Age-related differences in inter-digit coupling during finger pinching

Preliminary report: Reduced hand sensory and motor function in persons living with heart failure

Despite the growing evidence highlighting reduced functional independence in persons living with heart failure (PwHF), the underlying mechanisms that lead to reduced functional independence in this patient population are unknown. Given the association between functional independence and fine motor skills, which are functionally related to hand sensory and motor functions, we hypothesized that PwHF exhibit reduced sensory and motor function of hands compared to healthy individuals. We recruited a total of 10 PwHF (age: 57.6 ± 12.5 years old, four females) and a total of age- & sex-matched healthy control individuals (age: 58.2 ± 12.2 years old, four females). Participants performed a wide range of tests assessing the level of independence, fitness, cognitive function, and hand sensorimotor function. While the level of independence was comparable between two groups, PwHF exhibited reduced sensory and motor function. Compared to healthy participants, the ability to identify an object via tactile and proprioceptive inputs was reduced in PwHF, though the tactile mechanoreceptor function showed normal integrity. Similarly, PwHF exhibited a decline in manipulating small objects and steady grip force production. Heart failure seems to have repercussions that extend to the sensorimotor control of hand actions in advance to a decline in functional independence. These results underscore the need of further investigation as to the underlying mechanisms of reduced sensorimotor function, potential intervention targets, and determine whether assessments of hand sensorimotor function can serve as a vehicle to quantify restoration of self-care functionality.

The Effect of the Postural Control Strategy on the Recognition Error of Center-of-Pressure Sway

The purpose of this study was to examine the effect of postural control strategies on the recognition error (RE) of center-of-pressure (COP) sway forward based on perceived exertion. Participants were 43 middle-aged or elderly people. We measured the maximum COP sway forward (100% center-of-pressure distance(COP-D)), 60% and 30% COP-D of 100% COP-D based on perceived exertion, and participants were classified into the good balance group and bad balance group by RE. The RE and trunk and leg angles were evaluated during COP sway forward. Results showed that RE being significantly higher for 30% COP-D and the group with a larger RE had a significantly larger trunk angle. Therefore, they may have used hip strategy predominantly to perform postural control ability, not only maximum values, but also on perceived exertion.

Ageing and skeletal muscle force control: current perspectives and future directions

During voluntary muscle contractions, force output is characterized by constant inherent fluctuations, which can be quantified either according to their magnitude or temporal structure, that is, complexity. The presence of such fluctuations when targeting a set force indicates that control of force is not perfectly accurate, which can have significant implications for task performance. Compared to young adults, older adults demonstrate a greater magnitude and lower complexity in force fluctuations, indicative of decreased steadiness, and adaptability of force output, respectively. The nature of this loss‐of‐force control depends not only on the age of the individual but also on the muscle group performing the task, the intensity and type of contraction and whether the task is performed with additional cognitive load. Importantly, this age‐associated loss‐of‐force control is correlated with decreased performance in a range of activities of daily living and is speculated to be of greater importance for functional capacity than age‐associated decreases in maximal strength. Fortunately, there is evidence that acute physical activity interventions can reverse the loss‐of‐force control in older individuals, though whether this translates to improved functional performance and whether lifelong physical activity can protect against the changes have yet to be established. A number of mechanisms, related to both motor unit properties and the behavior of motor unit populations, have been proposed for the age‐associated changes in force fluctuations. It is likely, though, that age‐associated changes in force control are related to increased common fluctuations in the discharge times of motor units.

The Aging Surgeon: Evidence and Experience

BACKGROUND

With doctors in short supply and a strong demand for surgeon services in all areas of the United States, urban and rural, there are pressures to remain in active practice for longer. Even with an older workforce, there are currently no requirements for when a surgeon must retire in the United States.

OBJECTIVES

The aim of this article was to highlight the importance of the aging surgeon to the medical community and to provide an evidence-based overview of age-related cognitive and physical issues that develop during the later stages of a surgeon's career.

