this effect could not be explained by neural output which is estimated from lower threshold motor units that are continuously active.

Visual Information Processing in Older Adults: Force Control and Motor Unit Pool Modulation

Increased visual information about a task impairs force control in older adults. To date, however, it remains unclear how increased visual information changes the activation of the motor unit pool differently for young and older adults. Therefore, this study aimed to determine how increased visual information alters the activation of the motor neuron pool and influences force control in older adults. Fifteen older adults (66-86 years, seven women) and fifteen young adults (18-30 years, eight women) conducted a submaximal constant force task (15% of maximum) with ankle dorsiflexion for 20 s. The visual information processing was manipulated by changing the amount of force visual feedback into a low-gain (0.05°) or high-gain (1.2°) condition. Older adults exhibited greater force variability, especially at high-gain visual feedback. This exacerbated force variability from low- to high-gain visual feedback was associated with modulations of multiple motor units, not single motor units. Specifically, increased modulation of multiple motor units from 10 to 35 Hz may contribute to the amplification in force variability. Therefore, our findings suggest evidence that high-gain visual feedback amplifies force variability of older adults which is related to increases in the activation of motor neuron pool from 10 to 35 Hz.

Influence of pedal characteristics on pedaling control and neural drive in older adults

This study was aimed to investigate whether pedal characteristics and age affect pedal position accuracy, fluctuation, and neural drive variability during a position control task. Twelve older (age: 72.8 ± 3.6 years) and twelve young (age: 23.8 ± 4.4 years) adults performed trapezoidal position control tasks involving holding plantar flexor contraction for 10 s with four pedal conditions (regular and pulley types × standard and low forces). Neural drive of the triceps surae muscle was estimated with high-density surface electromyograms and individual motor unit decomposition methods. The central 5 s of the sustained contraction phase was used for analysis. Variabilities of the angle and neural drive are presented by the coefficient of variation. We observed that the angle fluctuation was greater in older than young adults for four pedal conditions (p < 0.05). Regardless of age, using pulley pedals increased angle fluctuation more than regular pedals (p < 0.05). No significant interaction was found for pedal conditions and age in pedal position accuracy, angle fluctuation, or neural output. Our results suggest that older adults have poor control ability to maintain pedal angles, and pulley pedals make it difficult to adjust the pedal angles regardless of age. However, the neural output estimated by the continuously active motor units failed to explain these differences.

Force Steadiness: From Motor Units to Voluntary Actions

Voluntary actions are controlled by the synaptic inputs that are shared by pools of spinal motor neurons. The slow common oscillations in the discharge times of motor units due to these synaptic inputs are strongly correlated with the fluctuations in force during submaximal isometric contractions (force steadiness) and moderately associated with performance scores on some tests of motor function. However, there are key gaps in knowledge that limit the interpretation of differences in force steadiness.

Examining modifications of execution strategies during a continuous task

How strategies are formulated during a performance is an important aspect of motor control. Knowledge of the strategy employed in a task may help subjects achieve better performances, as it would help to evidence other possible strategies that could be used as well as help perfect a certain strategy. We sought to investigate how much of a performance is conditioned by the initial state and whether behavior throughout the performance is modified within a short timescale. In other words, we focus on the process of execution and not on the outcome. To this scope we used a repeated continuous circle tracing task. Performances were decomposed into different components (i.e., execution variables) whose combination is able to numerically determine movement outcome. By identifying execution variables of speed and duration, we created an execution space and a solution manifold (i.e., combinations of execution variables yielding zero discrepancy from the desired outcome) and divided the subjects according to their initial performance in that space into speed preference, duration preference, and no-preference groups. We demonstrated that specific strategies may be identified in a continuous task, and strategies remain relatively stable throughout the performance. Moreover, as performances remained stable, the initial location in the execution space can be used to determine the subject’s strategy. Finally, contrary to other studies, we demonstrated that, in a continuous task, performances were associated with reduced exploration of the execution space.

A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation

Background

Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications.

Objective

This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States.

Methods

In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach.

Results

In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information.

Conclusions

Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults’ perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults’ access to home modifications.

