A framework for identifying the adaptations responsible for differences in pegboard times between middle-aged and older adults

Practice-Induced Changes in Manual Dexterity of Older Adults Depend on Initial Pegboard Time

INTRODUCTION

The purpose of our study was to determine the influence of practice on the pegboard times and peg-manipulation phases of older adults who were classified as having either slow or fast initial pegboard times.

METHODS

Participants ( n = 26, 70 ± 6.6 yr) completed two evaluation sessions and six practice sessions in which they performed 25 trials (5 blocks of 5 trials) of the grooved pegboard test. All practice sessions were supervised, and the time to complete each trial was recorded. In each evaluation session, the pegboard was mounted on a force transducer so that the downward force applied to the board could be measured.

RESULTS

Participants were stratified into two groups based on the initial time to complete the grooved pegboard test: a fast group (68.1 ± 6.0 s) and a slow group (89.6 ± 9.2 s). Both groups exhibited the classic two-phase profile (acquisition + consolidation) for learning a de novo motor skill. Despite the similar learning profile for the two groups, there were differences between groups in the phases of the peg-manipulation cycle that became faster with practice. The fast group seemed to reduce trajectory variability when transporting the peg, whereas the slow group seemed to exhibit both a decrease in trajectory variability and greater precision when inserting pegs into the holes.

CONCLUSIONS

The changes underlying practice-induced decreases in grooved pegboard time differed for older adults who initially had either a fast or a slow pegboard time.

Cognitive preoccupation with drinking and behavioral effects of alcohol as predictors of current consumption patterns

BACKGROUND

Acute alcohol responses such as tolerance to alcohol-induced motor impairment and heightened sensitivity to alcohol-induced disinhibition are associated with heavier drinking. Additionally, certain cognitive characteristics may also indicate problem-drinking. For example, cognitive and emotional preoccupation (CEP) with alcohol is associated with heavier drinking. However, it is not clear if cognitive markers have value as predicators of heavier drinking beyond that of well-established alcohol response markers. The current study sought to test the predictive potential of CEP in the context of two well-documented alcohol response markers of heavy drinking.

METHODS

Data aggregated from three studies comprised a sample of 94 young adult drinkers with no history of alcohol use disorder. Participants' motor coordination (grooved pegboard) and behavioral disinhibition (cued go/no-go) were assessed following consumption of 0.65g/kg alcohol and a placebo. CEP was measured via the Temptation and Restraint Inventory (TRI).

RESULTS

Drinkers who expressed both alcohol response markers reported drinking higher doses regardless of their level of CEP. Among drinkers who expressed low sensitivity to both disinhibition and motor impairment, higher CEP was associated with higher typical quantities. Low sensitivity to motor impairment functioned as a standalone marker of heavier drinking.

CONCLUSIONS

The findings suggest that a combination of tolerance to motor impairment and high alcohol-induced disinhibition may be sufficient to promote heavier consumption even in the absence of cognitive markers associated with problem drinking. Results also suggest that cognitive characteristics may drive early drinking and contribute to the development of tolerance to acute alcohol effects.

Meta-analyses of cognitive functions in early-treated adults with phenylketonuria

Our study estimated size of impairment for different cognitive functions in early-treated adults with PKU (AwPKU) by combining literature results in a meta-analytic way. We analysed a large set of functions (N = 19), each probed by different measures (average = 12). Data were extracted from 26 PKU groups and matched controls, with 757 AwPKU contributing 220 measures. Effect sizes (ESs) were computed using Glass' ∆ where differences in performance between clinical/PKU and control groups are standardized using the mean and standard deviation of the control groups. Significance was assessed using measures nested within independent PKU groups as a random factor. The weighted Glass' ∆ was - 0.44 for all functions taken together, and - 0.60 for IQ, both highly significant. Separate, significant impairments were found for most functions, but with great variability (ESs from -1.02 to -0.18). The most severe impairments were in reasoning, visual-spatial attention speed, sustained attention, visuo-motor control, and flexibility. Effect sizes were larger with speed than accuracy measures, and with visuo-spatial than verbal stimuli. Results show a specific PKU profile that needs consideration when monitoring the disease.