METHODS

A search of the PubMed/MEDLINE database was performed for the phrase "aging surgeon." Inclusion criteria were applied to include only those articles related to surgeon age or retirement. Additional reports were handpicked from citations to substantiate claims with statistical evidence.

RESULTS

The aging surgeon contributes extensive experience to patient care, but is also prone to age-related changes in cognition, vision, movement, and stress as it relates to new techniques, surgical performance, and safety measures. Studies show that although surgeons are capable of operating well into their senior years, there is the potential of decline. Nevertheless, there are proven recommendations on how to prepare an older surgeon for retirement.

CONCLUSIONS

Age-related trends in cognitive and physical decline must be counterbalanced with wisdom gained through decades of surgical experience.

Evaluation of the elderly health examination app based on the comprehensive evaluation method of AHP-fuzzy theory

This research hopes to provide scientific research support for the optimization and development of the elderly health check application by studying the evaluation method of the elderly health check APP, so that the elderly users can easily enjoy the intelligent health check service. First, use the in-depth interview method and the affinity graph analysis method to extract the evaluation elements, and then use the comprehensive evaluation method that combines the analytic hierarchy process and the fuzzy theory to evaluate the health check APP for the elderly. The results show that in the evaluation research of the elderly health examination APP, the operation learning and information processing of the software are the most important. For the elderly, a health examination APP that can be used quickly and has clear and accurate information processing functions is the most satisfactory. When designing the elderly health check application program, the physical and mental factors of the elderly should be considered, taking the elderly as the center, and designing a health check application suitable for the elderly according to the characteristics of the elderly.

Digit Force Controls and Corresponding Brain Activities in Finger Pressing Performance: A Comparison Between Older Adults and Young Individuals

This study aims toward an investigation and comparison of the digital force control and the brain activities of older adults and young groups during digital pressing tasks. A total of 15 young and 15 older adults were asked to perform force ramp tasks at different force levels with a custom pressing system. Near-infrared spectroscopy was used to collect the brain activities in the prefrontal cortex and primary motor area. The results showed that the force independence and hand function of the older adults were worse than that of the young adults. The cortical activations in the older adults were higher than those in the young group during the tasks. A significant hemodynamic between-group response and mild negative correlations between brain activation and force independence ability were found. Older adults showed poor force independence ability and manual dexterity and required additional brain activity to compensate for the degeneration.

Performance, complexity and dynamics of force maintenance and modulation in young and older adults

The present study addresses how task constraints and aging influence isometric force control. We used two tasks requiring either force maintenance (straight line target force) or force modulation (sine-wave target force) around different force levels and at different modulation frequencies. Force levels were defined relative the individual maximum voluntary contraction. A group of young adults (mean age ± SD = 25 ± 3.6 years) and a group of elderly (mean age = 77 ± 6.4 years) took part in the study. Age- and task-related effects were assessed through differences in: (i) force control accuracy, (ii) time-structure of force fluctuations, and (iii) the contribution of deterministic (predictable) and stochastic (noise-like) dynamic components to the expressed behavior. Performance-wise, the elderly showed a pervasive lower accuracy and higher variability than the young participants. The analysis of fluctuations showed that the elderly produced force signals that were less complex than those of the young adults during the maintenance task, but the reverse was observed in the modulation task. Behavioral complexity results suggest a reduced adaptability to task-constraints with advanced age. Regarding the dynamics, we found comparable generating mechanisms in both age groups for both tasks and in all conditions, namely a fixed-point for force maintenance and a limit-cycle for force modulation. However, aging increased the stochasticity (noise-driven fluctuations) of force fluctuations in the cyclic force modulation, which could be related to the increased complexity found in elderly for this same task. To our knowledge this is the first time that these different perspectives to motor control are used simultaneously to characterize force control capacities. Our findings show their complementarity in revealing distinct aspects of sensorimotor adaptation to task constraints and age-related declines. Although further research is still needed to identify the physiological underpinnings, the used task and methodology are shown to have both fundamental and clinical applications.

Age-related differences in bimanual movements: A systematic review and meta-analysis

BACKGROUND

With increasing age motor functions decline. The additional challenges of executing bimanual movements further hinder motor functions in older adults. The current systematic review and meta-analysis determined the effects of healthy aging on performance in bimanual movements as compared to younger adults.