Visual information processing in older adults: reaction time and motor unit pool modulation

Presently, there is no evidence that magnification of visual feedback has motor implications beyond impairments in force control during a visuomotor task. We hypothesized that magnification of visual feedback would increase visual information processing, alter the muscle activation, and exacerbate the response time in older adults. To test this hypothesis, we examined whether magnification of visual feedback during a reaction time task alters the premotor time and the motor unit pool activation of older adults. Participants responded as fast as possible to a visual stimulus while they maintained a steady ankle dorsiflexion force (15% maximum) either with low-gain or high-gain visual feedback of force. We quantified the following: 1) response time and its components (premotor and motor time), 2) force variability, and 3) motor unit pool activity of the tibialis anterior muscle. Older adults exhibited longer premotor time and greater force variability than young adults. Only in older adults, magnification of visual feedback lengthened the premotor time and exacerbated force variability. The slower premotor time in older adults with high-gain visual feedback was associated with increased force variability and an altered modulation of the motor unit pool. In conclusion, our findings provide novel evidence that magnification of visual feedback also exacerbates premotor time during a reaction time task in older adults, which is correlated with force variability and an altered modulation of motor unit pool. Thus these findings suggest that visual information processing deficiencies in older adults could result in force control and reaction time impairments. NEW & NOTEWORTHY It is unknown whether magnification of visual feedback has motor implications beyond impairments in force control for older adults. We examined whether it impairs reaction time and motor unit pool activation. The findings provide novel evidence that magnification of visual feedback exacerbates reaction time by lengthening premotor time, which implicates time for information processing in older adults, which is correlated with force variability and an altered modulation of motor unit pool.

Force Steadiness During a Cognitively Challenging Motor Task Is Predicted by Executive Function in Older Adults

Motor performance and cognitive function both decline with aging. Older adults for example are usually less steady for a constant-force task than young adults when performing low-intensity contractions with limb muscles. Healthy older adults can also show varying degrees of cognitive decline, particularly in executive function skills. It is not known, however, whether age-related changes in steadiness of low-force tasks and cognitive function are independent of one another. In this study, we determined if executive function skills in aging are associated with the steadiness during a low-force muscle contraction performed with and without the imposition of a cognitive challenge. We recruited 60 older adults (60–85 years old, 34 women, 26 men) and 48 young adults (19–30 years old, 24 women, 24 men) to perform elbow flexor muscle contractions at 5% of maximal voluntary contraction (MVC) force in the presence and absence of a difficult mental-math task (counting backward by 13 from a four-digit number). Force steadiness was quantified as the coefficient of variation (CV) of force and executive function was estimated with the Trail-making Test part A and B. The cognitive challenge increased the CV of force (i.e., decreased force steadiness) with greater changes in older adults than young adults (5.2 vs. 1.3%, respectively, cognitive challenge × age: P < 0.001). Older adults were 35% slower in both parts A and B of the Trail-making Test (P < 0.001), and to eliminate the effects of age and education on this variable, all further analyses were performed with the age-corrected z-scores for each individual using established normative values. Hierarchical regression models indicated that decreased force steadiness during a cognitive challenge trial was in part, explained by the performance in the Trail-making Test part A and B in older (r = 0.53 and 0.50, respectively, P < 0.05), but not in young adults (P > 0.05). Thus, healthy community-dwelling older adults, who have poorer executive function skills, exhibit reduced force steadiness during tasks when also required to perform a high cognitive demand task, and are likely at risk of reduced capacity to perform daily activities that involve cognitively challenging motor tasks.

Learning new gait patterns: Age-related differences in skill acquisition and interlimb transfer

Evidence from upper-extremity literature suggests that the normal ageing process affects an individual's ability to learn and retain a motor skill, but spares their ability to transfer the skill to the untrained, opposite limb. While this phenomenon has been well-studied in the upper-extremity, evidence in the lower-extremity is limited. Further, it is unclear to what extent age-related differences in motor learning and transfer are dependent on visual feedback of the motor task. Therefore, the purpose of this study was to examine the effects of ageing on motor learning, retention, and interlimb transfer during walking with and without visual feedback. Forty-four subjects (24 young; 20 older adults) were tested on a treadmill over two consecutive days. On day 1, subjects learned a new gait pattern by performing a foot-trajectory tracking task that necessitated greater hip and knee flexion during the swing phase of the gait. On day 2, subjects repeated the task with their training leg to test retention, then with their untrained leg to test interlimb transfer. Trials without visual feedback were also collected on both days. Results indicated that older adults had reduced ability to learn the task, and also exhibited lower retention and inter-limb transfer. However, these differences were dependent on visual feedback as the groups performed similarly when feedback was removed. The findings provide novel evidence indicating that ageing impairs learning, retention, and transfer of motor skills in the lower-extremity during walking, which may have implications for gait therapy after stroke and other geriatric conditions.

Visuospatial function predicts one-week motor skill retention in cognitively intact older adults

Motor learning declines with aging, such that older adults retain less motor skill after practice compared to younger adults. However, it remains unclear if these motor learning declines are related to normal cognitive changes associated with aging. The purpose of this study was to examine which cognitive domains would best predict the amount of retention on a motor task one week after training in cognitively intact older adults. Twenty-one adults ages 65-84 years old were assessed with Repeatable Battery for the Assessment of Neuropsychological Status, which assesses five cognitive domains (immediate and delayed memory, visuospatial/constructional, language, and attention). Participants also completed one training session of a functional upper extremity task, and were re-tested one week later. Stepwise regression indicated that the visuospatial domain was the only significant predictor of how much skill participants retained over one week, with a visual perception subtest explaining the most variance. Results from this study support previous work reporting that older adults' capacity for motor learning can be probed with visuospatial tests. These tests may capture the structural or functional health of neural networks critical for skill learning within the aging brain, and provide valuable clinical insight about an individual's unique rehabilitation potential.