The Relative Importance of Vascular Risk Factors on Early Cognitive Aging Varies Only Slightly Between Men and Women

Objective

To investigate the sex-specific course and impact of vascular risk factors on cognitive aging in a rather young and healthy community-dwelling cohort.

Methods

We used data from a population-based cohort study, collected three times during 6 years, comprising 1,911 examinations from 798 participants aged 35–66 years at baseline. Cognitive performance on the Color-Word-Interference-Test, the Trail Making Tests (TMT) A&B, the Word Fluency Test, a 12-item word list, the Purdue Pegboard Test and a principal component global score were used as outcomes in linear mixed models. We evaluated (1) sex differences in cognitive trajectories, (2) the mediating role of hypertension, diabetes, smoking and obesity [body mass index (BMI) > 30] on sex differences and (3) in sex-stratified analyses, potential sex-specific effects of these risk factors on cognition.

Results

For all cognitive tests, we observed cognitive decline with age. Rates of decline slightly differed across sexes, showing a later but steeper decline for women in tests of memory (word list) and word fluency, but a steeper decline for men in tests of psychomotor speed and mental set shifting (TMT A&B) in older age. Women generally scored better on cognitive tests, but the slightly higher prevalence of classical vascular risks factors in men in our cohort could not explain these sex differences. Sex-stratified analyses revealed a generally small, concordantly negative, but quantitatively slightly different impact of diabetes, smoking and obesity on cognitive functions but mixed effects for arterial hypertension, depending on the blood pressure values, the treatment status and the duration of arterial hypertension.

Conclusion

Cognitive sex differences in this rather young and healthy cohort could not be explained by a differing prevalence of vascular risks factors across sexes. The association of cardiovascular risk factors with cognition, however, slightly differed between men and women, whereby effects were generally small. Whereas longtime diabetes, obesity and smoking had a sex-specific, but concordantly negative impact on psychomotor speed, executive and motor functions, we found some opposing effects for arterial hypertension. Our results can help to identify sex-specific susceptibilities to modifiable risk factors, to attract attention to potential information bias and to stimulate further research into alternative causes and mechanism of sex differences in cognitive aging.

The role of eye movements, attention, and hand movements on age-related differences in pegboard tests

Well-documented manual dexterity impairments in older adults may critically depend on the processing of visual information. The purpose of this study was to determine age-related changes in eye and hand movements during commonly used pegboard tests and the association with manual dexterity impairments in older adults. The relationship between attentional deficits and manual dexterity was also assessed. Eye movements and hand kinematics of 20 young (20-38 yr) and 20 older (65-85 yr) adults were recorded during 9-Hole Pegboard, Grooved Pegboard, and a visuospatial dual test. Results were compared with standardized tests of attention (The Test of Everyday Attention and Trail Making Test) that assess visual selective attention, sustained attention, attentional switching, and divided attention. Hand movement variability was 34% greater in older versus young adults when placing the pegs into the pegboard and this was associated with decreased pegboard performance, providing further evidence that increased movement variability plays a role in dexterity impairments in older adults. Older adults made more corrective saccades and spent less time gazing at the pegboard than young adults, suggesting altered visual strategies in older compared with young adults. The relationship between pegboard completion time and Trail Making Test B demonstrates an association between attentional deficits and age-related pegboard impairments. Results contribute novel findings of age-associated changes in eye movements during a commonly used manual dexterity task and offer insight into potential mechanisms underlying hand motor impairments in older adults.NEW & NOTEWORTHY This eye tracking study contributes novel findings of age-associated changes in eye movements during the commonly used pegboard tests of manual dexterity, including a greater number of corrective saccades and lesser time gazing at the pegboard holes in older compared with young adults. An association between attentional deficits and dexterity impairments in older adults is also highlighted. Results shed light on potential mechanisms underlying well-documented motor deficits in older adults.

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.

The execution of the Grooved Pegboard test in a Dual-Task situation: A pilot study

Background

Manual dexterity is an important aspect in everyday life, which is widely studied through the Grooved Pegboard Test (GPT). Since Dual-Tasks (DT) activities are widely investigated and important to simulate everyday life situations, the objectives of the present pilot study were the evaluation of the effect of a cognitive task and a motor task during the performance of the GPT and the feasibility of the GPT in a DT contest. A secondary objective was to evaluate the training effect of the GPT.