METHODS

Our comprehensive search identified 27 studies that reported bimanual movement performance measures. Each study included a between groups comparison of older (mean age=68.79years) and younger adults (mean age=23.14years). The 27 qualified studies generated 40 total outcome measure comparisons: (a) accuracy: 18, (b) variability: 14, and (c) movement time: eight.

RESULTS

Our meta-analysis conducted on a random effects model identified a relatively large negative standardized mean difference effect (ES=-0.93). This indicates that older adults exhibited more impaired bimanual movement performance in comparison to younger adults in our group of studies. Specifically, a moderator variable analysis revealed large negative effects in both accuracy (ES=-0.94) and variability (ES=-1.00), as well as a moderate negative effect (ES=-0.71) for movement time. These findings indicate that older adults displayed reduced accuracy, greater variability, and longer execution time when executing bimanual movements.

CONCLUSION

These meta-analytic findings revealed that aging impairs bimanual movement performance.

Force and Directional Force Modulation Effects on Accuracy and Variability in Low-Level Pinch Force Tracking

The authors investigated how varying the required low-level forces and the direction of force change affect accuracy and variability of force production in a cyclic isometric pinch force tracking task. Eighteen healthy right-handed adult volunteers performed the tracking task over 3 different force ranges. Root mean square error and coefficient of variation were higher at lower force levels and during minimum reversals compared with maximum reversals. Overall, the thumb showed greater root mean square error and coefficient of variation scores than did the index finger during maximum reversals, but not during minimum reversals. The observed impaired performance during minimum reversals might originate from history-dependent mechanisms of force production and highly coupled 2-digit performance.

Dynamical signatures of isometric force control as a function of age, expertise, and task constraints

From the conceptual and methodological framework of the dynamical systems approach, force control results from complex interactions of various subsystems yielding observable behavioral fluctuations, which comprise both deterministic (predictable) and stochastic (noise-like) dynamical components. Here, we investigated these components contributing to the observed variability in force control in groups of participants differing in age and expertise level. To this aim, young (18-25 yr) as well as late middle-aged (55-65 yr) novices and experts (precision mechanics) performed a force maintenance and a force modulation task. Results showed that whereas the amplitude of force variability did not differ across groups in the maintenance tasks, in the modulation task it was higher for late middle-aged novices than for experts and higher for both these groups than for young participants. Within both tasks and for all groups, stochastic fluctuations were lowest where the deterministic influence was smallest. However, although all groups showed similar dynamics underlying force control in the maintenance task, a group effect was found for deterministic and stochastic fluctuations in the modulation task. The latter findings imply that both components were involved in the observed group differences in the variability of force fluctuations in the modulation task. These findings suggest that between groups the general characteristics of the dynamics do not differ in either task and that force control is more affected by age than by expertise. However, expertise seems to counteract some of the age effects.NEW & NOTEWORTHY Stochastic and deterministic dynamical components contribute to force production. Dynamical signatures differ between force maintenance and cyclic force modulation tasks but hardly between age and expertise groups. Differences in both stochastic and deterministic components are associated with group differences in behavioral variability, and observed behavioral variability is more strongly task dependent than person dependent.

Assessing postural stability via the correlation patterns of vertical ground reaction force components

Background

Many methods have been proposed to assess the stability of human postural balance by using a force plate. While most of these approaches characterize postural stability by extracting features from the trajectory of the center of pressure (COP), this work develops stability measures derived from components of the ground reaction force (GRF).

Methods

In comparison with previous GRF-based approaches that extract stability features from the GRF resultant force, this study proposes three feature sets derived from the correlation patterns among the vertical GRF (VGRF) components. The first and second feature sets quantitatively assess the strength and changing speed of the correlation patterns, respectively. The third feature set is used to quantify the stabilizing effect of the GRF coordination patterns on the COP.