Altered visual strategies and attention are related to increased force fluctuations during a pinch grip task in older adults

The purpose of the study was to determine the visual strategies used by older adults during a pinch grip task and to assess the relations between visual strategy, deficits in attention, and increased force fluctuations in older adults. Eye movements of 23 older adults (>65 yr) were monitored during a low-force pinch grip task while subjects viewed three common visual feedback displays. Performance on the Grooved Pegboard test and an attention task (which required no concurrent hand movements) was also measured. Visual strategies varied across subjects and depended on the type of visual feedback provided to the subjects. First, while viewing a high-gain compensatory feedback display (horizontal bar moving up and down with force), 9 of 23 older subjects adopted a strategy of performing saccades during the task, which resulted in 2.5 times greater force fluctuations in those that exhibited saccades compared with those who maintained fixation near the target line. Second, during pursuit feedback displays (force trace moving left to right across screen and up and down with force), all subjects exhibited multiple saccades, and increased force fluctuations were associated (r_s = 0.6; P = 0.002) with fewer saccades during the pursuit task. Also, decreased low-frequency (<4 Hz) force fluctuations and Grooved Pegboard times were significantly related (P = 0.033 and P = 0.005, respectively) with higher (i.e., better) attention z scores. Comparison of these results with our previously published results in young subjects indicates that saccadic eye movements and attention are related to force control in older adults.NEW & NOTEWORTHY The significant contributions of the study are the addition of eye movement data and an attention task to explain differences in hand motor control across different visual displays in older adults. Older participants used different visual strategies across varying feedback displays, and saccadic eye movements were related with motor performance. In addition, those older individuals with deficits in attention had impaired motor performance on two different hand motor control tasks, including the Grooved Pegboard test.

Memory-guided force control in healthy younger and older adults

Successful performance of a memory-guided motor task requires participants to store and then recall an accurate representation of the motor goal. Further, participants must monitor motor output to make adjustments in the absence of visual feedback. The goal of this study was to examine memory-guided grip force in healthy younger and older adults and compare it to performance on behavioral tasks of working memory. Previous work demonstrates that healthy adults decrease force output as a function of time when visual feedback is not available. We hypothesized that older adults would decrease force output at a faster rate than younger adults, due to age-related deficits in working memory. Two groups of participants, younger adults (YA: N = 32, mean age 21.5 years) and older adults (OA: N = 33, mean age 69.3 years), completed four 20-s trials of isometric force with their index finger and thumb, equal to 25% of their maximum voluntary contraction. In the full-vision condition, visual feedback was available for the duration of the trial. In the no vision condition, visual feedback was removed for the last 12 s of each trial. Participants were asked to maintain constant force output in the absence of visual feedback. Participants also completed tasks of word recall and recognition and visuospatial working memory. Counter to our predictions, when visual feedback was removed, younger adults decreased force at a faster rate compared to older adults and the rate of decay was not associated with behavioral performance on tests of working memory.

Motor output oscillations with magnification of visual feedback in older adults

Magnification of task visual feedback increases force variability in older adults. Although the increased force variability with magnified visual feedback in older adults relates to the amplification of oscillations in force below 0.5Hz, the related frequency modulation in muscle activity remains unknown. The purpose of this study, therefore, was to characterize the oscillations in muscle activity that contribute to the amplification of force variability with magnified visual feedback in older adults. Fifteen older adults (76.7±6.4years, 7 females) performed isometric contractions at 15% of maximal voluntary contraction (MVC) with ankle dorsiflexion with low-gain (0.05°) or high-gain visual feedback (1.2°). The standard deviation (SD) of force increased significantly (55%) from low- to high-gain visual feedback condition (P<0.0001), without changing the mean force (P>0.5). The increase in force variability was related to greater power in force oscillations from 0 to 0.5Hz (R²=0.37). The increase in force oscillations was associated with greater power in EMG burst oscillations from 0.5 to 1.0Hz (R²=0.50). In conclusion, these findings suggest that magnification of visual feedback alters the modulation of the motor neuron pool in older adults and exacerbates force variability by increasing the oscillations in force below 0.5Hz.

