The neural basis of hand choice: An fMRI investigation of the Posterior Parietal Interhemispheric Competition model

Repetitive transcranial magnetic stimulation for motor function in stroke: a systematic review and meta-analysis of randomized controlled studies

OBJECTIVE

This study aimed to systematically evaluate the safety and effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor dysfunction in stroke patients.

METHODS

A systematic search was conducted in five online databases, namely, Medline, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and SPORTDiscus, from their inception to July 29, 2024. Studies meeting the predetermined inclusion criteria were included. The data were analyzed using RevMan 5.4.1 software and Stata 15.0. The subgroup analysis was conducted based on various disease stages and intervention frequencies. The overall effects were estimated using either the fixed effects model or the random effects model, with standardized mean differences (SMDs). The level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.

RESULTS

A total of 70 studies encompassing 2951 stroke survivors were included. The results of the quantitative analysis revealed that the application of 1 Hz rTMS over the contralesional primary motor cortex (M1) significantly improved motor function during both the early stage (< 1 month) with moderate effect size (n = 443, SMD = 0.44, 95% CI 0.24 to 0.63, P < 0.00001, I2 = 47%, fixed-effect model) and recovery period (1-6 months) with moderate effect size (n = 233, SMD = 0.61, 95% CI 0.34 to 0.87, P < 0.0001, I2 = 33%, fixed-effect model). In the context of activities of daily living (ADLs), the application of 1 Hz rTMS over the contralesional M1 can lead to improvements in ADLs among individuals in the early stages of stroke with moderate effect size (n = 343, SMD = 0.67, 95% CI 0.44 to 0.89, I2 = 79%, P < 0.00001, fixed-effect model). However, evidence to support that 1 Hz rTMS over contralesional M1 can improve motor dysfunction in the chronic phase of stroke (> 6 months) is insufficient.

CONCLUSION

Moderate- to high-quality evidence suggests that 1 Hz rTMS over the contralesional M1 may enhance motor function and independence in ADL during the early stages of stroke and the recovery period (within 6 months) with moderate effect. Nonetheless, as for the efficacy of 3, 5, 10, and 20 Hz rTMS in the treatment of motor dysfunction after stroke, it needs to be further determined. It is important to interpret these findings with caution in clinical practice due to the small sample sizes and low quality of the studies reviewed.

SYSTEMATIC REVIEW REGISTRATION

INPLASY, Registration number is INPLASY202360042. DOI number is https://doi.org/10.37766/inplasy2023.6.0042 .

Somatosensory stimulation on the wrist enhances the subsequent hand-choice by biasing toward the stimulated hand

Hand choice is an unconscious decision frequently made in daily life. The electroencephalogram before target presentation correlates with hand choice for the target where hand choice probability reaches equilibrium. However, whether neurophysiological interventions before target presentation influence hand choice remains unknown. Therefore, this study determined whether instantaneous somatosensory electrical stimulation administered to the unilateral wrist at 0, 300, or 600 ms before the target presentation facilitates or inhibits stimulated hand choice for targets around the hand selection equilibrium point. A single electrical stimulation comprised five trains of 1 ms electrical pulses, with a 20 ms inter-pulse interval. The stimulus intensity was set at 80% of the motor threshold. This study included 14 right-handed healthy adults (five females and nine males; mean age, 25.1 ± 4.64 years). Unilateral wrist stimulation significantly increased the probability of choosing the stimulated hand and led to a faster reaction time than bilateral wrist stimulation and no-stimulation conditions. The results suggest that prior somatosensory stimulation significantly affects the hand-choice process, effectively promoting the selection of the stimulated hand. These findings highlight the potential application of this stimulation method in stroke rehabilitation to facilitate the use of the paretic hand.

Patient Outcomes After Peripheral Nerve Injury Depend on Bimanual Dexterity and Preserved Use of the Affected Hand

BACKGROUND

Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life.

OBJECTIVE

To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes.

METHODS

Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand.

RESULTS

The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand.

CONCLUSION

After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.

Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis

Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.