Results

In addition to experimentally demonstrating the reliability of the proposed features, the efficacy of the proposed features has also been tested by using them to classify two age groups (18–24 and 65–73 years) in quiet standing. The experimental results show that the proposed features are considerably more sensitive to aging than one of the most effective conventional COP features and two recently proposed COM features.

Conclusions

By extracting information from the correlation patterns of the VGRF components, this study proposes three sets of features to assess human postural stability during quiet standing. As demonstrated by the experimental results, the proposed features are not only robust to inter-trial variability but also more accurate than the tested COP and COM features in classifying the older and younger age groups. An additional advantage of the proposed approach is that it reduces the force sensing requirement from 3D to 1D, substantially reducing the cost of the force plate measurement system.

Effects of task and age on the magnitude and structure of force fluctuations: insights into underlying neuro-behavioral processes

BACKGROUND

The present study aimed at characterizing the effects of increasing (relative) force level and aging on isometric force control. To achieve this objective and to infer changes in the underlying control mechanisms, measures of information transmission, as well as magnitude and time-frequency structure of behavioral variability were applied to force-time-series.

RESULTS

Older adults were found to be weaker, more variable, and less efficient than young participants. As a function of force level, efficiency followed an inverted-U shape in both groups, suggesting a similar organization of the force control system. The time-frequency structure of force output fluctuations was only significantly affected by task conditions. Specifically, a narrower spectral distribution with more long-range correlations and an inverted-U pattern of complexity changes were observed with increasing force level. Although not significant older participants displayed on average a less complex behavior for low and intermediate force levels. The changes in force signal's regularity presented a strong dependence on time-scales, which significantly interacted with age and condition. An inverted-U profile was only observed for the time-scale relevant to the sensorimotor control process. However, in both groups the peak was not aligned with the optimum of efficiency.

CONCLUSION

Our results support the view that behavioral variability, in terms of magnitude and structure, has a functional meaning and affords non-invasive markers of the adaptations of the sensorimotor control system to various constraints. The measures of efficiency and variability ought to be considered as complementary since they convey specific information on the organization of control processes. The reported weak age effect on variability and complexity measures suggests that the behavioral expression of the loss of complexity hypothesis is not as straightforward as conventionally admitted. However, group differences did not completely vanish, which suggests that age differences can be more or less apparent depending on task properties and whether difficulty is scaled in relative or absolute terms.

Force control in chronic stroke

Force control deficits are common dysfunctions after a stroke. This review concentrates on various force control variables associated with motor impairments and suggests new approaches to quantifying force control production and modulation. Moreover, related neurophysiological mechanisms were addressed to determine variables that affect force control capabilities. Typically, post stroke force control impairments include: (a) decreased force magnitude and asymmetrical forces between hands, (b) higher task error, (c) greater force variability, (d) increased force regularity, and (e) greater time-lag between muscular forces. Recent advances in force control analyses post stroke indicated less bimanual motor synergies and impaired low-force frequency structure. Brain imaging studies demonstrate possible neurophysiological mechanisms underlying force control impairments: (a) decreased activation in motor areas of the ipsilesional hemisphere, (b) increased activation in secondary motor areas between hemispheres, (c) cerebellum involvement, and (d) relatively greater interhemispheric inhibition from the contralesional hemisphere. Consistent with identifying neurophysiological mechanisms, analyzing bimanual motor synergies as well as low-force frequency structure will advance our understanding of post stroke force control.