Methods

A total of 31 young adults (20 man and 11 woman, age (SD): 27.7 (2.5)) performed the GPT eight times to understand the presence of a training effect before performing the GPT in DT. The additional tasks were a secondary cognitive task and a secondary motor task.

Results

All participants were able to complete the required conditions. The GPT performed in motor DT were significantly slower than those performed singularly (p < 0.01). The GPT performed with the cognitive task was slower than the secondary motor task (p < 0.05). A training effect was present up to the 4^th consecutive trial.

Conclusions

The GPT can be executed with a cognitive or motor task to increase the difficulty of the trial to better evaluate manual dexterity and cognitive capacities.

Force control during submaximal isometric contractions is associated with walking performance in persons with multiple sclerosis

Individuals with multiple sclerosis (MS) experience progressive declines in movement capabilities, especially walking performance. The purpose of our study was to compare the amount of variance in walking performance that could be explained by the functional capabilities of lower leg muscles in persons with MS and a sex- and age-matched control group. Participants performed two walking tests (6-min walk and 25-ft walk), strength tests for the plantar flexor and dorsiflexor muscles, and steady submaximal (10% and 20% maximum) isometric contractions. High-density electromyography (EMG) was recorded during the steady contractions, and the signals were decomposed to identify the discharge times of concurrently active motor units. There were significant differences between the two groups in the force fluctuations during the steady contractions (force steadiness), the strength of the plantar flexor and dorsiflexor muscles, and the discharge characteristics during the steady contractions. Performance on the two walking tests by the MS group was moderately associated with force steadiness of the plantar flexor and dorsiflexor muscles; worse force steadiness was associated with poorer walking performance. In contrast, the performance of the control group was associated with muscle strength (25-ft test) and force steadiness of the dorsiflexors and variance in common input of motor units to the plantar flexors (6-min test). These findings indicate that a reduction in the ability to maintain a steady force during submaximal isometric contractions is moderately associated with walking performance of persons with MS.NEW & NOTEWORTHY The variance in walking endurance and walking speed was associated with force control of the lower leg muscles during submaximal isometric contractions in individuals with multiple sclerosis (MS). In contrast, the fast walking speed of a sex- and age-matched control group was associated with the strength of lower leg muscles. These findings indicate that moderate declines in the walking performance of persons with MS are more associated with impairments in force control rather than decreases in muscle strength.

Serum SNTF, a Surrogate Marker of Axonal Injury, Is Prognostic for Lasting Brain Dysfunction in Mild TBI Treated in the Emergency Department

Mild traumatic brain injury (mTBI) causes persisting post-concussion syndrome for many patients without abnormalities on conventional neuroimaging. Currently, there is no method for identifying at-risk cases at an early stage for directing concussion management and treatment. SNTF is a calpain-derived N-terminal proteolytic fragment of spectrin (α_II-spectrin1-1176) generated in damaged axons following mTBI. Preliminary human studies suggest that elevated blood SNTF on the day of mTBI correlates with white matter disruption and lasting brain dysfunction. Here, we further evaluated serum SNTF as a prognostic marker for persistent brain dysfunction in uncomplicated mTBI patients treated in a Level I trauma center emergency department. Compared with healthy controls (n = 40), serum SNTF increased by 92% within 24 h of mTBI (n = 95; p < 0.0001), and as a diagnostic marker exhibited 100% specificity and 37% sensitivity (AUC = 0.87). To determine whether the subset of mTBI cases positive for SNTF preferentially developed lasting brain dysfunction, serum levels on the day of mTBI were compared with multiple measures of brain performance at 90 days post-injury. Elevated serum SNTF correlated significantly with persistent impairments in cognition and sensory-motor integration, and predicted worse performance in each test on a case by case basis (AUC = 0.68 and 0.76, respectively). SNTF also predicted poorer recovery of cognitive stress function from 30 to 90 days (AUC = 0.79–0.90). These results suggest that serum SNTF, a surrogate marker for axonal injury after mTBI, may have potential for the rapid prognosis of lasting post-concussion syndrome and impaired functional recovery following CT-negative mTBI. They provide further evidence linking axonal injury to persisting brain dysfunction after uncomplicated mTBI. A SNTF blood test, either alone or combined with other markers of axonal injury, may have important utilities for research, prognosis, management and treatment of concussion.