Cortical Patterns Shift from Sequence Feature Separation during Planning to Integration during Motor Execution

Performing sequences of movements from memory and adapting them to changing task demands is a hallmark of skilled human behavior, from handwriting to playing a musical instrument. Prior studies showed a fine-grained tuning of cortical primary motor, premotor, and parietal regions to motor sequences: from the low-level specification of individual movements to high-level sequence features, such as sequence order and timing. However, it is not known how tuning in these regions unfolds dynamically across planning and execution. To address this, we trained 24 healthy right-handed human participants (14 females, 10 males) to produce four five-element finger press sequences with a particular finger order and timing structure in a delayed sequence production paradigm entirely from memory. Local cortical fMRI patterns during preparation and production phases were extracted from separate No-Go and Go trials, respectively, to tease out activity related to these perimovement phases. During sequence planning, premotor and parietal areas increased tuning to movement order or timing, regardless of their combinations. In contrast, patterns reflecting the unique integration of sequence features emerged in these regions during execution only, alongside timing-specific tuning in the ventral premotor, supplementary motor, and superior parietal areas. This was in line with the participants' behavioral transfer of trained timing, but not of order to new sequence feature combinations. Our findings suggest a general informational state shift from high-level feature separation to low-level feature integration within cortical regions for movement execution. Recompiling sequence features trial-by-trial during planning may enable flexible last-minute adjustment before movement initiation.SIGNIFICANCE STATEMENT Musicians and athletes can modify the timing and order of movements in a sequence trial-by-trial, allowing for a vast repertoire of flexible behaviors. How does the brain put together these high-level sequence features into an integrated whole? We found that, trial-by-trial, the control of sequence features undergoes a state shift from separation during planning to integration during execution across a network of motor-related cortical areas. These findings have implications for understanding the hierarchical control of skilled movement sequences, as well as how information in brain areas unfolds across planning and execution.

Relevant factors for arm choice in reaching movement: a scoping review

[Purpose] Arm choice is an unconscious action selection performed in daily life. Even if hemiparetic stroke patients can use their paretic arm, they compensate for their movements with their non-paretic arm, leading to decreased function of their paretic arm. Therefore, we need to encourage stroke patients to actively use their paretic arm. For this purpose, it is imperative to understand the process of selection of the left or right hand by patients. Here, we conducted a scoping review to summarize the findings of previous studies on factors and brain regions related to choice of arm. [Methods] We used PubMed/Medline, EBSCO, and the Cochrane Library to obtain research literature according to the PRISMA Extension for Scoping Reviews guidelines. [Results] Twenty-five of the 81 articles obtained from the search met the defined criteria. Cost, success, and dominance were investigated as relevant factors for arm choice. We also extracted articles examining the relationship between the posterior parietal and premotor cortex activity and arm choice. [Conclusion] From these results, we considered ways to facilitate the use of the paretic arm, such as the use of virtual reality systems or exoskeletal robots to modulate the reaching cost and success rates, or non-invasive brain stimulation methods to modulate brain activity.

Hand choice is unaffected by high frequency continuous theta burst transcranial magnetic stimulation to the posterior parietal cortex

The current study used a high frequency TMS protocol known as continuous theta burst stimulation (cTBS) to test a model of hand choice that relies on competing interactions between the hemispheres of the posterior parietal cortex. Based on the assumption that cTBS reduces cortical excitability, the model predicts a significant decrease in the likelihood of selecting the hand contralateral to stimulation. An established behavioural paradigm was used to estimate hand choice in each individual, and these measures were compared across three stimulation conditions: cTBS to the left posterior parietal cortex, cTBS to the right posterior parietal cortex, or sham cTBS. Our results provide no supporting evidence for the interhemispheric competition model. We find no effects of cTBS on hand choice, independent of whether the left or right posterior parietal cortex was stimulated. Our results are nonetheless of value as a point of comparison against prior brain stimulation findings that, in contrast, provide evidence for a causal role for the posterior parietal cortex in hand choice.

Reaction time asymmetries provide insight into mechanisms underlying dominant and non-dominant hand selection

Handedness is often thought of as a hand "preference" for specific tasks or components of bimanual tasks. Nevertheless, hand selection decisions depend on many factors beyond hand dominance. While these decisions are likely influenced by which hand might show performance advantages for the particular task and conditions, there also appears to be a bias toward the dominant hand, regardless of performance advantage. This study examined the impact of hand selection decisions and workspace location on reaction time and movement quality. Twenty-six neurologically intact participants performed targeted reaching across the horizontal workspace in a 2D virtual reality environment, and we compared reaction time across two groups: those selecting which hand to use on a trial-by-trial basis (termed the choice group) and those performing the task with a preassigned hand (the no-choice group). Along with reaction time, we also compared reach performance for each group across two ipsilateral workspaces: medial and lateral. We observed a significant difference in reaction time between the hands in the choice group, regardless of workspace. In contrast, both hands showed shorter but similar reaction times and differences between the lateral and medial workspaces in the no-choice group. We conclude that the shorter reaction times of the dominant hand under choice conditions may be due to dominant hand bias in the selection process that is not dependent upon interlimb performance differences.