Force control is related to low-frequency oscillations in force and surface EMG

Force variability during constant force tasks is directly related to oscillations below 0.5 Hz in force. However, it is unknown whether such oscillations exist in muscle activity. The purpose of this paper, therefore, was to determine whether oscillations below 0.5 Hz in force are evident in the activation of muscle. Fourteen young adults (21.07±2.76 years, 7 women) performed constant isometric force tasks at 5% and 30% MVC by abducting the left index finger. We recorded the force output from the index finger and surface EMG from the first dorsal interosseous (FDI) muscle and quantified the following outcomes: 1) variability of force using the SD of force; 2) power spectrum of force below 2 Hz; 3) EMG bursts; 4) power spectrum of EMG bursts below 2 Hz; and 5) power spectrum of the interference EMG from 10–300 Hz. The SD of force increased significantly from 5 to 30% MVC and this increase was significantly related to the increase in force oscillations below 0.5 Hz (R² = 0.82). For both force levels, the power spectrum for force and EMG burst was similar and contained most of the power from 0–0.5 Hz. Force and EMG burst oscillations below 0.5 Hz were highly coherent (coherence = 0.68). The increase in force oscillations below 0.5 Hz from 5 to 30% MVC was related to an increase in EMG burst oscillations below 0.5 Hz (R² = 0.51). Finally, there was a strong association between the increase in EMG burst oscillations below 0.5 Hz and the interference EMG from 35–60 Hz (R² = 0.95). In conclusion, this finding demonstrates that bursting of the EMG signal contains low-frequency oscillations below 0.5 Hz, which are associated with oscillations in force below 0.5 Hz.

Age-related differences in the availability of visual feedback during bimanual pinch

PURPOSE

Previous research has indicated that older adults have significantly lower accuracy in terms of force control than young adults. In addition, accuracy of force control is known to decrease in the absence of visual feedback. However, whether the effect of visual feedback on fine motor control is similar for young adults and older adults is not clear. The purpose of this study, therefore, was to examine the effect of visual feedback on bimanual pinch force control in older adults.

METHODS

Thirty-one undergraduate students (age 19.7 ± 0.9 years) and 31 older adults (age 65.1 ± 8.1 years) participated in this study. After measuring finger-pinch maximal voluntary force (MVF), the participants were asked to maintain 10% MVF as steadily as possible in two different conditions: with visual feedback (visual feedback condition; VF condition) and without visual feedback (no visual feedback condition; NVF condition).

RESULTS

We found that older adults had significantly greater targeting error and force variability than young adults in the VF condition, but not in the NVF condition. In addition, older participants exhibited a significantly greater sum of power for the 0-4 and 4-8 Hz frequency bin than young adults (p < 0.05) in the VF condition, although there was no significant difference in the NVF condition.

CONCLUSIONS

These results suggest that older adults do not use visual information as effectively as younger adults to reduce force control error.

Increased force variability in chronic stroke: contributions of force modulation below 1 Hz

Increased force variability constitutes a hallmark of arm disabilities following stroke. Force variability is related to the modulation of force below 1 Hz in healthy young and older adults. However, whether the increased force variability observed post stroke is related to the modulation of force below 1 Hz remains unknown. Thus, the purpose of this study was to compare force modulation below 1 Hz in chronic stroke and age-matched healthy individuals. Both stroke and control individuals (N = 26) performed an isometric grip task to submaximal force levels. Coefficient of variation quantified force variability, and power spectrum density of force quantified force modulation below 1 Hz with a high resolution (0.07 Hz). Analyses indicated that force variability was greater for the stroke group compared with to healthy controls and for the paretic hand compared with the non-paretic hand. Force modulation below 1 Hz differentiated the stroke individuals and healthy controls, as well as the paretic and non-paretic hands. Specifically, stroke individuals (paretic hand) exhibited greater power ∼0.2 Hz (0.07–0.35 Hz) and lesser power ∼0.6 Hz (0.49–0.77 Hz) compared to healthy controls (non-dominant hand). Similarly, the paretic hand exhibited greater power ∼0.2 Hz, and lesser power ∼0.6 Hz than the non-paretic hand. Moreover, variability of force was strongly predicted from the modulation of specific frequencies below 1 Hz (R² = 0.80). Together, these findings indicate that the modulation of force below 1 Hz provides significant insight into changes in motor control after stroke.

Effects of aging on force coordination in bimanual task performance

We investigated within- and between-hands grip-load force coordination in both healthy young and older adult participants during bimanual tasks involving realistic actions. Age-related changes in manual behaviors such as grip force production and safety margins were expected in older adults. Within-hand grip-load coordination was expected to decrease with aging during the performance of dynamic actions, but not static actions. The effects of task and hand dominance on task performance were also evaluated. Grip force production increased with age; however, changes in fingertip frictional properties with aging increased the risk of object slip. Indices of within-hand grip-load coordination did not alter with age, but such indices were affected by task goals. The action of connecting two independent objects, particularly with rotational action, was associated with declines in all indices of within- and between-hands force coordination, independent of age. Evidence of task-specific differences in within-hand grip-load coordination in the current data set suggests that individual hand specification emerges and persists with age in everyday bimanual prehension tasks, independent of the action role assigned to the dominant and non-dominant hands.