Differences in postural sway among healthy adults are associated with the ability to perform steady contractions with leg muscles

Upright standing involves small displacements of the center of mass about the base of support. These displacements are often quantified by measuring various kinematic features of the center-of-pressure trajectory. The plantar flexors have often been identified as the key muscles for the control of these displacements; however, studies have suggested that the hip abductor and adductors may also be important. The purpose of our study was to determine the association between the force capabilities of selected leg muscles and sway-area rate across four balance conditions in young (25 ± 4 years; 12/19 women) and older adults (71 ± 5 years; 5/19 women). Due to the marked overlap in sway-area rate between the two age groups, the data were collapsed, and individuals were assigned to groups of low- and high-sway area rates based on a k-medoid cluster analysis. The number of participants assigned to each group varied across balance conditions and a subset of older adults was always included in the low-sway group for each balance condition. The most consistent explanatory variable for the variance in sway-area rate was force control of the hip abductors and ankle dorsiflexors as indicated by the magnitude of the normalized force fluctuations (force steadiness) during a submaximal isometric contraction. The explanatory power of the regression models varied across conditions, thereby identifying specific balance conditions that should be examined further in future studies of postural control.

Oscillations in neural drive and age-related reductions in force steadiness with a cognitive challenge

A cognitive challenge when imposed during a low-force isometric contraction will exacerbate sex- and age-related decreases in force steadiness, but the mechanism is not known. We determined the role of oscillations in the common synaptic input to motor units on force steadiness during a muscle contraction with a concurrent cognitive challenge. Forty-nine young adults (19-30 yr; 25 women, 24 men) and 36 old adults (60-85 yr; 19 women, 17 men) performed a cognitive challenge (counting backward by 13) during an isometric elbow flexion task at 5% of maximal voluntary contraction. Single-motor units were decomposed from high-density surface EMG recordings. For a subgroup of participants, motor units were matched during control and cognitive challenge trials, so the same motor unit was analyzed across conditions. Reduced force steadiness was associated with greater oscillations in the synaptic input to motor units during both control and cognitive challenge trials ( r = 0.45-0.47, P < 0.01). Old adults and young women showed greater oscillations in the common synaptic input to motor units and decreased force steadiness when the cognitive challenge was imposed, but young men showed no change across conditions (session × age × sex, P < 0.05). Oscillations in the common synaptic input to motor units is a potential mechanism for altered force steadiness when a cognitive challenge is imposed during low-force contractions in young women and old adults. NEW & NOTEWORTHY We found that oscillations in the common synaptic input to motor units were associated with a reduction in force steadiness when a cognitive challenge was imposed during low-force contractions of the elbow flexor muscles in young women and old men and women but not young men. Age- and sex-related muscle weakness was associated with these changes.

Poor estimates of motor variability are associated with longer grooved pegboard times for middle-aged and older adults

Goal-directed movements that involve greater motor variability are performed with an increased risk that the intended goal will not be achieved. The ability to estimate motor variability during such actions varies across individuals and influences how people decide to move about their environment. The purpose of our study was to identify the decision-making strategies used by middle-aged and older adults when performing two goal-directed motor tasks and to determine if these strategies were associated with the time to complete the grooved pegboard test. Twenty-one middle-aged (48 ± 6 yr; range 40-59 yr, 15 women) and 20 older adults (73 ± 4 yr; range 65-79 yr, 8 women) performed two targeted tasks, each with two normalized target options. Decision-making characteristics were not associated with time to complete the test of manual dexterity when the analysis included all participants, but slower pegboard times were associated with measures of greater movement variability during the target-directed actions. When the data were clustered on the basis of pegboard time rather than age, relatively longer times for the faster group were associated with greater motor variability during the prescribed tasks, whereas longer times for the slower group were associated with increased risk-seeking behavior (α) and greater variability in the targeted actions. NEW & NOTEWORTHY This study was the first to examine the association between decision-making choices and an NIH Toolbox test of manual dexterity (grooved pegboard test) performed by middle-aged and older adults. Significant associations were observed between decision-making choices and time to complete the test when the analyses were based on pegboard times rather than chronological age. This result indicates that decision-making choices of middle-aged and older adults, independent of age, were associated with time to complete a test of manual dexterity.