Fatigue-induced adjustment in antagonist coactivation by old adults during a steadiness task

The purpose of this study was to determine the adjustments in the level of coactivation during a steadiness task performed by young and old adults after the torque-generating capacity of the antagonist muscles was reduced by a fatiguing contraction. Torque steadiness (coefficient of variation) and electromyographic activity of the extensor and flexor carpi radialis muscles were measured as participants matched a wrist extensor target torque (10% maximum) before and after sustaining an isometric contraction (30% maximum) with wrist flexors to task failure. Time to failure was similar (P = 0.631) for young (417 ± 121 s) and old (452 ± 174 s) adults. The reduction in maximal voluntary contraction torque (%initial) for the wrist flexors after the fatiguing contraction was greater (P = 0.006) for young (32.5 ± 13.7%) than old (21.8 ± 6.6%) adults. Moreover, maximal voluntary contraction torque for the wrist extensors declined for old (-13.7 ± 12.7%; P = 0.030), but not young (-5.4 ± 13.8%; P = 0.167), adults. Torque steadiness during the matching task with the wrist extensors was similar before and after the fatiguing contraction for both groups, but the level of coactivation increased after the fatiguing contraction for old (P = 0.049) but not young (P = 0.137) adults and was twice the amplitude for old adults (P = 0.002). These data reveal that old adults are able to adjust the amount of antagonist muscle activity independent of the agonist muscle during steady submaximal contractions.

Aging affects postural tracking of complex visual motion cues

Postural tracking of visual motion cues improves perception-action coupling in aging, yet the nature of the visual cues to be tracked is critical for the efficacy of such a paradigm. We investigated how well healthy older (72.45 ± 4.72 years) and young (22.98 ± 2.9 years) adults can follow with their gaze and posture horizontally moving visual target cues of different degree of complexity. Participants tracked continuously for 120 s the motion of a visual target (dot) that oscillated in three different patterns: a simple periodic (simulated by a sine), a more complex (simulated by the Lorenz attractor that is deterministic displaying mathematical chaos) and an ultra-complex random (simulated by surrogating the Lorenz attractor) pattern. The degree of coupling between performance (posture and gaze) and the target motion was quantified in the spectral coherence, gain, phase and cross-approximate entropy (cross-ApEn) between signals. Sway-target coherence decreased as a function of target complexity and was lower for the older compared to the young participants when tracking the chaotic target. On the other hand, gaze-target coherence was not affected by either target complexity or age. Yet, a lower cross-ApEn value when tracking the chaotic stimulus motion revealed a more synchronous gaze-target relationship for both age groups. Results suggest limitations in online visuo-motor processing of complex motion cues and a less efficient exploitation of the body sway dynamics with age. Complex visual motion cues may provide a suitable training stimulus to improve visuo-motor integration and restore sway variability in older adults.

Visuomotor Correction is a Robust Contributor to Force Variability During Index Finger Abduction by Older Adults

We examined aging-related differences in the contribution of visuomotor correction to force fluctuations during index finger abduction via the analysis of two datasets from similar subjects. Study (1) Young (N = 27, 23 ± 8 years) and older adults (N = 14, 72 ± 9 years) underwent assessment of maximum voluntary contraction force (MVC) and force steadiness during constant-force (CF) index finger abduction (2.5, 30, 65% MVC). For each trial, visual feedback of the force (VIS) was provided for 8–10 s and removed for 8–10 s (NOVIS). Visual gain of the force feedback at 2.5% MVC was high; 12- and 26-fold greater than the 30 and 65% MVC targets. Mean force, standard deviation (SD) of force, and coefficient of variation (CV) of force was calculated for detrended (<0.5 Hz drift removed) VIS and NOVIS data segments. Study (2) A similar group of 14 older adults performed discrete, randomly-ordered VIS or NOVIS trials at low target forces (1–3% MVC) and high visual gain. Study (1) For young adults the CV of force was similar between VIS and NOVIS for the 2.5% (4.8 vs. 4.3%), 30% (3.2 vs. 3.2%) and 65% (3.5 vs. 4.2%) target forces. In contrast, for older adults the CV of force was greater for VIS than NOVIS for 2.5% MVC (6.6 vs. 4.2%, p < 0.001), but not for the 30% (2.4 vs. 2.4%) and 65% (3.1 vs. 3.3%) target forces. At 2.5% MVC, the increase in CV of force for VIS compared with NOVIS was significantly greater (age × visual condition p = 0.008) for older than young adults. Study (2) Similarly, for older adults performing discrete, randomly ordered trials the CV of force was greater for VIS than NOVIS (6.04 vs. 3.81%, p = 0.01). When visual force feedback was a dominant source of information at low forces, normalized force variability was ~58% greater for older adults, but only 11% greater for young adults. The significant effect of visual feedback for older adults was not dependent on the order of presentation of visual conditions. The results indicate that impaired processing of visuomotor information underlies the greater motor variability observed in older adults during lab-based isometric contractions of a hand muscle.