Modulation of force below 1 Hz: age-associated differences and the effect of magnified visual feedback

Oscillations in force output change in specific frequency bins and have important implications for understanding aging and pathological motor control. Although previous studies have demonstrated that oscillations from 0–1 Hz can be influenced by aging and visuomotor processing, these studies have averaged power within this bandwidth and not examined power in specific frequencies below 1 Hz. The purpose was to determine whether a differential modulation of force below 1 Hz contributes to changes in force control related to manipulation of visual feedback and aging. Ten young adults (25±4 yrs, 5 men) and ten older adults (71±5 yrs, 4 men) were instructed to accurately match a target force at 2% of their maximal isometric force for 35 s with abduction of the index finger. Visual feedback was manipulated by changing the visual angle (0.05°, 0.5°, 1.5°) or removing it after 15 s. Modulation of force below 1 Hz was quantified by examining the absolute and normalized power in seven frequency bins. Removal of visual feedback increased normalized power from 0–0.33 Hz and decreased normalized power from 0.66–1.0 Hz. In contrast, magnification of visual feedback (visual angles of 0.5° and 1.5°) decreased normalized power from 0–0.16 Hz and increased normalized power from 0.66–1.0 Hz. Older adults demonstrated a greater increase in the variability of force with magnification of visual feedback compared with young adults (P = 0.05). Furthermore, older adults exhibited differential force modulation of frequencies below 1 Hz compared with young adults (P<0.05). Specifically, older adults exhibited greater normalized power from 0–0.16 Hz and lesser normalized power from 0.66–0.83 Hz. The changes in force modulation predicted the changes in the variability of force with magnification of visual feedback (R² = 0.80). Our findings indicate that force oscillations below 1 Hz are associated with force control and are modified by aging and visual feedback.

Dynamical degrees of freedom and correlations in isometric finger force production

Prior research has concluded that the correlations of isometric finger forces represent the extent to which the fingers are controlled as a single unit. If this is the case, finger force correlations should be consistent with estimates of the controlled (dynamical) degrees of freedom in finger forces. The present study examined the finger force correlations and the dynamical degrees of freedom in four isometric force tasks. The tasks were to produce a preferred level of force with the (a) Index, (b) Ring, (c) Both fingers and also to (d) Rest the fingers on the load cells. Dynamical degrees of freedom in finger forces were lowest in the Both finger force task and progressively higher in the Ring, Index and Resting finger force tasks. The finger force correlations were highest in the Resting and lowest in the Index and Ring finger tasks. The results for the dynamical degrees of freedom in finger forces were consistent with a reduction in degrees of freedom in response to the degrees of freedom problem and the task constraints. The results for the finger force correlations were inconsistent with a reduction in the dynamical degrees of freedom. These findings indicate that finger force correlations do not necessarily reflect the coupling of finger forces. The findings also highlight the value of time-domain analyses to reveal the organization of control in isometric finger forces.

Age-related differences in finger force control are characterized by reduced force production

It has been repeatedly shown that precise finger force control declines with age. The tasks and evaluation parameters used to reveal age-related differences vary between studies. In order to examine effects of task characteristics, young adults (18-25 years) and late middle-aged adults (55-65 years) performed precision grip tasks with varying speed and force requirements. Different outcome variables were used to evaluate age-related differences. Age-related differences were confirmed for performance accuracy (TWR) and variability (relative root mean square error, rRMSE). The task characteristics, however, influenced accuracy and variability in both age groups: Force modulation performance at higher speed was poorer than at lower speed and at fixed force levels than at force levels adjusted to the individual maximum forces. This effect tended to be stronger for older participants for the rRMSE. A curve fit confirmed the age-related differences for both spatial force tracking parameters (amplitude and intercept) and for one temporal parameter (phase shift), but not for the temporal parameter frequency. Additionally, matching the timing parameters of the sine wave seemed to be more important than matching the spatial parameters in both young adults and late middle-aged adults. However, the effect was stronger for the group of late middle-aged, even though maximum voluntary contraction was not significantly different between groups. Our data indicate that changes in the processing of fine motor control tasks with increasing age are caused by difficulties of late middle-aged adults to produce a predefined amount of force in a short time.