Transcranial direct current stimulation over the posterior parietal cortex improves visuomotor performance and proprioception in the lower extremities

The purpose of this study was to examine whether anodal transcranial direct current stimulation (a-tDCS) over the posterior parietal cortex (PPC) could affect visuomotor performance and proprioception in the lower extremities. We evaluated visuomotor performance in 15 healthy volunteers using a visuomotor control task by plantar dorsiflexion of the ankle joint, and calculated the absolute difference between the target and measured angle. In addition, we evaluated proprioception using a joint position matching task. During the task, the subject reproduced the ankle joint plantar dorsiflexion angle presented by the examiner. We calculated the absolute difference between the presented and measured angles (absolute error) and the variation of measured angles (variable error). Simultaneously, a-tDCS (1.5 mA, 15 min) or sham stimulation was applied to the right PPC. We observed that the absolute error of the visuomotor control task and the variable error of the joint position matching task significantly decreased after a-tDCS. However, the absolute error of the joint position matching task was not affected. This study suggests that a-tDCS over the PPC improves visuomotor performance and reduces the variable error in the joint position matching task.

Theta but not beta activity is modulated by freedom of choice during action selection

Large-scale neurophysiological markers of action competition have been almost exclusively investigated in the context of instructed choices, hence it remains unclear whether these markers also apply to free choices. This study aimed to compare the specific brain dynamics underlying instructed and free decisions. Electroencephalography (EEG) was recorded while 31 participants performed a target selection task; the choice relied either on stimulus-response mappings (instructed) or on participants' preferences (free). Choice difficulty was increased by introducing distractors in the informative stimulus in instructed choices, and by presenting targets with similar motor costs in free choices. Results revealed that increased decision difficulty was associated with higher reaction times (RTs) in instructed choices and greater choice uncertainty in free choices. Midfrontal EEG theta (4-8 Hz) power increased with difficulty in instructed choices, but not in free choices. Although sensorimotor beta (15-30 Hz) power was correlated with RTs, it was not significantly influenced by choice context or difficulty. These results suggest that midfrontal theta power may specifically increase with difficulty in externally-driven choices, whereas sensorimotor beta power may be predictive of RTs in both externally- and internally-driven choices.

Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand, Even When Their Nondominant Is More Dexterous

OBJECTIVE

To identify how individuals respond to unilateral upper extremity peripheral nerve injury via compensation (increased use of the nondominant hand). We hypothesized that injury to the dominant hand would have a greater effect on hand use (left vs right choices). We also hypothesized that compensation would not depend on current (postinjury) nondominant hand performance because many patients undergo rehabilitation that is not designed to alter hand use.

DESIGN

Observational survey, single-arm.

SETTINGS

Academic research institution and referral center.

PARTICIPANTS

A total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury. Another 14 declined participation. Referred sample, including all eligible patients from 16 months at 1 nerve injury clinic and 1 hand therapy clinic.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Hand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function.

RESULTS

Participants preferred their dominant hand regardless of whether it was injured: hand usage (dominant/nondominant) did not differ from typical adults, regardless of injured side (P>.07), even though most participants (77%) were more dexterous with their uninjured nondominant hand (mean asymmetry index, -0.16±0.25). The Block Building Task was sensitive to hand dominance (P=2 × 10-4) and moderately correlated with Motor Activity Log amount scores (r2=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10-3), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury factors (P>.1).

CONCLUSIONS

Patients with peripheral nerve injury with dominant hand injury do not compensate with their unaffected nondominant hand, even if it is more dexterous. For the subset of patients unlikely to recover function with the injured hand, they could benefit from rehabilitation that encourages compensation with the nondominant hand.

Cortical beta-band power modulates with uncertainty in effector selection during motor planning

Although beta-band activity during motor planning is known to be modulated by uncertainty about where to act, less is known about its modulations to uncertainty about how to act. To investigate this issue, we recorded oscillatory brain activity with EEG while human participants (n = 17) performed a hand choice reaching task. The reaching hand was either predetermined or of participants' choice, and the target was close to one of the two hands or at about equal distance from both. To measure neural activity in a motion artifact-free time window, the location of the upcoming target was cued 1,000-1,500 ms before the presentation of the target, whereby the cue was valid in 50% of trials. As evidence for motor planning during the cuing phase, behavioral observations showed that the cue affected later hand choice. Furthermore, reaction times were longer in the choice trials than in the predetermined trials, supporting the notion of a competitive process for hand selection. Modulations of beta-band power over central cortical regions, but not alpha-band or theta-band power, were in line with these observations. During the cuing period, reaches in predetermined trials were preceded by larger decreases in beta-band power than reaches in choice trials. Cue direction did not affect reaction times or beta-band power, which may be due to the cue being invalid in 50% of trials, retaining effector uncertainty during motor planning. Our findings suggest that effector uncertainty modulates beta-band power during motor planning.NEW & NOTEWORTHY Although reach-related beta-band power in central cortical areas is known to modulate with the number of potential targets, here we show, using a cuing paradigm, that the power in this frequency band, but not in the alpha or theta band, is also modulated by the uncertainty of which hand to use. This finding supports the notion that multiple possible effector-specific actions can be specified in parallel up to the level of motor preparation.