Variability in common synaptic input to motor neurons modulates both force steadiness and pegboard time in young and older adults

KEY POINTS

The fluctuations in force during a steady isometric contraction (force steadiness) are associated with oscillations in common synaptic input to the involved motor neurons. Decreases in force steadiness are associated with increases in pegboard times in older adults, although a mechanism for this link has not been established. We used a state-space model to estimate the variability in common synaptic input to motor neurons during steady, isometric contractions. The estimate of common synaptic input was derived from the discharge times of motor units as recorded with high-density surface electrodes. We found that the variability in common synaptic input to motor neurons modulates force steadiness for young and older adults, as well as pegboard time for older adults.

ABSTRACT

We investigated the associations between grooved pegboard times, force steadiness (coefficient of variation for force) and variability in an estimate of the common synaptic input to motor neurons innervating the wrist extensor muscles during steady contractions performed by young and older adults. The discharge times of motor units were derived from recordings obtained with high-density surface electrodes when participants performed steady isometric contractions at 10% and 20% of maximal voluntary contraction force. The steady contractions were performed with a pinch grip and wrist extension, both independently (single action) and concurrently (double action). The variance in common synaptic input to motor neurons was estimated with a state-space model of the latent common input dynamics. There was a statistically significant association between the coefficient of variation for force during the steady contractions and the estimated variance in common synaptic input in young (r2  = 0.31) and older (r2  = 0.39) adults, although not between either the mean or the coefficient of variation for interspike interval of single motor units with the coefficient of variation for force. Moreover, the estimated variance in common synaptic input during the double-action task with the wrist extensors at the 20% target was significantly associated with grooved pegboard time (r2  = 0.47) for older adults but not young adults. These findings indicate that longer pegboard times of older adults were associated with worse force steadiness and greater fluctuations in the estimated common synaptic input to motor neurons during steady contractions.

Expectation of movement generates contrasting changes in multifinger synergies in young and older adults

Anticipatory synergy adjustment (ASA) is a feed-forward control mechanism that describes a continuous decrease in the stability of the current motor state beginning about 150 ms prior to a state transition. Recently, we described an associated phenomenon in which the system stability was reduced solely in response to a cue that generates an expectation of a state change, independent of whether the state change actually occurs. Both phenomena are of the same kind (stability reduction), but evoked by distinct antecedent conditions. Since, logically, cuing for movement must occur before the initiation of that movement, we named this new phenomenon 'Stage-1 ASA' and rechristened the well-established version 'Stage-2 ASA'. Here, we used a four-finger, isometric force production task to explore (1) the effect of healthy aging on Stage-1 ASA, and (2) if Stage-1 ASA resulted in a more rapid state change. Young and older adult participants produced 10% of their maximal force when they did not expect to produce any change in the force, and when they expected to change their force in an unknown direction and at an unknown time. In the latter condition, the 10% constant-force phase was followed by a choice reaction time task, in which the participants rapidly changed their force to follow a moving target presented on a computer monitor. Both young and older adults displayed equivalent amount of Stage-1 ASA. This was driven by a 42% reduction in finger-force variability in young adults. In contrast, it was driven by a 38% increase in finger-force variability in older adults. We speculate that the reduction in finger force variability assists the young adults in rapid state changes via two mechanisms: (1) the finger forces occupy a restricted set of states that are optimal for quick state transitions, and (2) lower variability during steady state translates into lower self-motion during state transition. Self-motion is the covariation between finger forces that fails to change the total force. The older adults are unable to adopt this strategy, and the increase in finger-force variability arises from (1) the adoption of an alternative strategy of destabilizing the attractor associated with the current state to facilitate state transitions and (2) the inability to coordinate multiple finger forces. Finally, older adults displayed longer reaction times than young adults, but a clear relation between Stage-1 ASA and consequent behavioral benefit in terms of reduced reaction time remained elusive.