Aging, neuromuscular decline, and the change in physiological and behavioral complexity of upper-limb movement dynamics

Aging is characterized by a general decline in physiological and behavioral function that has been widely interpreted within the context of the loss of complexity hypothesis. In this paper, we examine the relation between aging, neuromuscular function and physiological-behavioral complexity in the arm-hand effector system, specifically with reference to physiological tremor and isometric force production. Experimental findings reveal that the adaptive behavioral consequences of the aging-related functional decline in neurophysiological processes are less pronounced in simple motor tasks which provides support for the proposition that the motor output is influenced by both extrinsic (e.g., task related) and intrinsic (e.g., coordination, weakness) factors. Moreover, the aging-related change in complexity can be bidirectional (increase or decrease) according to the influence of task constraints on the adaptation required of the intrinsic properties of the effector system.

The Influence of Age and Work-Related Expertise on Fine Motor Control

Age-related decline of fine motor control commences even in middle adulthood. Less is known, however, whether age-related changes can be postponed through continuous practice. In this study we tested how age and professional expertise influence fine motor control in middle-aged adults. Forty-eight right-handed novices and experts (35 to 65 years) performed submaximal precision grip force modulation tasks with index or middle finger opposing the thumb, either with the right hand or the left hand. Novices revealed expected age-related differences in all performance measures (force initialization, mean applied force, variability), whereas experts outperformed novices in all outcome measures. Expertise seems to contribute to maintaining manual skills into older age, as indicated by the age and expertise interaction for the force initialization.

Force control of quadriceps muscle is bilaterally impaired in subacute stroke

We tested the hypothesis that force variability and error during maintenance of submaximal isometric knee extension are greater in subacute stroke patients than in controls and are related to motor impairments. Contralesional (more-affected) and ipsilesional (less-affected) legs of 33 stroke patients with sufficiently high motor abilities (62 ± 13 yr, 16 ± 2 days postinjury) and the dominant leg of 20 controls (62 ± 10 yr) were tested in sitting position. After peak knee extension torque [maximum voluntary contraction (MVC)] was established, subjects maintained 10, 20, 30, and 50% of MVC as steady and accurate as possible for 10 s by matching voluntary force to the target level displayed on a monitor. Coefficient of variation (CV) and root-mean-square error (RMSE) were used to quantify force variability and error, respectively. The MVC was significantly smaller in the more-affected than less-affected leg, and both were significantly lower than in controls. The CV was significantly larger in the more-affected than less-affected leg at 20 and 50% MVC, whereas both were significantly larger compared with controls across all force levels. Both more-affected and less-affected legs of patients showed significantly greater RMSE than controls at 30 and 50% MVC. The CV and RMSE were not related to the Fugl-Meyer motor score or to the Rivermead Mobility Index. The CV negatively correlated with MVC in controls but only in the less-affected leg of patients. It is concluded that isometric knee extension strength and force control are bilaterally impaired soon after stroke but more so in the more-affected leg. Future studies should examine possible mechanisms and the evolution of these changes.