Local field potentials in the parietal reach region reveal mechanisms of bimanual coordination

Primates use their arms in complex ways that frequently require coordination between the two arms. Yet the planning of bimanual movements has not been well-studied. We recorded spikes and local field potentials (LFP) from the parietal reach region (PRR) in both hemispheres simultaneously while monkeys planned and executed unimanual and bimanual reaches. From analyses of interhemispheric LFP-LFP and spike-LFP coherence, we found that task-specific information is shared across hemispheres in a frequency-specific manner. This shared information could arise from common input or from direct communication. The population average unit activity in PRR, representing PRR output, encodes only planned contralateral arm movements while beta-band LFP power, a putative PRR input, reflects the pattern of planned bimanual movement. A parsimonious interpretation of these data is that PRR integrates information about the movement of the left and right limbs, perhaps in service of bimanual coordination.

Interhemispheric Parietal-Frontal Connectivity Predicts the Ability to Acquire a Nondominant Hand Skill

Introduction: After chronic impairment of the right dominant hand, some individuals are able to compensate with increased performance with the intact left nondominant hand. This process may depend on the nondominant (right) hemisphere's ability to access dominant (left) hemisphere mechanisms. To predict or modulate patients' ability to compensate with the left hand, we must understand the neural mechanisms and connections that underpin this process. Methods: We studied 17 right-handed healthy adults who underwent resting-state functional connectivity (FC) magnetic resonance imaging scans before 10 days of training on a left-hand precision drawing task. We sought to identify right-hemisphere areas where FC from left-hemisphere seeds (primary motor cortex, intraparietal sulcus [IPS], inferior parietal lobule) would predict left-hand skill learning or magnitude. Results: Left-hand skill learning was predicted by convergent FC from left primary motor cortex and left IPS onto the same small region (0.31 cm3) in the right superior parietal lobule (SPL). Discussion: For patients who must compensate with the left hand, the right SPL may play a key role in integrating left-hemisphere mechanisms that typically control the right hand. Our study provides the first model of how interhemispheric functional connections in the human brain may support compensation after chronic injury to the right hand.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

Transcranial direct current stimulation of the posterior parietal cortex biases human hand choice

Hand choices—deciding which hand to use to reach for targets—represent continuous, daily, unconscious decisions. The posterior parietal cortex (PPC) contralateral to the selected hand is activated during a hand-choice task, and disruption of left PPC activity with a single-pulse transcranial magnetic stimulation prior to the execution of the motion suppresses the choice to use the right hand but not vice versa. These findings imply the involvement of either bilateral or left PPC in hand choice. To determine whether the effects of PPC’s activity are essential and/or symmetrical in hand choice, we increased or decreased PPC excitability in 16 healthy participants using transcranial direct current stimulation (tDCS; 10 min, 2 mA, 5 × 7 cm) and examined its online and residual effects on hand-choice probability and reaction time. After the right PPC was stimulated with an anode and the left PPC with a cathode, the probability of left-hand choice significantly increased and reaction time significantly decreased. However, no significant changes were observed with the stimulation of the right PPC with a cathode and the left PPC with an anode. These findings, thus, reveal the asymmetry of PPC-mediated regulation in hand choice.

Hierarchical Action Encoding Within the Human Brain

Humans are able to interact with objects with extreme flexibility. To achieve this ability, the brain does not only control specific muscular patterns, but it also needs to represent the abstract goal of an action, irrespective of its implementation. It is debated, however, how abstract action goals are implemented in the brain. To address this question, we used multivariate pattern analysis of functional magnetic resonance imaging data. Human participants performed grasping actions (precision grip, whole hand grip) with two different wrist orientations (canonical, rotated), using either the left or right hand. This design permitted to investigate a hierarchical organization consisting of three levels of abstraction: 1) “concrete action” encoding; 2) “effector-dependent goal” encoding (invariant to wrist orientation); and 3) “effector-independent goal” encoding (invariant to effector and wrist orientation). We found that motor cortices hosted joint encoding of concrete actions and of effector-dependent goals, while the parietal lobe housed a convergence of all three representations, comprising action goals within and across effectors. The left lateral occipito-temporal cortex showed effector-independent goal encoding, but no convergence across the three levels of representation. Our results support a hierarchical organization of action encoding, shedding light on the neural substrates supporting the extraordinary flexibility of human hand behavior.