Peg-manipulation capabilities of middle-aged adults have a greater influence on pegboard times than those of young and old adults

Declines in manual dexterity are frequently quantified as the time it takes to complete the grooved pegboard test. The test requires individuals to manipulate 25 pegs, one at a time, by removing them from a well and inserting them into a prescribed hole. The manipulation of each peg involves four phases: selection, transport, insertion, and return. The purpose of our study was to compare the times to complete the four phases of peg manipulation and the forces applied to the pegboard during peg insertion as young, middle-aged, and old adults performed the grooved pegboard test. The relative significance of the peg-manipulation attributes for 30 young (24.0 ± 4.4 years), 15 middle-aged (46.5 ± 6.5 years), and 15 old (70.4 ± 4.0 years) adults was assessed with a multiple-regression analysis. The grooved pegboard test was performed on a force plate. Pegboard times for the old adults (81 ± 17 s) were longer than those for young (56 ± 7 s) and middle-aged (58 ± 11 s) adults. Regression analysis indicated that the explanatory variables for the pegboard times of young (R² = 0.33) and middle-aged (R² = 0.78) adults were the times for the peg insertion and return phases, whereas the predictors for old adults (R² = 0.49) were the times for the peg selection and transport phases. The relative influence of peg-manipulation capabilities on a pegboard test of manual dexterity was greater for middle-aged adults than for young and old adults.

Motor unit discharge characteristics and walking performance of individuals with multiple sclerosis

Walking performance of persons with multiple sclerosis (MS) is strongly influenced by the activation signals received by lower leg muscles. We examined the associations between force steadiness and motor unit discharge characteristics of lower leg muscles during submaximal isometric contractions with tests of walking performance and disability status in individuals who self-reported walking difficulties due to MS. We expected that worse walking performance would be associated with weaker plantar flexor muscles, worse force steadiness, and slower motor unit discharge times. Twenty-three individuals with relapsing-remitting MS (56 ± 7 yr) participated in the study. Participants completed one to three evaluation sessions that involved two walking tests (25-ft walk and 6-min walk), a manual dexterity test (grooved pegboard), health-related questionnaires, and measurement of strength, force steadiness, and motor unit discharge characteristics of lower leg muscles. Multiple regression analyses were used to construct models to explain the variance in measures of walking performance. There were statistically significant differences (effect sizes: 0.21-0.60) between the three muscles in mean interspike interval (ISI) and ISI distributions during steady submaximal contractions with the plantar flexor and dorsiflexor muscles. The regression models explained 40% of the variance in 6-min walk distance and 47% of the variance in 25-ft walk time with two or three variables that included mean ISI for one of the plantar flexor muscles, dorsiflexor strength, and force steadiness. Walking speed and endurance in persons with relapsing-remitting MS were reduced in individuals with longer ISIs, weaker dorsiflexors, and worse plantar flexor force steadiness. NEW & NOTEWORTHY The walking endurance and gait speed of persons with relapsing-remitting multiple sclerosis (MS) were worse in individuals who had weaker dorsiflexor muscles and greater force fluctuations and longer times between action potentials discharged by motor units in plantar flexor muscles during steady isometric contractions. These findings indicate that the control of motor unit activity in lower leg muscles of individuals with MS is associated with their walking ability.

Peg-manipulation capabilities during a test of manual dexterity differ for persons with multiple sclerosis and healthy individuals

Manual dexterity declines with advancing age and the development of neurological disorders. Changes in manual dexterity are frequently quantified as the time it takes to complete the grooved pegboard test, which requires individuals to manipulate 25 pegs. The manipulation of each peg involves four phases: selection, transport, insertion, and return. The purpose of the study was to compare the times to complete the four phases of manipulating each peg and the forces applied to the pegboard during peg selection and insertion in persons with multiple sclerosis (MS) and age- and sex-matched healthy adults. Multiple-regression models that could explain the variance in pegboard times for each group of participants were compared to assess the relative significance of the peg-manipulation attributes. The performance of 17 persons with MS (52.2 ± 8.3 years) was compared with 17 control subjects (52.2 ± 11.5 years). The grooved pegboard test was performed on a force plate. Pegboard times for the MS group (104 ± 40 s) were longer than those for the Control group (61 ± 15 s). Regression analysis indicated that the pegboard times for the MS group could be predicted by the time for the peg-selection phase (R ² = 0.78), whereas the predictors for Control group (R ² = 0.77) were the times for the peg-transport (partial r = 0.80) and selection (partial r = 0.58) phases. The variance in the time it took the MS participants to complete the grooved pegboard test was strongly related to the time required to select each peg, whereas the pegboard times for the Control subjects depended mostly on the duration of the transport phase but also on the time to select each peg.