Aging effects on object transport during gait

The ability to manipulate objects deteriorates with increasing age. In the coordination of fingertip forces underlying object manipulation, older adults use excessive grip (normal) forces but maintain anticipatory force control during simple manipulations. Daily activities are often more complex and involve grasp manipulations while simultaneously performing other activities. When walking while carrying an object, young adults couple grip forces to gait-induced inertial force changes (anticipatory control). It is unclear if anticipatory control is preserved in older adults during demanding tasks. The purpose of this study was therefore to investigate aging effects on grasp control when walking and transporting an object. We included gait perturbations to vary task difficulty and step regularity associated with walking. Twelve healthy older (65-84 years) and young (20-30 years) adults transported a hand-held object during unperturbed walking, obstacle crossing and step-length changes. While older subjects employed higher grip-inertial force ratios, they showed a strong force coupling comparable to that of the young during unperturbed walking and step-length changes. During obstacle crossing the forces in the older group were less tightly coupled (grip force delays). Gait patterns were similar between groups. Our findings indicate that older adults maintain anticipatory control during regular and irregular walking. Grasp control changes in older adults only during obstacle crossing suggest that overall task demands (balance requirements, attention demands) may contribute to declines of manual dexterity in functional tasks. This highlights the need to investigate grasp control within complex tasks when aiming to understand impairments of older adults encountered in daily life.

Robotic approaches to the posterior spine

STUDY DESIGN

This anatomic study described robotic approaches to the posterior thoracolumbar spine in a porcine model. Ergonomics, control, and approach and technical difficulties were noted.

OBJECTIVE

The objective of this study was to develop a robotic approach to the posterior thoracolumbar spine maximizing surgeon ergonomics and control.

SUMMARY OF BACKGROUND DATA

Surgery is both physically and mentally demanding, and strains from ergonomics and the aging process may negatively impact surgical skills. In spine surgery, control and precision are extremely important due to the close proximity to the spinal cord. The da Vinci robotic surgery system has offered better ergonomics and control in urology, gynecology, and cardiac surgery, and is rapidly gaining adoption. To date, there have been no published reports of da Vinci robotic spine surgery, motivating us to assess its potential in posterior spine surgery.

METHODS

Posterior spine da Vinci approaches were tested on a pig without spinal pathology with an open subperiosteal dissection. A laser instrument and prototype robotic burr and rongeur instruments were tested on laminotomy, laminectomy, disc incision, and dural suturing procedures.

RESULTS

Open dissection of the posterior spine provided sufficient access to successfully perform laminotomy, laminectomy, disc incision, and dural suturing procedures. Prototype burr and rongeur instruments were effective with good control. The laser instrument coagulated the epidural venous plexus and incised the anulus. Robot ergonomics allowed the surgeon to perform procedures for a full day with significantly less fatigue and reduced hand tremor.

CONCLUSION

The da Vinci could perform the major noninstrumented procedures of the posterior spine with improved ergonomics and control. Surgeon fatigue and tremor were reduced. With some modification of prototype and commercial instruments a posterior spine surgery instrument kit can be developed. Future clinical studies can better assess patient and surgeon benefits of using the da Vinci robot for posterior spine surgeries.

Strength training improves the tri-digit finger-pinch force control of older adults

OBJECTIVE

To investigate the effect of unilateral upper-limb strength training on the finger-pinch force control of older men.

DESIGN

Pretest and post-test 6-week intervention study.

SETTING

Exercise science research laboratory.

PARTICIPANTS

Eleven neurologically fit older men (age range, 70-80y).

INTERVENTION

The strength training group (n=7) trained twice a week for 6 weeks, performing dumbbell bicep curls, wrist flexions, and wrists extensions, while the control group subjects (n=4) maintained their normal activities.

MAIN OUTCOME MEASURES

Changes in force variability, targeting error, peak power frequency, proportional power, sample entropy, digit force sharing, and coupling relations were assessed during a series of finger-pinch tasks. These tasks involved maintaining a constant or sinusoidal force output at 20% and 40% of each subject's maximum voluntary contraction. All participants performed the finger-pinch tasks with both the preferred and nonpreferred limbs.

RESULTS

Analysis of covariance for between-group change scores indicated that the strength training group (trained limb) experienced significantly greater reductions in finger-pinch force variability and targeting error, as well as significantly greater increases in finger-pinch force, sample entropy, bicep curl, and wrist flexion strength than did the control group.

CONCLUSIONS

A nonspecific upper-limb strength-training program may improve the finger-pinch force control of older men.